118 research outputs found
The role of clinical neuropsychology in neuromotor rehabilitation
No full textL'ictus e la sclerosi multipla (SM) sono condizioni di disabilità cronica, che comprendono deficit motori, cognitivi e psicologici, quindi una scarsa qualità della vita correlata alla salute (HRQoL). Attraverso un approccio biopsicosociale multidisciplinare, il focus del presente lavoro è quello di esplorare i potenziali benefici delle tecnologie e degli interventi basati sulla plasticità in un contesto di riabilitazione clinica.
In questa tesi discuto i risultati preliminari sugli effetti della stimolazione cerebellare transcranica a corrente continua (ctDCS) combinata con il Task-Oriented Circuit Training nella SM: quest'ultimo ha migliorato l'equilibrio, la mobilità e il funzionamento esecutivo, ma la tDCS cerebellare non ha potenziato gli effetti dell'allenamento. L'ansia e la depressione non hanno mostrato cambiamenti significativi, sebbene i pazienti percepissero una migliore HRQoL mentale dopo il trattamento.
È presentato inoltre un protocollo di studio nella SM con l'obiettivo di testare l'efficacia della Video Game Therapy rispetto all'allenamento con piattaforma di equilibrio. La nostra aspettativa è di rilevare con la VGT un effetto più significativo su mobilità, equilibrio, dual-task e componente psicologica.
Inoltre, vengono esposti i dati di pazienti con ictus subacuto sottoposti ad Action Observation Training. Tutti i pazienti hanno migliorato la funzione motoria; tuttavia, il deficit di attenzione, la gravità dell'ictus e l'ansia/depressione sono predittori significativi per l'incremento nel funzionamento senso-motorio. I pazienti con deficit di attenzione hanno descritto un livello inferiore di coinvolgimento e una minore accuratezza negli esercizi computerizzati interattivi utilizzati per mantenere la concentrazione durante il training. Il trend dell’accuratezza mostra un miglioramento sostenuto fino alla 3° settimana e poi un calo, forse a causa di una diminuzione del coinvolgimento nel training.
Nei pazienti affetti da malattie croniche è necessario mantenere nel tempo una certa continuità nel trattamento multidisciplinare per ridurre l'impatto sulla malattia. Attraverso la Stroke Impact Scale, abbiamo dimostrato che la disabilità e la HRQoL sono migliorate dopo la riabilitazione indipendentemente dal tipo di trattamento, ma si sono deteriorate 6 anni dopo l'ictus, ad eccezione dei domini di memoria e capacità di pensiero, emozioni e comunicazione. La gravità dell'ictus, il sesso maschile e l'età avanzata sono fattori che hanno influenzato il punteggio totale. Il punteggio alla SIS-16 (solo domini fisici), la presenza di deficit sensoriale e il setting del paziente erano fattori legati a SIS-16 alla fine della riabilitazione e dopo 6 mesi.
Durante il COVID-19 il servizio di riabilitazione è stato interrotto/limitato e le modalità di intervento sono cambiate. Per contenere il contagio, è stato proposto un programma di teleriabilitazione in un campione di pazienti con disabilità fisiche, che mostrano un buon livello di fattibilità e accettabilità, nonostante i limiti tecnologici. L'età, la riserva cognitiva e la resilienza risultano predittori di soddisfazione con la teleriabilitazione. Restano da definire le linee guida per il lavoro in modalità remota, nonché una formazione del personale e dei pazienti e la creazione di piattaforme digitali adeguate.
Questi studi presentano il limite della piccola dimensione campionaria e della mancanza di dati neurofisiologici quantitativi; inoltre sono stati condotti anche durante la pandemia, comportando difficoltà organizzative e risultando fattore confondente dei dati raccolti.
