Publications by authors named "Marco Iosa"

128 Publications

Hand rehabilitation with sonification techniques in the subacute stage of stroke.

Sci Rep 2021 Mar 31;11(1):7237. Epub 2021 Mar 31.

Fondazione S. Lucia, I.R.C.C.S., Rome, Italy.

After a stroke event, most survivors suffer from arm paresis, poor motor control and other disabilities that make activities of daily living difficult, severely affecting quality of life and personal independence. This randomized controlled trial aimed at evaluating the efficacy of a music-based sonification approach on upper limbs motor functions, quality of life and pain perceived during rehabilitation. The study involved 65 subacute stroke individuals during inpatient rehabilitation allocated into 2 groups which underwent usual care dayweek) respectively of standard upper extremity motor rehabilitation or upper extremity treatment with sonification techniques. The Fugl-Meyer Upper Extremity Scale, Box and Block Test and the Modified Ashworth Scale were used to perform motor assessment and the McGill Quality of Life-it and the Numerical Pain Rating Scale to assess quality of life and pain. The assessment was performed at baseline, after 2 weeks, at the end of treatment and at follow-up (1 month after the end of treatment). Total scores of the Fugl-Meyer Upper Extremity Scale (primary outcome measure) and hand and wrist sub scores, manual dexterity scores of the affected and unaffected limb in the Box and Block Test, pain scores of the Numerical Pain Rating Scale (secondary outcomes measures) significantly improved in the sonification group compared to the standard of care group (time*group interaction < 0.05). Our findings suggest that music-based sonification sessions can be considered an effective standardized intervention for the upper limb in subacute stroke rehabilitation.
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http://dx.doi.org/10.1038/s41598-021-86627-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012636PMC
March 2021

Auditory Cue Based on the Golden Ratio Can Improve Gait Patterns in People with Parkinson's Disease.

Sensors (Basel) 2021 Jan 29;21(3). Epub 2021 Jan 29.

IRCSS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy.

The harmonic structure of walking relies on an irrational number called the golden ratio (ϕ): in healthy subjects, it coincides with the stride-to-stance ratio, and it is associated with a smooth gait modality. This smoothness is lost in people with Parkinson's disease (PD), due to deficiencies in the execution of movements. However, external auditory cues seem to facilitate movement, by enabling the timing of muscle activation, and helping in initiating and modulating motor output. Based on a harmonic fractal structure of gait, can the administration of an auditory cue based on individual's ϕ-rhythm improve, in acute, gait patterns in people with PD? A total of 20 participants (16 males, age 70.9 ± 8.4 years, Hoehn and Yahr stage-II) were assessed through stereophotogrammetry: gait spatio-temporal parameters, and stride-to-stance ratio were computed before, during, and after the ϕ-rhythm administration. Results show improvements in terms of stride length ( = 0.018), walking speed ( = 0.014), and toe clearance ( = 0.013) when comparing gait patterns before and after the stimulus. Furthermore, the stride-to-stance ratio seems to correlate with almost all spatio-temporal parameters, but it shows the main changes in the before-during rhythm comparison. In conclusion, ϕ-rhythm seems an effective cue able to compensate for defective internal rhythm of the basal ganglia in PD.
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http://dx.doi.org/10.3390/s21030911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866385PMC
January 2021

The Michelangelo Effect: Art Improves the Performance in a Virtual Reality Task Developed for Upper Limb Neurorehabilitation.

Front Psychol 2020 7;11:611956. Epub 2021 Jan 7.

IRCCS Fondazione Santa Lucia, Rome, Italy.

The vision of an art masterpiece is associated with brain arousal by neural processes occurring quite spontaneously in the viewer. This aesthetic experience may even elicit a response in the motor areas of the observers. In the neurorehabilitation of patients with stroke, art observation has been used for reducing psychological disorders, and creative art therapy for enhancing physical functions and cognitive abilities. Here, we developed a virtual reality task which allows patients, by moving their hand on a virtual canvas, to have the illusion of painting some art masterpieces, such as The Creation of Adam of Michelangelo or The birth of Venus of Botticelli. Twenty healthy subjects (experiment 1) and four patients with stroke (experiment 2) performed this task and a control one in which they simply colored the virtual canvas. Results from User Satisfaction Evaluation Questionnaire and the NASA Task Load Index highlighted an appropriate level of usability. Moreover, despite the motor task was the same for art and control stimuli, the art condition was performed by healthy subjects with shorter trajectories ( = 0.001) and with a lower perception of physical demand ( = 0.049). In experiment 2, only the patients treated with artistic stimuli showed a reduction in the erroneous movements performed orthogonally to the canvas ( < 0.05). This finding reminds the so-called Mozart effect that improves the performance of subjects when they listen to classic music. Thus, we called this improvement in the performance when interacting with an artistic stimulus as Michelangelo effect.
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http://dx.doi.org/10.3389/fpsyg.2020.611956DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7817887PMC
January 2021

Early balance training with a computerized stabilometric platform in persons with mild hemiparesis in subacute stroke phase: A randomized controlled pilot study.

Restor Neurol Neurosci 2020 ;38(6):467-475

Fondazione Santa Lucia, Scientific Institute for Research and Healthcare, Rome, Italy.

Background: Along with conventional therapy, novel tools are being developed in balance training for the rehabilitation of persons with stroke sequelae. The efficacy of Computerized Balance Training thus far been the object of studies only in persons with chronic stroke.

Objective: To investigate the effects of an early Computerized Balance Training on balance, walking endurance and independence in activities of daily living, in persons with mild hemiparesis in subacute phase.

