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Tana M, Bottoni A, Cota F, Papacci P, Di Polito A, Del Vecchio A, Vento AL, Campagnola B, Celona S, Cricenti L, Bastoni I, Tirone C, Aurilia C, Lio A, Paladini A, Nobile S, Perri A, Sbordone A, Esposito A, Fattore S, Ferrara PE, Ronconi G, Vento G. Early Respiratory Physiotherapy versus an Individualized Postural Care Program for Reducing Mechanical Ventilation in Preterm Infants: A Randomised Controlled Trial. Children (Basel) 2023; 10:1761. [PMID: 38002852 PMCID: PMC10670353 DOI: 10.3390/children10111761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Tactile stimulation manoeuvres stimulate spontaneous breathing in preterm newborns. The aim of this study is to evaluate the effect of early respiratory physiotherapy on the need for mechanical ventilation during the first week of life in preterm infants with respiratory failure. METHODS This is a monocentric, randomised controlled trial. Preterm infants (gestational age ≤ 30 weeks) not intubated in the delivery room and requiring non-invasive respiratory support at birth were eligible for the study. The intervention group received early respiratory physiotherapy, while the control group received only a daily physiotherapy program (i.e., modifying the infant's posture in accordance with the patient's needs). RESULTS between October 2019 and March 2021, 133 preterm infants were studied, 68 infants in the study group and 65 in routine care. The study group showed a reduction in the need for mechanical ventilation (not statistically significant) and a statistically significant reduction in hemodynamically significant patent ductus arteriosus with respect to the control group (19/68 (28%) vs. 35/65 (54%), respectively, p = 0.03). CONCLUSIONS early respiratory physiotherapy in preterm infants requiring non-invasive respiratory support at birth is safe and has proven to be protective against haemodynamically significant PDA.
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Affiliation(s)
- Milena Tana
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Anthea Bottoni
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Francesco Cota
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Patrizia Papacci
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessia Di Polito
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Arianna Del Vecchio
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Anna Laura Vento
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Benedetta Campagnola
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Sefora Celona
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Laura Cricenti
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Ilaria Bastoni
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Chiara Tirone
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Claudia Aurilia
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessandra Lio
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Angela Paladini
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Stefano Nobile
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alessandro Perri
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Annamaria Sbordone
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Alice Esposito
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Simona Fattore
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
| | - Paola Emilia Ferrara
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Gianpaolo Ronconi
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (A.D.P.); (A.D.V.); (A.L.V.); (B.C.); (S.C.); (L.C.); (I.B.); (P.E.F.); (G.R.)
| | - Giovanni Vento
- Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.T.); (A.B.); (F.C.); (P.P.); (C.T.); (C.A.); (A.L.); (A.P.); (S.N.); (A.P.); (A.S.); (A.E.); (S.F.)
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Gallotti M, Campagnola B, Cocchieri A, Mourad F, Heick JD, Maselli F. Effectiveness and Consequences of Direct Access in Physiotherapy: A Systematic Review. J Clin Med 2023; 12:5832. [PMID: 37762773 PMCID: PMC10531538 DOI: 10.3390/jcm12185832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Background. Direct access in physiotherapy (DAPT) occurs when a patient has the ability to self-refer to physical therapy without physician referral. This model of care in musculoskeletal diseases (MSDs) has shown better outcomes than the traditional-based medical model of care that requires physician referral to access physiotherapist services. This traditional physician referral often results in a delay in care. Unfortunately, DAPT is still not permitted in