In conclusione, gli studi confermano che la presenza di disturbi cognitivi o dell'umore oltre ad influenzarsi a vicenda possono avere un forte impatto sul processo di riabilitazione e sul suo esito finale; da qui l'importanza del ruolo del neuropsicologo nel setting neuroriabilitativoStroke and multiple sclerosis (MS) are chronic disability condition, comprising motor, cognitive and psychological deficit, thus a poor health-related quality of life.Through a multidisciplinary biopsychosocial approach, the focus of the present work is to explore the potential benefits of plasticity-based technologies and interventions in a clinical rehabilitation setting. Studies described below confirm that the presence of cognitive or mood disorder besides influencing each other’s may greatly impact the process of rehabilitation and its final outcome.
In this thesis I discuss preliminary results on the effects of combined cerebellar transcranial Direct Current Stimulation (ctDCS) with Task-Oriented Circuit Training in MS: the latter effectively ameliorated balance, mobility and executive functioning, but cerebellar tDCS did not boost training effects. Anxiety/depression did not show significant changes, although patients perceived a better mental HRQoL after treatment.
We also present, in MS, a study protocol with the aim to test the efficacy of Video Game Therapy compared with balance platform training. Our expectancy is to detect a more significant effect on mobility, balance and dual-task through VGT, besides an improvement in the psychological component.
Moreover, I presented data of subacute stroke patient who underwent Action Observation Training. All patients improved motor function; however, attention deficit, stroke severity and anxiety/depression are significant predictor for increment of sensorimotor functioning. Patients with attention deficit described a lower level of engagement and a lower mean accuracy of interactive computerized exercises used to maintain concentration during the training. With regards to accuracy, trends showed sustained improvement up to the 3° week and then decayed – perhaps due to a decrease in involvement of the training.
In chronic diseases patients, it is essential to maintain a certain continuity in the multidisciplinary treatment over time due to reduce the impact on illness. Through the Stroke Impact Scale, we showed that Disability and HR-QoL improved after rehabilitation independently of type treatment, but deteriorated 6 years after stroke, except for Memory and Thinking Ability, Emotions and Communication domains. Stroke severity, male gender and older age are all factors that influenced total score. Baseline SIS-16 (only physical domains), presence of a sensory deficit and patient's setting were factors related to SIS-16 at the end of rehabilitation and after 6 months. During COVID-19, rehabilitation service has been interrupted or limited and the modalities of intervention have inevitably changed. To contain the contagion, was proposed a telerehabilitation program in a sample of patients with physical disabilities, which show a good level of feasibility and acceptability, despite some technology challenges. Age, cognitive reserve, and resilience were significant predictors of satisfaction with telerehabilitation. However, since the COVID-19 is still present, it remains to be set out practical guidelines on how to work with remote modality, as well as a staff and patient training and creation of adequate digital platforms.
These studies, besides the limit of the small sample size and lack of quantitative neurophysiological data, were carried out also during the pandemic, involving organizational difficulties, as well as being a confounding factor of data collected.
In conclusion, this thesis highlights the relation between cognitive and motor processes and raise several practical implications for designing effective rehabilitation programs, that impact also in mood and HRQOL. Of note, intervention must be encompasses not only physical activity but address all aspects of everyday life, including cognitive functioning, psychological well-being and social participation; hence the importance of the role of the neuropsychologist in the neurorehabilitation setting
Indigenous peoples and climate justice. A critical analysis of international human rights law and governance
No full textThis book provides a new interpretation of international law specifically dedicated to Indigenous peoples in the context of a climate justice approach. The book presents a critical analysis of past and current developments at the intersection of human rights and international environmental law and governance. The book suggests new ways forward and demonstrates the need for a paradigmatic shift that would enhance the meaningful participation of Indigenous peoples as fundamental actors in the conservation of biodiversity and in the fight against climate change. The book offers guidance on a number of critical intersecting and interdependent issues at the forefront of climate change law and policy – inside and outside of the UN climate change regime. The author suggests that the adoption of a critical perspective on international law is needed in order to highlight inherent structural and systemic issues of the international law regime which are all issues that ultimately impede the pursue of climate justice for Indigenous peoples.
