5 research outputs found
Cerebral Palsy: from Motor Skills to Social Prediction
No full textThis PhD program stems from my need as a Physiatric physician specialising in the management of Cerebral Palsy (CP), to better answer some of the questions that have been partially addressed in the course of my18 years of clinical practice and, above all, can contribute to improving the care and quality of life for children with cerebral palsy and their families.
CP represents the most common congenital physical disability in the paediatric setting. Neuromotor impairment has always been the connotative element, but the complexity and variability of clinical expression of this condition is now well accepted. It follows that children with CP require comprehensive and multidisciplinary care that is time-consuming and often onerous for the family. So, the aim of my studies is to test various solutions that optimise the benefits of time-limited treatments in school-age patients. We know that, at school age, children's interests diversify and their compliance with treatment gradually declines, with high dropout rates and rehabilitation failure. It is becoming increasingly important for rehabilitation services to understand and adapt their programs and initiatives to meet evolving needs for children and their families.
The first chapter offers a narrative excursus of the medical-scientific and socio-cultural evolution about CP. It is a condition that has been considered a deficit or an exclusive physical impairment for many years. We now understand it to be a health condition in an adverse environment. The rehabilitation approach has shifted its focus from the segmented to the whole person, seeking to implement increasingly personalised medicine that also uses technological tools to enhance outcomes and increase treatment compliance.
Two of the three research projects presented are related to rehabilitation treatment protocols designed from a goal directed perspective. The first utilises a brain neurostimulation technique; the second uses robotic instrumentation; the third project investigates social and non-social prediction skills, never explored on a population of children with CP thus far.
The second chapter describes in detail the non-invasive vagus nerve stimulation (tVNS) application in a double blind randomised controlled trial. This is combined with a bimanual treatment protocol in children with unilateral CP. We just published the protocol and started the enrollment process.
The third chapter presents a project investigating the integrated instrumental assessment with the upper limbs kinematic and robotic treatment (ARMEO-spring) of the upper limb in the rehabilitation process of children with hemiparesis and the preliminary data analysis.
The fourth chapter reports the results of a multidimensional assessment of social and non-social prediction regarding the abilities of children with unilateral and bilateral CP.
Lastly, the interpretation of this data and implications for future research and for clinical management of CP children are discussed.This PhD program stems from my need as a Physiatric physician specialising in the management of Cerebral Palsy (CP), to better answer some of the questions that have been partially addressed in the course of my18 years of clinical practice and, above all, can contribute to improving the care and quality of life for children with cerebral palsy and their families.
CP represents the most common congenital physical disability in the paediatric setting. Neuromotor impairment has always been the connotative element, but the complexity and variability of clinical expression of this condition is now well accepted. It follows that children with CP require comprehensive and multidisciplinary care that is time-consuming and often onerous for the family. So, the aim of my studies is to test various solutions that optimise the benefits of time-limited treatments in school-age patients. We know that, at school age, children's interests diversify and their compliance with treatment gradually declines, with high dropout rates and rehabilitation failure. It is becoming increasingly important for rehabilitation services to understand and adapt their programs and initiatives to meet evolving needs for children and their families.
The first chapter offers a narrative excursus of the medical-scientific and socio-cultural evolution about CP. It is a condition that has been considered a deficit or an exclusive physical impairment for many years. We now understand it to be a health condition in an adverse environment. The rehabilitation approach has shifted its focus from the segmented to the whole person, seeking to implement increasingly personalised medicine that also uses technological tools to enhance outcomes and increase treatment compliance.
Two of the three research projects presented are related to rehabilitation treatment protocols designed from a goal directed perspective. The first utilises a brain neurostimulation technique; the second uses robotic instrumentation; the third project investigates social and non-social prediction skills, never explored on a population of children with CP thus far.
The second chapter describes in detail the non-invasive vagus nerve stimulation (tVNS) application in a double blind randomised controlled trial. This is combined with a bimanual treatment protocol in children with unilateral CP. We just published the protocol and started the enrollment process.
The third chapter presents a project investigating the integrated instrumental assessment with the upper limbs kinematic and robotic treatment (ARMEO-spring) of the upper limb in the rehabilitation process of children with hemiparesis and the preliminary data analysis.
The fourth chapter reports the results of a multidimensional assessment of social and non-social prediction regarding the abilities of children with unilateral and bilateral CP.