Methods: Thirty-two persons with a recent hemiparesis (within 4 weeks from stroke onset), able to maintain a standing position for at least 30 seconds, were randomly assigned to an experimental or control group. The control group (CG) were administered conventional physiotherapy of 40 minutes twice a day, 5 times a week for 4 weeks, while the experimental group (EG) underwent conventional physiotherapy 40 minutes once a day and Computerized Balance Training once a day, 5 times a week for 4 weeks. Outcomes were evaluated by means of Berg Balance Scale (BBS), Tinetti Balance Scale (TBS), Two Minutes Walk Test (2MWT), Barthel Index (BI) and stabilometric tests.

Results: Twelve participants for each group completed the training. Each group experienced 8 dropouts. The mean age (years) was 58.1±20.4 for EG and 59.7±14,7 for CG; the days from stroke were respectively 27.9±15.5 and 20±11.7. The difference between the two groups was statistically significant in experimental group for BBS (p = 0.003), for TBS (p = 0.028), for Sensory Integration and Balance tests performed with closed eyes on steady (p = 0.009) or instable surface (p = 0.023). and for 2MWT (p = 0.008).

Conclusions: Computerized Balance Training is an effective therapeutic tool for balance and gait endurance improvement in persons with stroke in subacute phase.
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http://dx.doi.org/10.3233/RNN-201055DOI Listing
January 2020

Influence of systemic infection and comorbidities on rehabilitation outcomes in severe acquired brain injury.

Eur J Phys Rehabil Med 2021 Feb 9;57(1):69-77. Epub 2020 Nov 9.

Head of Severe Brain Injury Rehabilitation Unit, ICS Maugeri SPA SB, Institute of Nervi, IRCCS, Genoa, Italy.

Background: Severe infectious complications are a frequent problem in patients with disability due to a severe acquired brain injury. Previous studies reported that the rehabilitation outcome is significantly lower in patients colonized or infected. However, these results could be influenced by comorbidities of those patients admitted in rehabilitation hospital with a lower functional status.

Aim: To explore the influence of systemic infection, in particular concerning multidrug resistant bacteria and analyze the role of comorbidities, as a risk factor for the development of systemic infection, on rehabilitation outcomes in patients with severe brain injury.

Design: This research is a cohort, prospective-observational study, comparing patients with and without systemic infections, in terms of rehabilitation outcomes.

Setting: An Italian Intensive Care Rehabilitation Department.

Population: A group of 221 patients (mean age: 59 years, range: 16-93 years, 127 males, 94 females) with severe acquired brain injury admitted to rehabilitation hospital.

Methods: We compared the rehabilitation outcomes between patients with and without a systemic infection (at least a positive blood culture) during the rehabilitation period. A secondary analysis was performed on 70 patients with infection versus 70 patients without infection, matched for functional status at admission. The used clinical scores were: Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Coma Recovery Scale Revised (CRS-R), Glasgow Coma Scale (GCS), Functional Independence Measure (FIM), Glasgow Outcome Scale (GOS), Disability Rating Scale (DRS), Levels of Cognitive Functioning (LCF) administered at admission and discharge. Length of hospitalization and the role of comorbidities were also considered.

Results: The group of patients with systemic infection (in particular due to Gram-negative bacteria) had a significantly lower outcome for 5 out 6 clinical scales and with a more than doubled length of hospitalization (P<0.001). However, these patients with, at least, a positive blood culture resulted having lower functional status at admission. In the secondary analysis, worst outcome was found in patients with positive blood culture in terms of FIM (P=0.033), GOS (P=0.048), and CRS-R (P=0.001).

Conclusions: Systemic infections during rehabilitation increased the length of hospitalization and reduce the rehabilitative outcomes, even when the analysis was performed on groups matched for the functional status at admission. Moreover, the cardiological and endocrine metabolic comorbidities seem to influence the outcome, without representing a further risk factor for systemic infection.

Clinical Rehabilitation Impact: The impact of infections during rehabilitation inpatient should be more taken into account, with specific procedures and suitable environments to avoid the diffusions of infections.
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http://dx.doi.org/10.23736/S1973-9087.20.05939-0DOI Listing
February 2021

An Italian Neurorehabilitation Hospital Facing the SARS-CoV-2 Pandemic: Data From 1207 Patients and Workers.

Front Neurol 2020 9;11:584317. Epub 2020 Oct 9.

Fondazione Santa Lucia, IRCCS, Rome, Italy.

The aim of the present observational study is to report on the data from a large sample of inpatients, clinical staff and other workers at an Italian neurorehabilitation hospital dealing with SARS-CoV-2 infections, in order to analyze how it might have affected the management and the effectiveness of neurorehabilitation. The data on infection monitoring, obtained by 2,192 swabs, were reported and compared among 253 patients, 722 clinical professionals and 232 other hospital workers. The number of admissions and neurorehabilitation sessions performed in the period from March-May 2020 was compared with those of the same period in 2019. Four patients and three clinical professionals were positive for COVID-19 infection. Six out of these seven people were from the same ward. Several measures were taken to handle the infection, putting in place many restrictions, with a significant reduction in new admissions to the hospital ( < 0.001). However, neither the amount of neurorehabilitation for inpatients ( = 0.681) nor the effectiveness of treatments ( = 0.464) were reduced when compared to the data from 2019. Our data show that the number of infections was contained in our hospital, probably thanks to the protocols adopted for reducing contagion and the environmental features of our wards. This allowed inpatients to continue to safely spend more than 3 hours per day in neurorehabilitation, effectively improving their independence in the activities of daily living.
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http://dx.doi.org/10.3389/fneur.2020.584317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581710PMC
October 2020

Incidence and Persistence of Viral Shedding in COVID-19 Post-acute Patients With Negativized Pharyngeal Swab: A Systematic Review.

Front Med (Lausanne) 2020 28;7:562. Epub 2020 Aug 28.

Santa Lucia Foundation, Rome, Italy.

