1,720,960 research outputs found
Immersive virtual reality for upper limb rehabilitation in patients with neurolpgical disorders
No full textIntroduzione: L’ictus cerebrale e la sclerosi multipla (SM) rappresentano primarie cause di disabilità acquisita in età adulta al mondo. Menomazioni all’arto superiore (AS) sono spesso presenti e impattano fortemente sull’indipendenza e qualità di vita dei soggetti. La neuroriabilitazione ha l’obiettivo di incrementare la plasticità neurale esperienza-dipendente al fine di migliorare il funzionamento cerebrale compromesso da patologie neurologiche; la Realtà Virtuale (RV) offre la possibilità di erogare un’esperienza di apprendimento intensiva in ambienti personalizzati ed arricchiti. In considerazione del rapporto costo-efficacia dell’hardware, sistemi di RV immersiva (RVI) tramite visori binoculari (Head-Mounted Displays, HMDs) sono attualmente oggetto di intensa ricerca scientifica nonostante la applicabilità clinica sia stata ancora parzialmente indagata.
Obiettivi: Questo percorso di ricerca è stato finalizzato allo sviluppo e alla sperimentazione clinica di un sistema di RVI tramite HMD per la riabilitazione neuromotoria dell’AS in soggetti con disabilità neurologica; inoltre, è stata sintetizzata la letteratura scientifica corrente rispetto all’efficacia degli HMDs per migliorare la menomazione dell’AS in pazienti post-stroke.
Metodi: Nel primo articolo sono state descritte le caratteristiche tecnologiche del sistema HMD sviluppato, testandone la fattibilità in una coorte di 16 soggetti con esiti di stroke attraverso singola esposizione. Nel secondo articolo è stata analizzata l’affidabilità di parametri cinematici AS clinicamente rilevanti registrati attraverso HMD e confrontati con un sistema optoelettronico, includendo in uno studio trasversale 14 pazienti post-stroke. Successivamente, sono state sistematicamente raccolte le evidenze pubblicate sull’efficacia degli HMDs nell’incremento della funzionalità dell’AS in persone con esiti di ictus cerebrale tramite studi multisessione, sintetizzati in una scoping review (articolo 3). Infine, è stata analizzata la fattibilità del sistema con HMDs in soggetti con SM ricercando correlazioni cliniche tra fatigue, embodiment, e performance motoria in uno studio clinico a singola sessione.
Risultati: Per quanto concerne la fattibilità e l’accettabilità clinica del sistema HMD sviluppato, tutti i pazienti hanno riportato elevati valori di tollerabilità e nessun soggetto ha riferito eventi indesiderati sia tra soggetti post-stroke che con SM. Il sistema utilizzato si è rivelato in grado di identificare la posizione stimata delle mani e la relativa velocità di picco in stretto accordo con quanto registrato da un sistema di analisi cinematica di riferimento in pazienti stroke (distanza massima: pendenza media=0.94±0.1; velocità di picco: pendenza media=1.06±0.12). Inoltre, applicazioni sperimentali rispetto all‘uso di HMDs hanno riscontrato effetti positivi nell’incremento della funzione motoria dell’AS in adulti con stroke cronico, inducendo conseguenze positive in termini di uso dell’arto e autonomia funzionale. Infine, in persone con SM sottoposte ad una sessione di RVI tramite HMD, la fatigue ha mostrato un ruolo significativo nel determinare l’entità di embodiment percepito, influenzando la performance motoria dell’AS.