many countries. Objectives. The primary objective of this systematic review was to compare the effectiveness, safety, and the accuracy of DAPT compared to the physician-led model of care for the management of patients with musculoskeletal disorders. The secondary objective of the present study is to define the physiotherapists' characteristics or qualifications involved in DAPT. Materials and methods. Databases searched included: Medline, Scopus and Web of Science. Databases were searched from their inception to July 2022. Research strings were developed according to the PICO model of clinical questions (patient, intervention, comparison, and outcome). Free terms or synonyms (e.g., physical therapy; primary health care; direct access; musculoskeletal disease; cost-effectiveness) and when possible MeSH (Medical Subject Headings) terms were used and combined with Boolean operators (AND, OR, NOT). Risk of bias assessment was carried out through Version 2 of the Cochrane risk-of-bias tool (ROB-2) for randomized controlled trials (RCTs) and the Newcastle Ottawa Scale (NOS) for observational studies. Authors conducted a qualitative analysis of the results through narrative analysis and narrative synthesis. The narrative analysis was provided for an extraction of the key concepts and common meanings of the different studies, while the summary narrative provided a textual combination of data. In addition, a quantitative analysis was conducted comparing the analysis of the mean and differences between the means. Results. Twenty-eight articles met the inclusion criteria and were analyzed. Results show that DAPT had a high referral accuracy and a reduction in the rate of return visits. The medical model had a higher use of imaging, drugs, and referral to another specialist. DAPT was found to be more cost-effective than the medical model. DAPT resulted in better work-related outcomes and was superior when considering patient satisfaction. There were no adverse events noted in any of the studies. In regard to health outcomes, there was no difference between models. ROB-2 shows an intermediate risk of bias risk for the RCTs with an average of 6/9 points for the NOS scale for observational studies. Conclusion. DAPT is a safe, less expensive, reliable triage and management model of care that results in higher levels of satisfaction for patients compared to the traditional medical model. Prospero Registration Number: CRD42022349261.
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Affiliation(s)
- Marco Gallotti
- Catholic University of the Sacred Heart, Rome Campus, 00168 Rome, Italy
| | - Benedetta Campagnola
- University Hospital Foundation Campus Bio-Medico, Rome University, 00128 Rome, Italy
| | | | - Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Luxembourg, Luxembourg
| | - John D. Heick
- Department of Physical Therapy, Northern Arizona University, P.O. Box 15105, Flagstaff, AZ 86011, USA
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
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Tamantini C, Cordella F, Lauretti C, Luzio FSD, Campagnola B, Cricenti L, Bravi M, Bressi F, Draicchio F, Sterzi S, Zollo L. Tailoring Upper-Limb Robot-Aided Orthopedic Rehabilitation on Patients' Psychophysiological State. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3297-3306. [PMID: 37486842 DOI: 10.1109/tnsre.2023.3298381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Physical therapy keeps exploiting more and more the capabilities of the robot of adapting the treatments to patients' needs. This paper aims at presenting a psychophysiological-aware control strategy for upper limb robot-aided orthopedic rehabilitation. The main features are the capability of i) generating point-to-point trajectories inside an adaptable workspace, ii) providing assistance in guiding the patients' limbs in accomplishing the assigned task allowing them to freely move with a certain degree of spatial and temporal autonomy and iii) tuning the control parameters according to the patients' kinematics performance and psychophysiological state. The implemented control strategy is validated in a real clinical setting on eight orthopedic patients undergoing twenty daily robot-aided rehabilitation sessions. The psychophysiological-aware control strategy evidenced a positive impact on the enrolled participants since they are effectively conducted in a calmer condition with respect to the patients who did not receive the psychophysiological adaptation. Moreover, clinical performance indicators suggest that the proposed tailored control strategy improves motor functions.