Lastly, the interpretation of this data and implications for future research and for clinical management of CP children are discussed
Self-reported gait unsteadiness in mildly impaired neurological patients: an objective assessment through statistical gait analysis
No full textBackground Self-reported gait unsteadiness is often a problem in neurological patients without any clinical evidence of ataxia, because it leads to reduced activity and limitations in function. However, in the literature there are only a few papers that address this disorder. The aim of this study is to identify objectively subclinical abnormal gait strategies in these patients. Methods Eleven patients affected by self-reported unsteadiness during gait (4 TBI and 7 MS) and ten healthy subjects underwent gait analysis while walking back and forth on a 15-m long corridor. Time-distance parameters, ankle sagittal motion, and muscular activity during gait were acquired by a wearable gait analysis system (Step32, DemItalia, Italy) on a high number of successive strides in the same walk and statistically processed. Both self-selected gait speed and high speed were tested under relatively unconstrained conditions. Non-parametric statistical analysis (Mann-Whitney, Wilcoxon tests) was carried out on the means of the data of the two examined groups. Results The main findings, with data adjusted for velocity of progression, show that increased double support and reduced velocity of progression are the main parameters to discriminate patients with self-reported unsteadiness from healthy controls. Muscular intervals of activation showed a significant increase in the activity duration of the Rectus Femoris and Tibialis Anterior in patients with respect to the control group at high speed. Conclusions Patients with a subjective sensation of instability, not clinically documented, walk with altered strategies, especially at high gait speed. This is thought to depend on the mechanisms of postural control and coordination. The gait anomalies detected might explain the symptoms reported by the patients and allow for a more focused treatment design. The wearable gait analysis system used for long distance statistical walking assessment was able to detect subtle differences in functional performance monitoring, otherwise not detectable by common clinical examination
Pairing transcutaneous vagus nerve stimulation with an intensive bimanual training in children and adolescents with cerebral palsy: study protocol of a randomized sham-controlled trial
No full textBackground: Gross motor function impairments and manual dexterity deficits are frequently observed in children and adolescents with Cerebral Palsy (CP), having a major impact on their activity level and autonomy. Improving manual dexterity and activity level of patients with CP is often the focus of rehabilitation. Novel and adjuvant treatment methods that could support the standard training also in chronic conditions are a research priority. The transcutaneous Vagus Nerve Stimulation (tVNS) is a non-invasive brain stimulation technique, which provides a bottom-up stimulation of subcortical and cortical brain structures, enhancing brain GABA and Noradrenaline levels. This technique may play a pivotal role in brain plasticity, which has not been tested in CP patients before.
Methods: 44 children and adolescents with CP will be involved, treated in pairs in a randomized, double-blind, pre-post test study. The two groups will undergo the Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) for 2 consecutive weeks, with 3 h daily sessions for 5 days per week, for an overall time interval of 30 h; the training will be combined with the application for 75 min/day of active or sham tVNS, in separate, randomly allocated groups. The primary outcome measure will include the scores at the Assisting Hand Assessment and Box and Block Test, and at an ad-hoc visuomotor task evaluating manual visuomotor control. Secondary outcomes will include the scores at the Children’s Hand Experience Questionnaire, Canadian Occupational Performance Measure, Melbourne Assessment of Unilateral Upper Limb Function, Gross Motor Function Measure, Vineland, Pediatric quality of life inventory. The evaluation points will include pre (T0), post (T1) and 3-month follow up (T2) assessments. Safety and tolerability will also be assessed.
Results: The results of this trial will assess whether tVNS can effectively boost the effects of an intensive two-week bimanual training, in improving manual dexterity in children and adolescents with cerebral palsy, ensuring safety and tolerability throughout the intervention period
tACS-combined motor training for the rehabilitation of the upper limb in children and adolescents with cerebral palsy: A randomized, sham-controlled trial protocol
No full texttACS-combined motor training for the rehabilitation of the upper limb in children and adolescents with cerebral palsy: A randomized, sham-controlled trial protocol.
No full textBackgroundChildren with cerebral palsy (CP) commonly face gross motor function impairments and manual dexterity deficits, significantly affecting their activity level and independence and, ultimately, quality of life. Rehabilitation often targets improving manual dexterity and activity levels, but standard therapies have limited efficacy. Hence, exploring novel methods to enhance upper limb functionality is crucial. Transcranial alternating current stimulation (tACS), by delivering currents oscillating at specific frequencies syncing with the brain's electrical rhythms, has been demonstrated to modulate neural oscillations and motor behavior.MethodThis randomized, double-blind, sham-controlled, pre-post test study involves 44 children and adolescents (6-17 yo) with CP treated in pairs, which will be randomly allocated to the experimental or control group receiving, respectively, active or sham fronto-cerebellar tACS delivered at the individual gamma frequency. After tACS, both groups will undergo bimanual training, including lower extremities (HABIT-ILE). Primary outcome measures will include the Assisting Hand Assessment, Box and Block Test, and a Visuomotor Task administered via computer for manual visuomotor control evaluation. Secondary outcomes will encompass the Children's Hand Experience Questionnaire, Canadian Occupational Performance Measure, Melbourne Assessment of Unilateral Upper Limb Function, Gross Motor Function Measure, Vineland version 2, Pediatric Quality of Life Inventory, and EEG power recorded in fronto-central regions at rest before (at T0), soon after (at T1), and 3 months after the end of (T2) the training. Safety and tolerability will be assessed by pre- and post-tACS recordings of oxygen saturation and heart rate, along with self-report questionnaires on sensations and side-effects.DiscussionThis study investigates whether an intensive HABIT-ILE program combined with fronto-cerebellar gamma tACS can boost training effects on manual dexterity in children and adolescents with CP, while ensuring safety and tolerability throughout the intervention period.Trial registrationClinicalTrials.gov NCT06372041