Discussione e Conclusioni: Sistemi di RVI-HMD rappresentano strumenti clinici rilevanti per incrementare la riabilitazione motoria dell’AS in pazienti con disordini neurologici (stroke, SM), potenzialmente utili per massimizzare processi di apprendimento motorio in uno scenario amplificato. L’esposizione ad HMD ha riscontrato vasta accettabilità e tollerabilità sia in persone con esiti di stroke che con SM. Ulteriori sperimentazioni cliniche sono necessarie al fine di analizzare correlati neurofisiologici a recupero neurologico, embodiment e comportamento motorio in soggetti stroke in fase subacuta e in persone con SM, oltre che indagare applicazioni da remoto e interventi combinati.Introduction: Stroke and multiple sclerosis (MS) represent a major cause of acquired adult disability worldwide. Upper limb (UL) impairments are often present, and they critically impact subjects’ independence and quality of life. Neurorehabilitation is aimed to boost experience-dependent neural plasticity to improve brain functioning due to neurological disorders, and Virtual Reality (VR) offers the chance to provide a more intensive learning experience including individualized and enriched practice environments. Due to the hardware’s cost-effectiveness, Head Mounted Display (HMD) immersive VR systems are currently the focus of intense research, while their clinical applicability is still partially explored.
Aims: This research pathway was focused on developing and clinically testing an HMD IVR system for UL motor rehabilitation in neurologically impaired subjects; therefore, we synthesize the existing knowledge on HMD use for improving UL impairment in post-stroke patients.
Methods: In the first paper we described the technological characteristics of the designed HMD system, testing its feasibility in a cohort of 16 stroke survivors through a single-session exposure. In the second paper, we explored the kinematic reliability of UL clinically meaningful parameters recorded through HMD and compared with a marker-based reference system, involving 14 post-stroke subjects in a cross-sectional study. Therefore, we systematically collected published evidence on HMDs’ effectiveness in improving UL functioning in post-stroke people including multisession clinical studies, summarized in a scoping review (paper 3). Lastly, we investigated the HMD-system feasibility in MS people focusing on clinical correlations across fatigue, embodiment, and motor performance in a single-session clinical project.
Results: Concerning the feasibility and the clinical acceptability of the HMD-based system developed, all patients reported high tolerability rates, and no subjects reported adverse events or discomfort symptoms across post-stroke and MS people. The HMD used proved to detect hand position estimation and hand peak velocities in close agreement to those recorded by a reference marker-based system in people after stroke (maximum distance: mean slope = 0.94 ± 0.1; peak velocity: mean slope = 1.06 ± 0.12). Additionally, HMD applications showed beneficial effects in increasing UL motor function in adult chronic stroke survivors, with positive consequences in subjects’ arm use and independence. Besides, in people with MS experiencing an IVR session through HMD, fatigue showed a significant role in determining the rate of embodiment experienced, affecting the consequent UL motor performance.
Discussion and Conclusions: IVR-HMD-based system represents a valuable clinical tool to improve UL motor rehabilitation in patients affected by neurological disorders (i.e., stroke, MS), potentially enhancing motor learning processes in an amplified scenario. HMD exposure showed large acceptability and high tolerability rates both in stroke and MS people. Further clinical investigations are needed in order to analyze neurophysiological correlates to neurological recovery, embodiment perception, and motor behavior in subacute stroke subjects and in MS people, other than testing remote and combined applications
The effectiveness of home-based transcranial direct current stimulation on chronic pain: A systematic review and meta-analysis
No full textObjective: As highlighted by the COVID-19 pandemic, identifying strategies for home-based patient management is crucial. As pain is highly prevalent and imposes significant burdens, interest in its remote management is steadily increasing. Transcranial Direct Current Stimulation (tDCS) seems promising in this context. Methods: This systematic review and meta-analysis aimed to determine the effectiveness of home-based tDCS in pain management (PROSPERO, CRD42023452899). The extracted data included clinical conditions, interventions, comparators, outcome measures, adverse effects, and risk of bias; the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment was carried out. Results: 12 records (9 randomized controlled trials [RCTs], 446 participants, 266 undergoing tDCS) were included in the systematic review. The meta-analysis showed