Giada Giacomini is an experienced researcher in international human rights law, international environmental law, climate change law and policy, and with an interest in climate vulnerable communities. She holds a PhD in Public, Comparative and International Law. She specializes in climate justice, critical legal studies and non-anthropocentric law. Upon completion of her PhD studies, she completed an Internship at the Independent Redress Mechanism of the Green Climate Fund. She is currently involved in several research projects dealing with ecosocial work, environmental conservation and Indigenous peoples, and climate litigation
Role of Smartphone Applications in the Assessment and Management of Fatigue in Patients with Multiple Sclerosis: A Scoping Review
No full textAbstract: Fatigue is a common symptom in Multiple Sclerosis (MS), and its assessment depends entirely on patient reports. Importantly, managing MS symptoms is increasingly supported by Digital Health Technology (DHT), which includes Mobile Health Technology (mHT). Considering the growing interest, we aimed to synthesise evidence about smartphone applications for the assessment and management of fatigue in MS, as well as to investigate their usability, feasibility, and reliability. We performed a literature search in PubMed, Science Direct, and Embase using a scoping review approach. We included 16 articles and, although many lacked crucial methodological details, DHT was evaluated in all MS clinical subtypes and with disease durations up to more than 20 years. Despite the marked heterogeneity in terms of the employed methods, all documented a high degree of usability, assessed both as feedback from participants and completed tasks. Moreover, the feasibility assessment also showed good results, as apps were able to discriminate between patients with and without fatigue. Importantly, most also showed excellent results in terms of reliability, and some patients reported a reduction in fatigue thanks to mHT. Despite limitations, mHT has been positively evaluated by patients, suggesting a promising role of DHT in the self-management of MS
Impronte narrative. Di segni su carta, mappe in cammino e sconfinamenti urbani
No full textQuesto capitolo nasce da una riflessione sull’alternanza tra sosta e movimento: lungi dall’intendere mobilità e immobilità come poli opposti di un discorso binario, in questa breve riflessione si pone invece l’accento sul dialogo tra stasi e movimento, tra pensiero e azione e, dunque, anche tra gesto e testo a partire da una prospettiva interdisciplinare, che incrocia la geografia culturale con le scienze sociali, il nuovo paradigma delle mobilità con la geocritica. Questo discorso (im)mobile bene si adatta a una pratica tra tutte, camminare, la cui lentezza ha assunto nel tempo un carattere simbolico ed etico, oltre che estetico: vi sono infatti all’interno della narrativa urbana contemporanea una serie di testimonianze che abbracciano esplicitamente la prospettiva in cammino come forma di resistenza alla comune indifferenza nei confronti dei luoghi
Indigenous peoples and climate change. The Yanesha people’s case from a participatory justice perspective
No full textThis paper analyses the main results of the fieldwork conducted by the author for the purposes of determining the impacts of climate change in traditionally living Yanesha communities of the Palcazu, Peru. It gives an overview of the relationship between the Yanesha people and their sacred territory before delving into the data gathered during the fieldwork carried out in November 2018. It concludes by linking the Yanesha people’s case to the broader issue of climate justice, arguing that Indigenous peoples’ participatory rights should be at the centre of a fair and inclusive international and national climate governance regime that recognizes both their vulnerability and their role as agents of environmental conservation
sj-docx-1-eeg-10.1177_15500594231209397 - Supplemental material for A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures
No full textSupplemental material, sj-docx-1-eeg-10.1177_15500594231209397 for A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures by Annibale Antonioni, Martina Galluccio, Riccardo Toselli, Andrea Baroni, Giulia Fregna, Nicola Schincaglia, Giada Milani, Michela Cosma, Giovanni Ferraresi, Monica Morelli, Ilaria Casetta, Alessandro De Vito, Stefano Masiero, Nino Basaglia, Paola Malerba, Giacomo Severini and Sofia Straudi in Clinical EEG and Neuroscience</p