After the global spread of a severe acute respiratory syndrome caused by a coronavirus (SARS-CoV-2), factors that influence viral diffusion have gained great attention. Human-to-human transmission mainly occurs through droplets, but viral RNA clearance in different biological fluids in coronavirus disease 2019 (COVID-19) remains unclear. We aimed to correlate the presence and the relevant temporal patterns of SARS-CoV-2 viral RNA in biological specimens (stool, urine, blood, and tears) of the transmission with clinical/epidemiological features in patients with COVID-19. We focused on the time window between the positivity of reverse transcriptase-polymerase chain reaction (RT-PCR) tests from different specimens. We used the Mantel-Cox log rank test to verify the differences in terms of viral shedding duration, while we employed the Mann-Whitney -test for subgroup analysis. This review protocol was registered with PROSPERO number: CRD42020183629. We identified 147 studies; we included 55 (1,348 patients) for epidemiological analysis, of which we included 37 (364 patients) for statistical analysis. The most frequently used specimens other than respiratory tract swabs were stool samples (or anal/rectal swabs), with a positivity rate of 48.8%, followed by urine samples, with a positivity rate of 16.4%; blood samples showed a positivity rate of 17.5%. We found that fecal positivity duration (median 19 days) was significantly ( < 0.001) longer than respiratory tract positivity (median 14 days). Limited data are available about the other specimens. In conclusion, medical and social communities must pay close attention to negativization criteria for COVID-19, because patients could have longer alternative viral shedding.
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http://dx.doi.org/10.3389/fmed.2020.00562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7483760PMC
August 2020

Sensorized Assessment of Dynamic Locomotor Imagery in People with Stroke and Healthy Subjects.

Sensors (Basel) 2020 Aug 13;20(16). Epub 2020 Aug 13.

SMART Lab, Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.

Dynamic motor imagery (dMI) is a motor imagery task associated with movements partially mimicking those mentally represented. As well as conventional motor imagery, dMI has been typically assessed by mental chronometry tasks. In this paper, an instrumented approach was proposed for quantifying the correspondence between upper and lower limb oscillatory movements performed on the spot during the dMI of walking vs. during actual walking. Magneto-inertial measurement units were used to measure limb swinging in three different groups: young adults, older adults and stroke patients. Participants were tested in four experimental conditions: (i) simple limb swinging; (ii) limb swinging while imagining to walk (dMI-task); (iii) mental chronometry task, without any movement (pure MI); (iv) actual level walking at comfortable speed. Limb swinging was characterized in terms of the angular velocity, frequency of oscillations and sinusoidal waveform. The dMI was effective at reproducing upper limb oscillations more similar to those occurring during walking for all the three groups, but some exceptions occurred for lower limbs. This finding could be related to the sensory feedback, stretch reflexes and ground reaction forces occurring for lower limbs and not for upper limbs during walking. In conclusion, the instrumented approach through wearable motion devices adds significant information to the current dMI approach, further supporting their applications in neurorehabilitation for monitoring imagery training protocols in patients with stroke.
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http://dx.doi.org/10.3390/s20164545DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7472606PMC
August 2020

Te.M.P.O., an app for using temporal musical mismatch in post-stroke neurorehabilitation: A preliminary randomized controlled study.

NeuroRehabilitation 2020 ;47(2):201-208

Fondazione Santa Lucia IRCCS, Rome, Italy.

Background: Recently, the potential rehabilitation value of music has been examined and music-based interventions and techniques such as the Negative Mismatch (MMN) have been increasingly investigated in the neurological rehabilitation context.

Objective: The aim of this study was to investigate the effectiveness of a negative mismatch-based therapy on the disability and quality of life in patients with stroke in sub-acute phase.

Methods: Thirty patients with a stroke diagnosis in sub-acute phase were randomly assigned to one of two groups: Mismatch (Mg) or Control (CTRLg) group. Both groups used an innovative Android application: Temporal Musical Patterns Organisation (Te.M.P.O). The Disability Rating Scale (DRS), the Modified Barthel Index (MBI) and the Stroke Specific Quality of Life scale (SSQoL) were used at the baseline (T0) and after four weeks of training (T1), in order to assess changes over time.

Results: Statistical analysis was performed using the data of 24 (Mg = 12, CTRLg = 12) subjects. The results show a major improvement of the Mg with respect to the CTRLg in all clinical scales score.

Conclusion: The temporal negative mismatch-based therapy performed with the Te.M.P.O. application could be useful in improving the disability and the quality of life in stroke survivors in a sub-acute phase.
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http://dx.doi.org/10.3233/NRE-203126DOI Listing
January 2021

Body Representations in Children with Cerebral Palsy.

Brain Sci 2020 Jul 28;10(8). Epub 2020 Jul 28.

IRCCS Santa Lucia Foundation, 00179 Rome, Italy.

We constantly process top-down and bottom-up inputs concerning our own body that interact to form body representations (BR). Even if some evidence showed BR deficits in children with cerebral palsy, a systematic study that evaluates different kinds of BR in these children, taking into account the possible presence of a general deficit affecting non-body mental representations, is currently lacking. Here we aimed at investigating BR (i.e., Body Semantics, Body Structural Representation and Body Schema) in children with cerebral palsy (CP) taking into account performance in tasks involving body stimuli and performance in tasks involving non-body stimuli. Thirty-three CP (age range: 5-12 years) were compared with a group of 103 typically-developing children (TDC), matched for age and sex. 63.64% of children with CP showed a very poor performance in body representation processing. Present data also show alterations in different body representations in CP in specific developmental stages. In particular, CP and TDC performances did not differ between 5 to 7 years old, whereas CP between 8 and 12 years old showed deficits in the Body Structural Representation and Body Schema but not in Body Semantics. These findings revealed the importance of taking into account the overall development of cognitive domains when investigating specific stimuli processing in children who do not present a typical development and were discussed in terms of their clinical implications.
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http://dx.doi.org/10.3390/brainsci10080490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463564PMC
July 2020

Return to Work and Quality of Life after Stroke in Italy: A Study on the Efficacy of Technologically Assisted Neurorehabilitation.