that home-based tDCS might produce large and clinically relevant improvement in chronic pain intensity at the end of the intervention (standard mean difference [SMD] -0.95, 95% CI -1.34 to -0.56; p < 0.01; 404 participants, low certainty), as well as small clinically unimportant improvement at short-term follow-up (SMD -0.50, 95% CI -0.82 to -0.19; p < 0.01; 160 participants, moderate certainty). A subgroup analysis showed that it might clinically improve the chronic pain related to fibromyalgia and knee osteoarthritis. Moreover, home-based tDCS seems to modulate pressure pain threshold, heat pain threshold, and heat and cold tolerance at the end of the intervention. Notably, tDCS appeared to be generally safe, well-accepted and easily applied at home. Conclusions: Low to moderate certainty evidence suggests that home-based self-administered tDCS is a safe and effective tool for managing various types of chronic pain. Further well-designed, large-scale RCTs are warranted
Characterizing practice-dependent motor learning after a stroke
Full text linkBackground: After stroke, patients must learn to use residual motor function correctly. Consistently, motor learning is crucial in stroke motor recovery. We assessed motor performance, practice-dependent on-line motor learning, and factors potentially affecting them in stroke patients. Methods: This is a cross-sectional observational study. Twenty-six patients with first brain stroke leading to upper limb motor deficit in the subacute or chronic timeframe were enrolled. They performed a Finger Tapping Task (FTT) with both the affected and unaffected limbs. We assessed how patients learn to perform motor tasks despite the motor deficit and the differences in performance between the unaffected and affected limbs. Furthermore, by randomizing the order, we evaluated the possible inter-limb transfer of motor learning (i.e. transfer of a motor skill learned in one limb to the opposite one). Moreover, sleep, attention, anxiety, and depression were assessed through specific tests and questionnaires. Results: Improved FTT accuracy and completed sequences for the affected limb were observed, even if lower than for the unaffected one. Furthermore, when patients initially performed the FTT with the unaffected limb, they showed higher accuracy in subsequent task completion with the affected limb than subjects who started with the affected limb. Only anxiety and attentional abilities showed significant correlations with motor performance. Conclusions: This work provides relevant insights into motor learning in stroke. Practice-dependent on-line motor learning is preserved in stroke survivors, and an inter-limb transfer effect can be observed. Attentional abilities and anxiety can affect learning after stroke, even if the effect of other factors cannot be excluded
Tele-Mindfulness Program for Mental Health in Previously Hospitalized COVID-19 Patients: A quasi-experimental study
No full textBackground: Nearly half of subjects after COVID-19 still experience symptoms after 12 weeks, as described in the Post-Covid Syndrome (PCS). Other than the physical alterations perceived, mental health disorders have been frequently reported. Mindfulness-Based Interventions (MBIs) showed beneficial effects on psychological well-being in patients with respiratory dysfunctions, but they have been rarely tested in severe COVID-19 survivors. Objective: In a quasi-experimental study, test the clinical and psychological effects of a 12-week Tele-MBI in previously hospitalized COVID-19 patients and analyze the feasibility of the intervention. Methods: Subjects earlier hospitalized due to COVID-19 were enrolled 12 weeks after the infection onset, they were assigned to the intervention group (TG) or to the control one (n-TG). Subjects enrolled in the TG attended a 12-week home-based T-MBI and patients of both groups received multimodal rehabilitation interventions according to their own therapeutic needs. Mental health (anxiety, depression, post-traumatic stress disorder (PTSD) symptoms, sleep quality, self-efficacy, and resilience) and quality of life were detected before and after treatment. The feasibility of the T-MBI applied was also investigated. Results: A total of 88 subjects were included (44 in the TG and 44 in the n-TG; 63.6% males, mean age 64.4 ± 10.6). Most characteristics were similar between groups at the baseline; TG patients showed greater improvements in different psychological metrics (anxiety, depression, PTSD, resilience, and self-efficacy) compared to n-TG while no differences were found for perceived quality of life. T-MBI was well-accepted by patients. Conclusion: Tele-Mindfulness program seems effective in reducing anxiety, depression, and post-traumatic stress disorder symptoms and increasing resilience and self-efficacy in subjects who required hospitalization due to COVID-19
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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