sj-docx-2-eeg-10.1177_15500594231209397 - Supplemental material for A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures
No full textSupplemental material, sj-docx-2-eeg-10.1177_15500594231209397 for A Multimodal Analysis to Explore Upper Limb Motor Recovery at 4 Weeks After Stroke: Insights From EEG and Kinematics Measures by Annibale Antonioni, Martina Galluccio, Riccardo Toselli, Andrea Baroni, Giulia Fregna, Nicola Schincaglia, Giada Milani, Michela Cosma, Giovanni Ferraresi, Monica Morelli, Ilaria Casetta, Alessandro De Vito, Stefano Masiero, Nino Basaglia, Paola Malerba, Giacomo Severini and Sofia Straudi in Clinical EEG and Neuroscience</p
Telerehabiltation in Italy During the COVID-19 Lockdown: A Feasibility and Acceptability Study
No full textThis study examined the feasibility and acceptability of a telerehabilitation program during the COVID-19 pandemic in a sample of adult patients with physical disabilities. Of the twenty-three patients enrolled, 11 agreed to participate in a video-based telerehabilitation program. Barriers and facilitators to the adoption of telerehabilitation were identified and clinical, demographic, and psychological variables were analysed as predictors of success. Age, cognitive reserve, and resilience were significant predictors of satisfaction with telerehabilitation (p<0.05). The telerehabilitation program was perceived as feasible and was well accepted by patients, despite some technology challenges. However, patients who took advantage of telerehabilitation perceived differences in the quality of service and preferred traditional in-person treatment to service delivery via telerehabilitation
Orientarsi tra le nuvole: cartografie, atlanti e pratiche mappanti nel racconto a fumetti
No full textA partire dalla recente nascita della ‘comic book geography’ (Dittmer 2014), il contributo intende proporre la ‘comic book cartography’ come un’ulteriore linea di ricerca volta ad esplorare le contaminazioni tra fumetto e cartografia.
L’approccio transdisciplinare proposto si fonda sull’intersezione tra geografia e analisi geocritica, tra ‘comics studies’ e teoria cartografica post-rappresentazionale. Attraverso una lettura ‘carto-centrata’ di alcuni casi di studio italiani e internazionali, il fumetto viene inteso come una mappa che coinvolge autore e lettore in una vera e propria pratica di orientamento.
[Abstract eng] Orientating among the balloons: maps, atlases and mapping practices in comic books
Starting from the recently emerged field of ‘comic book geography’ (Dittmer 2014), the article proposes ‘comic book cartography’ as a further research line to explore the intersections bewteen comics and cartography.
The proposed transdisciplinary approach is based on the encounter between geography and geocriticism, comics studies and post-representational theories in cartography. Through a ‘carto-centred’ reading of both Italian and international case studies, the comic book is interpreted as a map inolving author and reader in an orientation practice
Variations in Health-Related Quality of Life After Stroke: Insights From a Clinical Trial on Arm Rehabilitation With a Long-Term Follow-Up
No full textDespite rehabilitation, stroke patients continue to have impaired function and reduced health-related quality of life (HRQoL) even in a chronic stage. However, no clear information is available on long-term variations in HRQoL. In this study, we aimed to report the short- and long-term changes in HRQoL in a subacute stroke sample that was enrolled in a clinical trial on arm rehabilitation. Thirty-nine stroke survivors (62% male, mean age 68 years) were assessed using the Stroke Impact Scale Version 2.0 (SIS 2.0) pre and post rehabilitation and at 6 months and 6 years follow-up. Long-term changes in physical function were explored through clinically meaningful changes in the Stroke Impact Scale-16 (SIS-16). After rehabilitation (P < .001), an overall improvement was found in all SIS domains except the memory and thinking, emotions, and communication domains. The baseline SIS-16 score (P < .001), the presence of a sensory deficit, and rehabilitation setting (P < .05) were factors related to the SIS-16 domain scores at the end of rehabilitation and at 6 months follow-up. Patients showed the most deterioration in the mobility (P < .001), strength (P < .003), and hand function (P < .05) domains 6 years after stroke. Stroke severity, male gender, and age >65 years are related with a long-term HRQoL reduction after stroke
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