Int J Environ Res Public Health 2020 07 20;17(14). Epub 2020 Jul 20.

IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Rome, Italy.

Cerebrovascular diseases, including stroke, are historically considered diseases of old adults so only in a few studies has "return to work" (RTW) been considered as an index of rehabilitative outcome. At the moment, data on RTW in patients with stroke are highly variable: four different reviews reported the following ranges: 11-85%, 19-73%, 22-53%, and 40-45%. The absence of re-integration to work after a stroke is shown to be associated with an increase of cardiac disorders and depression, with a higher level of mortality, with social isolation and with insufficient adaptive skills. The aim of this study was to verify the effectiveness of technological treatment, performed with optic (SonicHand) and wearable (Riablo™) systems providing auditory and visual biofeedback, on RTW in patients with stroke. RTW was found to be associated with a higher independence in the activities of daily living (assessed by the Modified Barthel Index). No significant differences were found between technological versus conventional rehabilitation in terms of RTW, despite the former showing a higher odds ratio than the latter (OR = 9 vs. 6). Assistive devices were mainly used in patients who had not returned to work. Finally, quality of life was found higher in those patients who returned to work with the same conditions (work duties and time) as before stroke.
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http://dx.doi.org/10.3390/ijerph17145233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7399919PMC
July 2020

Visuomotor Integration for Coupled Hand Movements in Healthy Subjects and Patients With Stroke.

Front Bioeng Biotechnol 2020 30;8:591. Epub 2020 Jun 30.

Department of Biomedical Sciences, University of Sassari, Sassari, Italy.

Many studies have investigated the bilateral upper limb coordination during movements under different motor and visual conditions. Bilateral training has also been proposed as an effective rehabilitative protocol for patients with stroke. However, the factors influencing in-phase vs. anti-phase coupling have not yet been fully explored. In this study, we used a motion capture device based on two infrared distance sensors to assess whether the up and down oscillation of the less functional hand (the non-dominant one in healthy younger and older subjects and the paretic one in patients with stroke) could be influenced by in-phase or anti-phase coupling of the more functional hand and by visual feedback. Similar patterns were found between single hand movements and in-phase coupled movements, whereas anti-phase coupled movements were less ample, less sinusoidal, but more frequent. These features were particularly evident for patients with stroke who showed a reduced waveform similarity of bilateral movements in all conditions but especially for anti-phase movements under visual control. These results indicate that visuomotor integration in patients with stroke could be less effective than in healthy subjects, probably because of the attentional overload required when moving the two limbs in an alternating fashion.
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http://dx.doi.org/10.3389/fbioe.2020.00591DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339959PMC
June 2020

A Water-Based Sequential Preparatory Approach vs. Conventional Aquatic Training in Stroke Patients: A Randomized Controlled Trial With a 1-Month Follow-Up.

Front Neurol 2020 18;11:466. Epub 2020 Jun 18.

Fondazione Santa Lucia IRCCS, Rome, Italy.

Many studies hypothesize that people who have suffered stroke could benefit from water-based exercises to improve their strength and ability to perform the activities of daily living. The study aim was to compare the effects of a water-based sequential preparatory approach (SPA) and conventional aquatic therapy in improving motor functions and quality of life in patients with chronic stroke. Thirty-three chronic stroke outpatients diagnosed with hemiplegia were recruited and randomly assigned to the experimental or control group. Subjects in the experimental group underwent a trial water-based SPA balance training, and patients in the control group were given traditional water balance training. Both groups of participants underwent 45 min of therapy twice a week for 4 weeks. All patients were evaluated before treatment (T0), after 4 weeks of training (T1), and 4 weeks after the end of training (T2) using the Berg balance scale (BBS), the modified Barthel index (MBI), the Tinetti balance and gait scale (TBG), the Stroke Specific Quality Of Life Scale (SS-QOL), and the modified Ashworth scale (MAS). After the training, statistically significant differences ( < 0.05) were found between the groups in their score averages on the BBS ( = 0.01) and the SS-QOL scale ( = 0.03). Furthermore, the SPAg showed a significantly greater percentage of improvement on the BBS ( = 0.02) and the SS-QOL ( = 0.03). Both groups obtained a significantly improved MAS score ( < 0.01). Results indicate that water training based on an SPA is more effective than traditional aquatic training for balance rehabilitation of chronic poststroke patients.
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http://dx.doi.org/10.3389/fneur.2020.00466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7326023PMC
June 2020

Adipokines as Potential Biomarkers in the Neurorehabilitation of Obese Stroke Patients.

Curr Neurovasc Res 2020 ;17(4):437-445

Department of Life, Health and Environmental Sciences, University of L'Aquila-67100, L'Aquila, Italy.

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation.

Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified.

Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM).

Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM.

Conclusion: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.
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http://dx.doi.org/10.2174/1567202617666200603150901DOI Listing
January 2020

Neuroplasticity and brain reorganization associated with positive outcomes of multidisciplinary rehabilitation in progressive multiple sclerosis: A fMRI study.

Mult Scler Relat Disord 2020 Jul 6;42:102127. Epub 2020 May 6.

Santa Lucia Foundation IRCCS, Rome, Italy.

Background: Multiple sclerosis (MS) is characterized by a range of symptoms, including motor, sensorimotor and cognitive impairments, that limit the quality of life. A multidisciplinary rehabilitation approach in people affected by multiple sclerosis was recently reported to improve the functional abilities of MS patients in daily activities. The purpose of the study was to assess the effect of multidisciplinary rehabilitation on the whole brain of MS patients by means of functional magnetic resonance imaging (fMRI).