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Bressi F, Cricenti L, Bravi M, Pannunzio F, Cordella F, Lapresa M, Miccinilli S, Santacaterina F, Zollo L, Sterzi S, Campagnola B. Treatment of the Paretic Hand with a Robotic Glove Combined with Physiotherapy in a Patient Suffering from Traumatic Tetraparesis: A Case Report. Sensors (Basel) 2023; 23:3484. [PMID: 37050544 PMCID: PMC10099243 DOI: 10.3390/s23073484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND cervical spinal cord injury leads to loss of upper limb functionality, which causes a decrease in autonomy to perform activities of daily living. The use of robotic technologies in rehabilitation could contribute to improving upper limb functionality and treatment quality. This case report aims to describe the potential of robotic hand treatment with Gloreha Sinfonia, in combination with conventional rehabilitation, in a tetraparetic patient. MATERIAL fifteen rehabilitative sessions were performed. Evaluations were conducted pre-treatment (T0), post-treatment (T1), and at two-months follow-up (T2) based on: the upper-limb range of motion and force assessment, the FMA-UE, the 9-Hole Peg Test (9HPT), and the DASH questionnaire. A virtual reality game-based rating system was used to evaluate the force control and modulation ability. RESULTS the patient reported greater ability to use hands with less compensation at T1 and T2 assessments. Improvements in clinical scales were reported in both hands at T1, however, at T2 only did the dominant hand show further improvement. Improved grip strength control and modulation ability were reported for T1. However a worsening was found in both hands at T2, significant only for the non-dominant hand. The maximum force exerted increased from T0 to T2 in both hands. CONCLUSION hand treatment combining physical therapy and Gloreha Sinfonia seems to have benefits in functionality and dexterity in tetraparetic patient in the short term. Further studies are needed to confirm these findings, to verify long-term results, and to identify the most appropriate modalities of robotic rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, 00135 Rome, Italy
| | - Fabiana Pannunzio
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Francesca Cordella
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Martina Lapresa
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation of Rome, 00128 Rome, Italy
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Bressi F, Campagnola B, Cricenti L, Santacaterina F, Miccinilli S, Di Pino G, Fiori F, D'Alonzo M, Di Lazzaro V, Ricci L, Capone F, Pacilli A, Sterzi S, Bravi M. Upper limb home-based robotic rehabilitation in chronic stroke patients: A pilot study. Front Neurorobot 2023; 17:1130770. [PMID: 37009638 PMCID: PMC10061073 DOI: 10.3389/fnbot.2023.1130770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionRobotic therapy allow to propose sessions of controlled and identical exercises, customizing settings, and characteristics on the individual patient. The effectiveness of robotic assisted therapy is still under study and the use of robots in clinical practice is still limited. Moreover, the possibility of treatment at home allows to reduce the economic costs and time to be borne by the patient and the caregiver and is a valid tool during periods of pandemic such as covid. The aim of this study is to assess whether a robotic home-based treatment rehabilitation using the iCONE robotic device has effects on a stroke population, despite the chronic condition of patients involved and the absence of a therapist next to the patient while performing the exercises.Materials and methodsAll patients underwent an initial (T0) and final (T1) assessment with the iCONE robotic device and clinical scales. After T0 evaluation, the robot was delivered to the patient's home for 10 days of at-home treatment (5 days a week for 2 weeks).ResultsComparison between T0 and T1 evaluations revealed some significant improvements in robot-evaluated indices such as Independence and Size for the Circle Drawing exercise and Movement Duration for Point-to-Point exercise, but also in the MAS of the elbow. From the analysis of the acceptability questionnaire, a general appreciation of the robot emerged: patients spontaneously asked for the addition of further sessions and to continue therapy.DiscussionTelerehabilitation of patients suffering from a chronic stroke is an area that is still little explored. From our experience, this is one of the first studies to carry out a telerehabilitation with these characteristics. The use of robots can become a method to reduce the rehabilitation health costs, to ensure continuity of care, and to arrive in more distant places or where the availability of resources is limited.ConclusionFrom the data obtained, this rehabilitation seems to be promising for this population. Moreover, promoting the recovery of the upper limb, iCONE can improve patient's quality of life. It would be interesting to conduct RCT studies to compare a conventional treatment in structure with a robotic telematics treatment.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
- *Correspondence: Laura Cricenti
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giovanni Di Pino
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesca Fiori
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurology, Neurophysiology and Neurobiology and Biomedical Robotics and Biomicrosystems, Campus Bio-Medico University of Rome, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Lorenzo Ricci
