45 research outputs found
The role of psychological well-being in multiple sclerosis rehabilitation
No full textBACKGROUND: In patients affected by multiple sclerosis (MS) the disabilities increase during the progression of the disease, with a negative impact on quality of life. Rehabilitation improves motor performances, but remains unclear the role of psychological variables on motor recovery. AIM: The aim of this study was to investigate the role of the psychological well-being during a rehabilitation care in MS patients with moderate to severe disability. DESIGN: Longitudinal study. SETTING: Outpatients in a Neurorehabilitation Unit of Pisa and Ferrara University Hospital. POPULATION: 93 subjects affected by MS with moderate to severe degree of impairment were recruited (43 male, 50 female; mean age 53±11.19 years). In relation to the Expanded Disability Status Scale (EDSS) score the sample was divided in two group: Group 1 with moderate impairment (EDSS 4-5.5) and Group 2 with severe impairment (EDSS 6-7). METHODS: Psychological and functional status was assessed before and after a motor rehabilitative treatment, appropriate to their clinical needs. Parameters collected were: Short Form 36, Patient Health Questionnaire, Fatigue Severity Scale, 6-minute walking test and 10-meter walking test. RESULTS: Mood disorders, low quality of life (QoL) and high perceived fatigue are characteristic symptoms in our sample. Results do not show a direct correlation with motor impairment. Mood improves in both groups, while walking endurance and speed ability recovers only in Group 1, on the contrary QoL improves only in Group 2. Regression analysis show that in Group 1 a better QoL predicts a higher motor recovery, whereas in Group 2 the improvement of walking endurance influences the subjective well-being at the discharge. CONCLUSIONS: Subjective well-being is related with the perception of the new condition of life. In less impaired patients psychological status can influence the liability toward rehabilitation treatment, while in more impaired patients motor recovery affect well-being. Therefore, the psychological counselling should be provided during the rehabilitation treatment in order to achieve a successful patients' care. CLINICAL REHABILITATION IMPACT: Our approach contributes to bring out the role of subjective factors on motor rehabilitation outcome and the functional recovery effect on the psychological well-being. The knowledge of subjective needs related to disability degree should be used to customize an appropriate care in MS patients
Benefits of an intensive task-oriented circuit training in Multiple Sclerosis patients with mild disability
No full textBACKGROUND: Exercise is well tolerated and induces relevant improvements in physical and mental functioning of persons with Multiple Sclerosis (MS). Unfortunately, due to the wide variety of symptoms and the broad range of exercise interventions, it is not possible to make unified exercise recommendation as to what type of exercise is safe and effective for persons with MS.OBJECTIVE: The aim was to test the impact of an intensive task-oriented training on motor function and quality of life in 17 MS patients with an Expanded Disability Status Scale (EDSS) between 4 and 5.5.METHODS: Patients underwent a two-week intensive, task-oriented rehabilitation program. Outcome measures were: Berg Balance Scale, Gait Dynamic Index, 6 Minute Walking Test, Physiological Cost Index, Fatigue Severity Scale, 10 metres Walking Test, Timed Up and Go test, Short form 36, Multiple Sclerosis Impact Scale, Patient Health Questionnaire. RESULTS: All outcome measures showed a significant improvement after the treatment except for the 6 Minute Walking test and the Short form 36 that showed a trend of improvement although not statistically significant.CONCLUSIONS: An intensive task-oriented rehabilitation protocol is effective in improving motor function and has a positive impact on quality of life in MS patients with moderate disability
Clinical evidences of brain plasticity in stroke patients
No full textEmerging findings deriving from neuromodulation and neuroradiology are providing us new insights about plasticity and functional reorganization of the brain after stroke, but the direct clinical assessment of motor function should still be considered an indispensable tool for the evaluation of the effects of plasticity in stroke patients. Recovery of motor function can be spontaneous or guided by training. Substantial functional recovery can occur spontaneously especially in the first month post-stroke. Instead, the guided recovery may take more time and may rely on a number of rehabilitation techniques which proved to be capable of stimulating cerebral plasticity. Even the time course of these processes is a decisive element. First, it is important to correlate the trends of plasticity after stroke, from the enhancement of earlier periods to the later stages, to the behavioral changes observed. Furthermore, it is crucial to distinguish recovery of function occurring through improvement of motor deficit from compensatory mechanisms, distinction that has also an effect on timing of recovery. Another relevant question is the maintenance over time of the improvements reached with the treatment, feature on which various clinical studies have been conducted in acute and chronic stroke patients. Further studies are needed to allow us to get a more precise definition of the potentiality of functional recovery and of the mechanisms underlying the recovery depending on its levels and timing. Understanding the mechanisms, the effects and the limits of neural plasticity may eventually help enhancing the recovery process in stroke patients, significantly improving the quality of life of these patients. Then, a greater attention towards the clinical implications of the changes related to plasticity can be a crucial element to further improve the therapeutic options used in neurorehabilitation