Methods: Thirty individuals affected by MS (49.9 ± 12.1 years; disease duration: 16.0 ± 8.5 years) with a medium-high severity of disease were enrolled. The fMRI examination assessed a range of action-related tasks involving passive movement, mental simulation of action and miming of action triggered by external stimuli, such as object photography. The three tasks were performed using each arm separately. The fMRI acquisitions were performed at T1 (inclusion in the study), T2 (3 months later, at the start of rehabilitation) and T3 (after 3 months of multidisciplinary rehabilitation).

Results: The fMRI results revealed a significant reduction in the activity of brain areas related to task-specific networks as well as the activation of cerebral regions not usually involved in task-specific related network, such as the medial prefrontal area.

Conclusions: The effectiveness of multidisciplinary rehabilitation on activity and participation has been established in previous studies. Our study sheds new light on the effect of such treatment on brain reorganization.
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http://dx.doi.org/10.1016/j.msard.2020.102127DOI Listing
July 2020

Covid-19: A Dynamic Analysis of Fatality Risk in Italy.

Front Med (Lausanne) 2020 30;7:185. Epub 2020 Apr 30.

Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Fondazione Santa Lucia, Rome, Italy.

Italy was the second country in the world to face a wide epidemic of Covid-19 after China. The ratio of the number of fatalities to the number of cases (case fatality ratio, CFR) recorded in Italy was surprisingly high and increased in the month of March. The older mean age of population, the changes in testing policy, and the methodological computation of CFR were previously reported as possible explanations for the incremental trend of CFR, a parameter theoretically expected to be constant. In this brief report, the official data provided by the Italian Ministry of Health were analyzed using fitting models and the linear fit method approach. This last methodology allowed us to reach two findings. The trend of the number of deaths followed a 1-3-day delay of positive cases. This delay was not compatible with a biological course of Covid-19 but was compatible with a health management explanation. The second finding is that the Italian number of deaths did not increase linearly with the number of positive cases, but their relationship could be modeled by a second-order polynomial function. The high number of positive cases might have a direct and an indirect effect on the number of deaths, the latter being related to the overwhelmed bed capacity of intensive care units.
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http://dx.doi.org/10.3389/fmed.2020.00185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7203466PMC
April 2020

Assistive products and childhood neurodisability: a retrospective study on factors associated with aids/orthoses prescription.

Eur J Phys Rehabil Med 2020 Aug 14;56(4):412-420. Epub 2020 May 14.

Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy.

Background: Children affected by pathologies causing neurodisability go through motor, cognitive, sensory and other limitations. The selection of assistive products can influence their level of independence and quality of life.

Aim: The present study investigated the possibility to assess the equipment needs of children with neurodisabilities, based on their clinical characteristics.

Design: A retrospective observational study.

Setting: Outpatients.

Population: Inclusion criteria: diagnosis of cerebral palsy or genetic/chromosomal/syndromic disorders, age range 0-18 years, intelligence quotient evaluation, medical history of positive or negative presence of epilepsy and of communication disorders, admission at our neurorehabilitation service between 2007 and 2017, and registration of all equipment prescribed to each child.

Methods: In 192 children (111 males, 57.81%) we evaluated the relationship between several independent variables (diagnosis, sex, Gross Motor Function Classification System level, intelligence quotient, history of epilepsy and communication disorders) and equipment prescription by means of logistic regression models.

Results: Our data showed significant correlation between the Gross Motor Function Classification System level and the equipment prescribed. A history of seizures was negatively correlated with walker prescriptions (the log odds of prescription decreases by -2.156; CI: -4.16 to -0.65) and positively with those of stroller (the log odds increases by 1.427; CI: 0.22 to 2.69). Stroller and knee-ankle-foot orthoses and hip-knee-ankle-foot orthoses prescriptions were negatively correlated with the cerebral palsy diagnosis. The prescription of foot orthoses was positively correlated with mental retardation (the log odds increases by 0.358; CI: 0.12 to 0.61). A negative correlation between communication disorders and the prescription of ankle-foot orthoses and communication/learning devices was also found (the log odds decreases by -0.833; CI -1.66 to -0.01).

Conclusions: Several clinical characteristics correlate with specific equipment needs.

Clinical Rehabilitation Impact: The definition of the clinical characteristics with a potential predicting value, may facilitate the task of physician on choosing what is more appropriate to prescribe, as well as the authorizing office responsible for evaluating the appropriateness of prescriptions. Furthermore, it could be possible to foresee the care needs in terms of type and number of aids/orthoses and to guarantee every disabled child the possibility to take advantage of the same opportunities.
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http://dx.doi.org/10.23736/S1973-9087.20.06224-3DOI Listing
August 2020

Clinical features of fallers among inpatient subacute stroke: an observational cohort study.

Neurol Sci 2020 Sep 7;41(9):2599-2604. Epub 2020 Apr 7.

Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Via Ardeatina, 306, 00179, Rome, Italy.

Background And Purpose: The aim of this study is to observe the differences between fallers, common fallers, and non-fallers in stroke patients compared with the global ability in a rehabilitation setting.

Materials And Methods: An observational and prospective study has been carried out. A total of 476 subacute stroke patients have been observed. The main outcome measures were assessed using the Canadian Neurological Scale (CNS), Barthel Index (BI), Functional Ambulatory Category (FAC), and Trunk Control Test (TCT) at admission to the rehabilitation unit and after 90 days of the rehabilitation treatment (nearly 3 h for day for 5 days for week) at the discharge with intermediate evaluations after the first and second months.

Results: Out of 397 patients, 109 reported 1 or more falls (27.5%), of whom 67 fell 1 time (fallers) in the hospital (16.9%) and 42 fell 2 or more times (common fallers) (10.6%). For fallers, BI and FAC scores had a significant effect (p = 0.003 for both). Common fallers had statistically significant differences in BI (p = 0.002), FAC (p = 0.012), and TCT scores (0.023) compared with non-fallers.