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fioravante Capone
- Unit of Neurology, Neurophysiology and Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | | | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Bressi F, Cinnera AM, Morone G, Campagnola B, Cricenti L, Santacaterina F, Miccinilli S, Zollo L, Paolucci S, Di Lazzaro V, Sterzi S, Bravi M. Combining Robot-Assisted Gait Training and Non-Invasive Brain Stimulation in Chronic Stroke Patients: A Systematic Review. Front Neurol 2022; 13:795788. [PMID: 35585844 PMCID: PMC9108455 DOI: 10.3389/fneur.2022.795788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gait impairment is one of the most common disorders of patients with chronic stroke, which hugely affects the ability to carry out the activities of daily living and the quality of life. Recently, traditional rehabilitation techniques have been associated with non-invasive brain stimulation (NIBS) techniques, which enhance brain plasticity, with the aim of promoting recovery in patients with chronic stroke. NIBS effectiveness in improving gait parameters in patients with chronic stroke has been in several studies evaluated. Robotic devices are emerging as promising tools for the treatment of stroke-related disabilities by performing repetitive, intensive, and task-specific treatments and have been proved to be effective for the enhancement of motor recovery in patients with chronic stroke. To date, several studies have examined the combination of NIBS with robotic-assisted gait training, but the effectiveness of this approach is not yet well established. The main purpose of this systematic review is to clarify whether the combination of NIBS and robot-assisted gait training may improve walking function in patients with chronic stroke. Our systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies eligible for review were identified through PubMed/MEDLINE, Embase, Scopus, and PEDro from inception to March 15, 2021, and the outcomes considered were gait assessments. Seven studies were included in the qualitative analysis of this systematic review, with a total population of 186 patients with chronic stroke. All studies specified technical characteristics of robotic devices and NIBS used, with high heterogeneity of protocols. Methodological studies have shown a significantly greater improvement in walking capacity recorded with 6MWT. Finally, research studies have highlighted a positive effect on walking recovery by combination of robot-assisted gait training with non-invasive brain stimulation. Furthermore, future studies should identify the best characteristics of the combined therapeutic protocols.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
- *Correspondence: Federica Bressi
| | - Alex Martino Cinnera
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Giovanni Morone
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, Rome, Italy
| | - Stefano Paolucci
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
| | - Vincenzo Di Lazzaro
- Unity of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Di Polito A, Del Vecchio A, Tana M, Papacci P, Vento AL, Campagnola B, Celona S, Cricenti L, Bastoni I, Tirone C, Lio A, Aurilia C, Bottoni A, Paladini A, Cota F, Ferrara PE, Ronconi G, Vento G. Effects of early respiratory physiotherapy on spontaneous respiratory activity of preterm infants: study protocol for a randomized controlled trial. Trials 2021; 22:492. [PMID: 34311783 PMCID: PMC8314465 DOI: 10.1186/s13063-021-05446-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tactile maneuvers stimulating spontaneous respiratory activity in preterm infants are recommended since birth, but data on how and how often these maneuvers are applied in clinical practice are unknown. In the last years, most preterm newborns with respiratory failure are preferentially managed with non-invasive respiratory support and by stimulating spontaneous respiratory activity from the delivery room and in neonatal intensive care unit (NICU), in order to avoid the risks of intubation and prolonged mechanical ventilation. Methods Preterm infants with gestational age < 31 weeks not intubated in the delivery room and requiring non-invasive respiratory support at birth will be eligible for the study. They will be randomized and allocated to one of two treatment groups: (1) the study group infants will be subject to the technique of respiratory facilitation within the first 24 h of life, according to the reflex stimulations, by the physiotherapist. The newborn is placed in supine decubitus and a slight digital pressure is exerted on a hemithorax. The respiratory facilitation technique will be performed for about three minutes and repeated for a total of 4/6 times in sequence, three times a day until spontaneous respiratory activity is achieved; thus, no respiratory support is required; (2) the control group infants will take part exclusively in the individualized postural care program. They will perform the technique of respiratory facilitation and autogenous drainage. Objective To evaluate the efficacy of early respiratory physiotherapy in reducing the incidence of intubation and mechanical ventilation in the first week of life (primary outcome). Discussion The technique of respiratory facilitation is based on reflex stimulations, applied early to preterm infant. Slight digital pressure is exerted on a “trigger point” of each hemithorax, to stimulate the respiratory activity with subsequent increase of the ipsilateral pulmonary minute ventilation and to facilitate the contralateral pulmonary expansion. This mechanism will determine the concatenation of input to all anatomical structures in relation to the area being treated, to promote spontaneous respiratory activity and reducing work of breathing, avoiding or minimizing the use of invasive respiratory support. Trial registration UMIN-CTR Clinical Trial UMIN000036066. Registered on March 1, 2019. Protocol 1. https://www.umin.ac.jp/ctr