Long-latency components of somatosensory evoked potentials during passive tactile perception of gratings
No full textPerception of tactile stimuli elicits Somatosensory Evoked Potentials (SEPs) that can be recorded via non-invasive electroencephalography (EEG). However, it is not yet clear how SEPs localization, shape and latency are modulated by different stimuli during mechanical tactile stimulation of fingertips. The aim of this work is thus to characterize SEPs generated by the tactile perception of gratings during dynamic passive stimulation of the dominant fingertip by means of a mechatronic platform. Results show that a random sequence of stimuli elicited SEPs with two long-latency components: (i) a negative deflection around 140 ms located in the frontal-central-parietal side in the contralateral hemisphere; (ii) a positive deflection around 250 ms located in the frontal-central midline. Time-frequency analysis revealed significant continuous bilateral desynchronization in the alpha band throughout the passive stimulation. These results are a fundamental step towards building a model of brain responses during perception of tactile stimuli for future benchmarking studies
The effects of robot-assisted gait training in progressive multiple sclerosis: A randomized controlled trial
No full textBackground: Gait and mobility impairments are common in progressive multiple sclerosis (MS), leading to reduced quality of life (QoL). Objective: In this randomized controlled study, we tested the effects of robot-assisted gait training (RAGT) and compared it to conventional physiotherapy, measuring walking ability, depression, fatigue, and QoL in patients with progressive MS and severe gait disability. Methods: Fifty-two participants (Expanded Disability Status Scale score 6-7) completed the study protocol. They received two sessions/week over 6 weeks of RAGT or conventional walking therapy. Outcome measures were Six-Minute Walk Test, Ten-Meter Walk Test, Timed Up and Go Test, Berg Balance Scale, Fatigue Severity Scale, Patient Health Questionnaire, and Short Form 36. They were performed pre-treatment, post-treatment, and at 3 months. Results: Walking endurance (p < 0.01) and balance (p < 0.01) were improved among those in the RAGT group. Positive effects on depression in both treatment groups were highlighted. However, only among those in the RAGT group was perceived physical functioning QoL increased. No significant effects on fatigue were found. Conclusion: RAGT is a treatment option in progressive MS patients with severe gait impairments to induce short-lasting effects on mobility and QoL
Bilateral cortical representation of tactile roughness
No full textRoughness is the most important feature for texture discrimination. Here we investigate how the bilateral cortical representation of touch is modulated by tactile roughness by analyzing the neural responses elicited by stimuli with various coarseness levels ranging from fine to medium. A prolonged stimulation was delivered to 10 healthy subjects by passively sliding tactile stimuli under the fingertip while recording the EEG to study the modulation of Somatosensory Evoked Potentials (SEPs) as well as activity in the theta and alpha bands. Elicited long-latency SEPs, namely bilateral P100-N140 and frontal P240 were consistent across stimuli. On the contrary, the temporal lag N140 – P240 was nonlinearly modulated both in contralateral and ipsilateral sides, in agreement with literature. Using a time-frequency analysis approach, we identified a theta band power increase in the [0 0.5]s interval and a partially overlapped power decrease in the alpha band which lasted throughout the stimulation. The estimated time these two phenomena were overlapped was comparable across stimuli, whereas a linear decrease in alpha band amplitude was reported when increasing the stimulus roughness in both contralateral and ipsilateral sides. This study showed that the selected tactile stimuli generated physiological bilateral responses that were modulated in a diversified way according to the stimulus roughness and side. Specifically, we identified sensory processing features (i.e., theta and alpha time overlap) invariant to the stimulus roughness (i.e., associated to a basic cortical mechanism of touch) and roughness-dependent cortical outputs comparable in the contralateral and ipsilateral sides that confirm a bilateral processing of tactile information
Rationale of an integrated robotic approach for upper limb functional rehabilitation
No full textUpper limb motor impairment often causes long-term disability in stroke patients and implies limitations in activities of daily living. Several studies tested robotic devices for proximal or distal upper limb rehabilitation and reported results principally focused on specific treated district without significant global effects. We propose a novel approach that integrates a hand distal effector in task-oriented arm training for upper limb functional rehabilitation. Four chronic stroke patients underwent to an intensive rehabilitative treatment using a robotic device that provides arm weight support and assistance of the hand closing/opening within specific setting in virtual reality. After treatment improvements in upper limb functional scales and in kinematic and pressure assessments were observed, highlighting effects on global upper limb motor performance and distal motor control. Furthermore a decrease in resting motor threshold and a reduction in silent period recorded from unaffected hemisphere were evident, suggesting a potential cortical reorganization