Conclusions: The severity of stroke may directly increase the risk of fall, and also indirectly, lengthening the hospitalization. Our study seems to suggest that patients with BI scores of between 21 and 30 on admission are more prone to fall in the first period of hospitalization, whereas in the second month, those with scores of between 11 and 20 on admission have a higher risk of falls. In the third month, patients with BI scores below 10 on admission are more susceptible to falls.
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http://dx.doi.org/10.1007/s10072-020-04352-2DOI Listing
September 2020

Robot-assisted therapy for arm recovery for stroke patients: state of the art and clinical implication.

Expert Rev Med Devices 2020 Mar 28;17(3):223-233. Epub 2020 Feb 28.

Clinical Laboratory of Experimental Neurorehabilitation, Fondazione Santa Lucia IRCCS, Rome, Italy.

: Robot-assisted therapy is an emerging approach that performs highly repetitive, intensive, task oriented and quantifiable neuro-rehabilitation. In the last decades, it has been increasingly used in a wide range of neurological central nervous system conditions implying an upper limb paresis. Results from the studies are controversial, for the many types of robots and their features often not accompanied by specific clinical indications about the target functions, fundamental for the individualized neurorehabilitation program.: This article reviews the state of the art and perspectives of robotics in post-stroke rehabilitation for upper limb recovery. Classifications and features of robots have been reported in accordance with technological and clinical contents, together with the definition of determinants specific for each patient, that could modify the efficacy of robotic treatments. The possibility of combining robotic intervention with other therapies has also been discussed.: The recent wide diffusion of robots in neurorehabilitation has generated a confusion due to the commingling of technical and clinical aspects not previously clarified. Our critical review provides a possible hypothesis about how to match a robot with subject's upper limb functional abilities, but also highlights the need of organizing a clinical consensus conference about the robotic therapy.
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http://dx.doi.org/10.1080/17434440.2020.1733408DOI Listing
March 2020

Stable or able? Effect of virtual reality stimulation on static balance of post-stroke patients and healthy subjects.

Hum Mov Sci 2020 Apr 15;70:102569. Epub 2020 Jan 15.

Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy.

Over the last decades, virtual reality (VR) emerged as a potential tool for developing new rehabilitation treatments in neurological patients. However, despite the increasing number of studies, a clear comprehension about the impact of immersive VR-treatment on balance and posture is still scarce. In the present study, we aimed to investigate the effects of VR cues on balance performances of subjects affected by stroke, age-matched healthy subjects, and young healthy subjects. Fifteen patients with sub-acute stroke, fifteen healthy elderly subjects and fifteen healthy young adults took part in this study. All groups were immersed in a CAVE system on a stabilometric platform. The experiment consisted in fourteen trials: (i) ten VR trials, which differed in term of speed and movement direction; (ii) two-stabilometric static sessions, with opened and closed eyes (one at the start and one at the end of the experimental session). Results showed that VR trials increased the sway path length (representative of the body sway amplitudes), in young subjects. Elderly and patients showed less changes in postural sway during virtual reality stimulation than young group. These findings may suggest that a physiological postural performance is not simply evaluable assessing stability, but also assessing the ability of adapting body oscillations to the external stimuli.
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http://dx.doi.org/10.1016/j.humov.2020.102569DOI Listing
April 2020

The development of body representations in school-aged children.

Appl Neuropsychol Child 2019 Dec 20:1-13. Epub 2019 Dec 20.

Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy.

Following the triadic taxonomy, three different body representations do exist, namely the body semantics, the body structural representation and the body schema. The development of these body representations has been widely investigated in toddlers, but several issues remain to be addressed in school age. To assess age- and gender-related changes in different body representations and to investigate the presence of different patterns of interplay between these representations of the body, 90 children (age range: 7-10) and 37 young adults (age range: 18-35) were given tasks assessing the body semantics, the body structural representation and the body schema as well as control tasks. The present results suggested that the body schema, evaluated by means of hand laterality judgments, was still not completely developed in school-aged children, whereas the body structural representation reached an adult-like pattern by the age of 9-10 years. Finally, body semantics was fully developed in school-aged children. These findings were discussed in terms of their theoretical implications, for a better understanding of body representation development; also, implications for clinical assessment of body representation disorders were discussed.
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http://dx.doi.org/10.1080/21622965.2019.1703704DOI Listing
December 2019

Upper limb motor improvement in chronic stroke after combining botulinum toxin A injection and multi-joints robot-assisted therapy: a case report.

Oxf Med Case Reports 2019 Oct 31;2019(10):omz097. Epub 2019 Oct 31.

Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research, Hospitalisation and Health Care (IRCCS) Santa Lucia Foundation, Rome, Italy.

Spasticity is one of the major complications after stroke. Botulinum toxin type A (BoNT-A) injection is commonly used to manage focal spasticity. However, it is uncertain whether BoNT-A can improve activities of daily living function of paretic arm. The recovery of functions of the affected arm is also the aim of robotic upper limb (UL) therapy. The motorized exoskeleton assists the patient in a large 3D work environment by promoting movement for the UL (shoulder, elbow, wrist, hand). The combination of the BoNT-A injection and the robotic therapy might enhance functional recovery after stroke. We reported the case of a chronic stroke patient in which the injection of BoNT-A was combined with multi-joint exoskeleton training. The patient showed improvement in the motor control of the UL, supporting the feasibility of this approach.
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http://dx.doi.org/10.1093/omcr/omz097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822606PMC
October 2019

Virtual reality in stroke rehabilitation: virtual results or real values?

Authors:
Marco Iosa

Arq Neuropsiquiatr 2019 24;77(10):679-680. Epub 2019 Oct 24.

Laboratory for the Study of Mind and Action in Rehabilitation Technologies, IRCCS Fondazione Santa Lucia, Rome, Italy.

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http://dx.doi.org/10.1590/0004-282X20190123DOI Listing
April 2020

Post-stroke Depression Increases Disability More Than 15% in Ischemic Stroke Survivors: A Case-Control Study.