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Affiliation(s)
- Alessia Di Polito
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arianna Del Vecchio
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Milena Tana
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Patrizia Papacci
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica. Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Anna Laura Vento
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Benedetta Campagnola
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Sefora Celona
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Laura Cricenti
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Ilaria Bastoni
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara Tirone
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandra Lio
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Claudia Aurilia
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anthea Bottoni
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Angela Paladini
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Dipartimento Scienze della salute della donna, del bambino e di sanità pubblica, Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paola Emilia Ferrara
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianpaolo Ronconi
- Servizio Medicina Fisica e Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giovanni Vento
- Dipartimento Universitario Scienze della Vita e Sanità Pubblica. Unità Operativa Complessa di Neonatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
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Bressi F, Bravi M, Campagnola B, Bruno D, Marzolla A, Santacaterina F, Miccinilli S, Sterzi S. Robotic treatment of the upper limb in chronic stroke and cerebral neuroplasticity: a systematic review. J BIOL REG HOMEOS AG 2020; 34:11-44. Technology in Medicine. [PMID: 33386032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stroke is the second cause of mortality and the third cause of long-term disability worldwide. Deficits in upper limb (UL) capacity persist at 6 months post-stroke in 30-66% of hemiplegic stroke patients with major limitations in activity of daily living (ADL), thus making the recovery of paretic UL function the main rehabilitation goal. Robotic rehabilitation plays a crucial role since it allows to perform a repetitive, intensive, and task-oriented treatment, adaptable to the patients' residual abilities, necessary to facilitate recovery and the rehabilitation of the paretic UL. It has been proposed that robot-mediated training may amplify neuroplasticity by providing a major interaction of proprioceptive and/or other sensory inputs with motor outputs, with significant modifications in functional connectivity (coherence) within the fronto-parietal networks (inter- and intra-hemispheric functional connectivity) related to processes of movement preparation and execution. However, the neurophysiological mechanisms underlying this reorganization are not entirely clear yet. Therefore, the aim of this study is to revise the literature, which assesses the effect of robotic treatment in the recovery of UL deficits measured in terms of neuroplasticity in patients affected by chronic stroke. This systematic review was conducted using PubMed, PEDro, Cinahl (EBSCOhost), Scopus and Cochrane databases. The research was carried out until February 2020 it included articles written in English language, published between 2009 and 2020, and the outcomes considered were neuroplasticity assessments. We included 23 studies over 6145 records identified from the preliminary research. The selected studies proposed different methods for neuroplasticity assessment (i.e. transcranial direct current stimulation (tDCS), EEG-Based Brain Computer Interface (BCI) and Neuroimaging (fMRI)), and different Robotic Rehabilitation treatments. These studies demonstrated a positive correlation between changes in central nervous circuits and post-treatment clinical outcomes. Our study has highlighted the effectiveness of robotic therapy in promoting mechanisms that facilitate re-learning and motor recovery in patients with post-stroke chronic disabilities. However, future studies should overcome the limitations of heterogeneity found in the current literature, by proposing a greater number of high-level RCTs, to better understand the mechanisms of robot-induced neuroplasticity, follow the clinical progress, estimate a prognosis of recovery of motor function, and plan a personalized rehabilitative programme for the patients.
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Affiliation(s)
- F Bressi
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - M Bravi
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - B Campagnola
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - D Bruno
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - A Marzolla
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - F Santacaterina
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - S Miccinilli
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
| | - S Sterzi
- Physical Medicine and Rehabilitation Department, Campus Bio-Medico University of Rome, Italy
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