Front Neurol 2019 27;10:926. Epub 2019 Aug 27.

Fondazione Santa Lucia-IRCCS, Rome, Italy.

We performed a retrospective, case-control study in consecutive ischemic stroke patients admitted to our stroke rehabilitation unit. Patients were matched for severity of neurological impairment (evaluated with the Canadian Neurological Scale, CNS), age (difference within 1 year), and onset admission interval (difference within 3 days). Participants were divided into two subgroups according to the presence or absence of PSD. Aim was to assess the specific influence of post-stroke depression (PSD) and antidepressant treatment on both basal functional status and rehabilitation outcomes. All PSD patients were treated primarily with serotoninergic antidepressants (AD). The final sample included 280 patients with depression (out of 320 found in a whole case series of 993 ischemic patients, i.e., 32.25%) and 280 without depression. Forty patients with depression were excluded because they had a history of severe psychiatric illness or aphasia, with a severe comprehension deficit. On one hand, PSD patients obtained lower Barthel Index (BI) and Rivermead Mobility Index (RMI) scores at both admission and discharge, with minor effectiveness of rehabilitative treatment and longer length of stay; on the other hand, this group had a lower percentage of dropouts. Lastly, PSD patients showed a different functional outcome, based on their response to antidepressant therapy, that was significantly better in responders than in non-responders (13.13%). Our results confirm the unfavorable influence of PSD on functional outcome, despite pharmacological treatment.
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http://dx.doi.org/10.3389/fneur.2019.00926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718567PMC
August 2019

Early body weight-supported overground walking training in patients with stroke in subacute phase compared to conventional physiotherapy: a randomized controlled pilot study.

Int J Rehabil Res 2019 Dec;42(4):309-315

Fondazione Santa Lucia, Scientific Institute for Research and Healthcare, Operative Unit 4.

Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown. The primary aim of this study was to evaluate the efficacy of a rehabilitative program that combines conventional approach with an early overground body weight-support training, in terms of recovery of independent walking focussing on patients with subacute stroke. The secondary aim was to evaluate the impact of body weight-support also on functional mobility, overall disability, and gait endurance. A total of 37 participants were enrolled and randomized to experimental group or control group for the baseline evaluations. In the experimental group, body weight-supported overground walking was added to conventional physiotherapy for 4 weeks. The outcome measurements used were: Functional Ambulation Classification (FAC), Rivermead Mobility Index, Barthel Index, and the 6-minute Walk Test. At the evaluation 1 week after the end of the intervention period, experimental group reached a statistically significant increase of independent walking as detected by FAC (experimental group: 3 vs. control group: 2, P < 0.01). No differences were observed by the other evaluation outcome measures. We conclude that BWS training may be more effective than conventional therapy alone in improving walking autonomy in persons with subacute stroke.
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http://dx.doi.org/10.1097/MRR.0000000000000363DOI Listing
December 2019

Influences of the biofeedback content on robotic post-stroke gait rehabilitation: electromyographic vs joint torque biofeedback.

J Neuroeng Rehabil 2019 07 23;16(1):95. Epub 2019 Jul 23.

Spinal Rehabilitation Laboratory - Neurological and Spinal Cord Injury Rehabilitation Department A, Santa Lucia Foundation IRCCS, Via Ardeatina 306 -, 00179, Rome, Italy.

Background: Add-on robot-mediated therapy has proven to be more effective than conventional therapy alone in post-stroke gait rehabilitation. Such robot-mediated interventions routinely use also visual biofeedback tools. A better understanding of biofeedback content effects when used for robotic locomotor training may improve the rehabilitation process and outcomes.

Methods: This randomized cross-over pilot trial aimed to address the possible impact of different biofeedback contents on patients' performance and experience during Lokomat training, by comparing a novel biofeedback based on online biological electromyographic information (EMGb) versus the commercial joint torque biofeedback (Rb) in sub-acute non ambulatory patients. 12 patients were randomized into two treatment groups, A and B, based on two different biofeedback training. For both groups, study protocol consisted of 12 Lokomat sessions, 6 for each biofeedback condition, 40 min each, 3 sessions per week of frequency. All patients performed Lokomat trainings as an add-on therapy to the conventional one that was the same for both groups and consisted of 40 min per day, 5 days per week. The primary outcome was the Modified Ashworth Spasticity Scale, and secondary outcomes included clinical, neurological, mechanical, and personal experience variables collected before and after each biofeedback training.

Results: Lokomat training significantly improved gait/daily living activity independence and trunk control, nevertheless, different effects due to biofeedback content were remarked. EMGb was more effective to reduce spasticity and improve muscle force at the ankle, knee and hip joints. Robot data suggest that Rb induces more adaptation to robotic movements than EMGb. Furthermore, Rb was perceived less demanding than EMGb, even though patient motivation was higher for EMGb. Robot was perceived to be effective, easy to use, reliable and safe: acceptability was rated as very high by all patients.

Conclusions: Specific effects can be related to biofeedback content: when muscular-based information is used, a more direct effect on lower limb spasticity and muscle activity is evidenced. In a similar manner, when biofeedback treatment is based on joint torque data, a higher patient compliance effect in terms of force exerted is achieved. Subjects who underwent EMGb seemed to be more motivated than those treated with Rb.
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http://dx.doi.org/10.1186/s12984-019-0558-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6652021PMC
July 2019

Dynamic motor imagery mentally simulates uncommon real locomotion better than static motor imagery both in young adults and elderly.

PLoS One 2019 26;14(6):e0218378. Epub 2019 Jun 26.

Department of Movement, Human and Health Sciences, Section of Health Sciences, University of Rome "Foro Italico", Rome, Italy.

A new form of Motor Imagery (MI), called dynamic Motor Imagery (dMI) has recently been proposed. The dMI adds to conventional static Motor Imagery (sMI) the presence of simultaneous actual movements partially replicating those mentally represented. In a previous research conducted on young participants, dMI showed to be temporally closer than sMI in replicating the real performance for some specific locomotor conditions. In this study, we evaluated if there is any influence of the ageing on dMI. Thirty healthy participants were enrolled: 15 young adults (27.1±3.8 y.o.) and 15 older adults (65.9±9.6y.o.). The performance time and the number of steps needed to either walk to a target (placed at 10m from participants) or to imagine walking to it, were assessed. Parameters were measured for sMI, dMI and real locomotion (RL) in three different locomotor conditions: forward walking (FW), backward walking (BW), and lateral walking (LW). Temporal performances of sMI and dMI did not differ between RL in the FW, even if significantly different to each other (p = 0.0002). No significant differences were found for dMI with respect to RL for LW (p = 0.140) and BW (p = 0.438), while sMI was significantly lower than RL in LW (p<0.001). The p-value of main effect of age on participants' temporal performances was p = 0.055. The interaction between age and other factors such as the type of locomotion (p = 0.358) or the motor condition (p = 0.614) or third level interaction (p = 0.349) were not statistically significant. Despite a slight slowdown in the performance of elderly compared to young participants, the temporal and spatial accuracy was better in dMI than sMI in both groups. Motor imagery processes may be strengthened by the feedback generated through dMI, and this effect appears to be unaffected by age.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218378PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6594612PMC
February 2020

Coma Recovery Scale-Revised With and Without the Emotional Stimulation of Caregivers.

Can J Neurol Sci 2019 09 29;46(5):607-609. Epub 2019 Jul 29.

IRCCS Santa Lucia Foundation, Rome, Italy.

The Coma Recovery Scale-Revised (CRS-R) is the gold standard of responsiveness assessment in patients with disorder of consciousness. The purpose of this study is to search for the efficacy of the caregivers' involvement in the evaluation of responsiveness in these patients. Responsiveness assessment was performed in 15 patients with CRS-R. The CRS-R was administered with and without the emotional stimulation of the primary caregiver at different times. Our preliminary findings seem to suggest that, including also the caregivers during CRS-R assessment, may obtain better responsiveness scoring than that obtained by professionals and might reduce the misdiagnosis rate.
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http://dx.doi.org/10.1017/cjn.2019.227DOI Listing
September 2019

Relationship Between Body Mass Index and Rehabilitation Outcomes in Subacute Stroke With Dysphagia.

Am J Phys Med Rehabil 2019 07;98(7):608-612

From the Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy (GM, MI, LM, SP); and Complex Operative Unit in Physical Medicine and Rehabilitation, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy (TP).

Objective: The aim of the study was to investigate the association between body mass index and rehabilitation outcome in hemiparetic patients with stroke in subacute phase.

Design: This was a prospective study testing the correlation between body mass index and the effectiveness of rehabilitation, measured using Barthel Index scores. We enrolled patients with subacute stroke (n = 664; age, 68 ± 14 yrs; length of hospital stay, 84 ± 34 days). We assessed the body mass index and Barthel Index both at admission and discharge. The effectiveness of rehabilitation was computed as the percentage increment in Barthel Index score with respect to the maximum achievable improvement.

Results: Effectiveness of rehabilitation was significantly correlated with the body mass index at discharge (R = 0.111, P = 0.004) and percentage change in body mass index (R = 0.253, P < 0.001), but not with body mass index at admission (R = 0.006, P = 0.869).

Conclusions: In addition to body mass index value, our findings suggest that rehabilitation outcomes can be influenced by the change in body mass index during rehabilitation.
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http://dx.doi.org/10.1097/PHM.0000000000001159DOI Listing
July 2019

A stimulus for eating. The use of neuromuscular transcutaneous electrical stimulation in patients affected by severe dysphagia after subacute stroke: A pilot randomized controlled trial.

NeuroRehabilitation 2019 ;44(1):103-110

Clinical Laboratory of Experimental Neurorehabilitation, I.R.C.C.S. Santa Lucia Foundation, Rome, Italy.

Background: Oropharyngeal dysphagia is a common problem in subacute stroke patients leading to aspiration pneumonia and malnutrition. Non-invasive neuromuscular electrical stimulation (NMES) coupled with traditional therapy could be best treatment option for patients with post-stroke dysphagia, however results are still inconclusive and more studies are requested.

Objective: The aim of the study was to investigate the effect of laryngopharyngeal neuromuscular electrical stimulation on dysphagia caused by stroke.

Methods: Thirty-three patients affected by subacute stroke and dysphagia participated in this study. The subjects were divided into NMES plus traditional dysphagia training (n = 17) and traditional dysphagia training alone in a time matched condition (n = 16). Both groups were treated 5 days/week for 8 weeks. All patients were evaluated before and after the treatment. The study was designed as a single blind randomized controlled trial. Primary outcomes were considered the status of swallowing function according to the Functional Oral Intake Scale (FOIS), the instrumental Fiberoptic Endoscopic Examination of Swallowing examination, the Penetration Aspiration Scale and the Pooling score and the presence of oropharyngeal secretion. Secondary outcomes were the type of diet taken by mouth; the need for postural compensations and the duration of the dysphagia training.

Results: A functional improvement was observed in both groups but treatment group showed a significant improvement for primary outcome with the exception of the pooling Score (p = 0.015, p = 0.203; p = 0.003; p = 0.048 respectively) and for secondary outcome p <0.005. The results confirm that laryngopharyngeal neuromuscular electrical stimulation in post-stroke patients with dysphonia improve outcome of the training.

Conclusions: Laryngopharyngeal neuromuscular electrical stimulation may be considered as an additional and effective treatment option for dysphagia after stroke.
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http://dx.doi.org/10.3233/NRE-182526DOI Listing
April 2019