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Gagliardo A, Grippo A, Di Stefano V, Carrai R, Scarpino M, Martini M, Falsini C, Rimmaudo G, Brighina F. Spatial and Temporal Gait Characteristics in Patients Admitted to a Neuro-Rehabilitation Department with Age-Related White Matter Changes: A Gait Analysis and Clinical Study. Neurol Int 2023; 15:708-724. [PMID: 37368328 DOI: 10.3390/neurolint15020044] [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: 03/14/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Patients with age-related white matter changes (ARWMC) frequently present a gait disorder, depression and cognitive impairment. Our aims are to define which alterations in the gait parameters are associated with motor or neuro-psychological impairment and to assess the role of motor, mood or cognitive dysfunction in explaining the variance of the gait parameters. METHODS Patients with gait disorders admitted to a Neuro-rehabilitation Department, affected by vascular leukoencephalopathy who had ARWMC confirmed by a brain MRI, were consecutively enrolled, classified by a neuroradiological scale (Fazekas 1987) and compared to healthy controls. We excluded subjects unable to walk independently, subjects with hydrocephalus or severe aphasia, with orthopaedic and other neurological pathologies conditioning the walking pattern. Patients and controls were assessed by clinical and functional scales (Mini Mental State Examination, Geriatric Depression Scale, Nevitt Motor Performance Scale, Berg Balance Scale, Functional Independence Measure), and computerised gait analysis was performed to assess the spatial and temporal gait parameters in a cross-sectional study. RESULTS We recruited 76 patients (48 males, aged 78.3 ± 6.2 years) and 14 controls (6 males, aged 75.8 ± 5 years). In the multiple regression analysis, the gait parameter with overall best model summary values, associated with the ARWMC severity, was the stride length even after correction for age, sex, weight and height (R2 = 0.327). The motor performances justified at least in part of the gait disorder (R2 change = 0.220), but the mood state accounted independently for gait alterations (R2 change = 0.039). The increase in ARWMC severity, the reduction of motor performance and a depressed mood state were associated with a reduction of stride length (R = 0.766, R2 = 0.587), reduction of gait speed (R2 = 0.573) and an increase in double support time (R2 = 0.421). CONCLUSION The gait disorders in patients with ARWMC are related to motor impairment, but the presence of depression is an independent factor for determining gait alterations and functional status. These data pave the way for longitudinal studies, including gait parameters, to quantitatively assess gait changes after treatment or to monitor the natural progression of the gait disorders.
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Affiliation(s)
- Andrea Gagliardo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Riccardo Carrai
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
- SODc Neurofisiopatologia, Dipartimento Neuromuscoloscheletrico e degli Organi di Senso, AOU Careggi, 50134 Firenze, Italy
| | - Monica Martini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy
| | | | - Giulia Rimmaudo
- Clinical Neurophysiology Unit, "Clinical Course", 90143 Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
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Hakiki B, Paperini A, Castagnoli C, Hochleitner I, Verdesca S, Grippo A, Scarpino M, Maiorelli A, Mosca IE, Gemignani P, Borsotti M, Gabrielli MA, Salvadori E, Poggesi A, Lucidi G, Falsini C, Gentilini M, Martini M, Luisi MLE, Biffi B, Mainardi P, Barretta T, Pancani S, Mannini A, Campagnini S, Bagnoli S, Ingannato A, Nacmias B, Macchi C, Carrozza MC, Cecchi F. Predictors of Function, Activity, and Participation of Stroke Patients Undergoing Intensive Rehabilitation: A Multicenter Prospective Observational Study Protocol. Front Neurol 2021; 12:632672. [PMID: 33897593 PMCID: PMC8060493 DOI: 10.3389/fneur.2021.632672] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation. Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers. Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes. Clinical Trial Registration:ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Bagnoli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Assunta Ingannato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Aprile I, Germanotta M, Cruciani A, Pecchioli C, Loreti S, Papadopoulou D, Montesano A, Galeri S, Diverio M, Falsini C, Speranza G, Langone E, Carrozza MC, Cecchi F. Poststroke shoulder pain in subacute patients and its correlation with upper limb recovery after robotic or conventional treatment: A secondary analysis of a multicenter randomized controlled trial. Int J Stroke 2020; 16:396-405. [PMID: 32640881 DOI: 10.1177/1747493020937192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Poststroke shoulder pain is a common complication. We aimed to investigate the prevalence of poststroke shoulder pain, with attention to the neuropathic component, and the relationship between poststroke shoulder pain and upper limb improvement in motor function, strength, disability, and quality of life after upper limb rehabilitation. METHODS This is a secondary analysis of a multicenter randomized controlled trial to compare upper limb conventional or robotic rehabilitation on 224 patients enrolled in eight rehabilitation centers. We assessed poststroke shoulder pain (using the Numerical Rating Scale and the Douleur Neuropathique 4), and upper limb motor function, strength, disability, and quality of life at baseline (T0), after 30 rehabilitation sessions (T1), and three months after the end of rehabilitation (T2). RESULTS A moderate/severe poststroke shoulder pain was reported by 28.9% of patients, while 19.6% of them showed a neuropathic component. At T0, the intensity of pain was higher in women and in patients with neglect syndrome, positively correlated with the time since stroke and disability and negatively correlated with motor function, strength, and the physical aspects of the quality of life.Moderate/severe pain and neuropathic component significantly reduced after both treatments and this reduction was maintained at T2. Finally, the intensity of pain at baseline was negatively correlated with the improvement of upper limb motor function. CONCLUSIONS Poststroke shoulder pain negatively impact on motor performance, strength, disability, and physical aspects of the quality of life as well as on upper limb motor recovery; however, it can be reduced after a robotic or a conventional rehabilitation. Therefore, we suggest considering poststroke shoulder pain when planning the rehabilitation intervention.
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Affiliation(s)
- I Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M Germanotta
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A Cruciani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Pecchioli
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S Loreti
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - A Montesano
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - S Galeri
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - M Diverio
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - G Speranza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - E Langone
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M C Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - F Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Cecchi F, Carrabba C, Bertolucci F, Castagnoli C, Falsini C, Gnetti B, Hochleitner I, Lucidi G, Martini M, Mosca IE, Pancani S, Paperini A, Verdesca S, Macchi C, Alt Murphy M. Transcultural translation and validation of Fugl–Meyer assessment to Italian. Disabil Rehabil 2020; 43:3717-3722. [DOI: 10.1080/09638288.2020.1746844] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- F. Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C. Carrabba
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - C. Falsini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - B. Gnetti
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - G. Lucidi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M. Martini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - I. E. Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S. Pancani
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - A. Paperini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - S. Verdesca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - C. Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - M. Alt Murphy
- Institute for Neuroscience and Physiology, Clinical Neuroscience, Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Cesaretti C, Grippo A, Vettori A, Atzori T, Baldini C, Falsini C, Martini M, Carrai R, Pizzi A. 47. Botulinum toxin for the upper limb after stroke: Comparison between incobotulinumtoxin A, botulinum toxin drug free of complexing proteins, and conventional botulinum toxin formulation. A preliminary study. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pizzi A, Falsini C, Martini M, Rossetti MA, Verdesca S, Tosto A. Urinary incontinence after ischemic stroke: Clinical and urodynamic studies. Neurourol Urodyn 2013; 33:420-5. [DOI: 10.1002/nau.22420] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/05/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Assunta Pizzi
- Neurorehabilitation Unit; Don C. Gnocchi Foundation, IRCCS; Florence Italy
| | - Catiuscia Falsini
- Neurorehabilitation Unit; Don C. Gnocchi Foundation, IRCCS; Florence Italy
| | - Monica Martini
- Neurorehabilitation Unit; Don C. Gnocchi Foundation, IRCCS; Florence Italy
| | | | - Sonia Verdesca
- Neurorehabilitation Unit; Don C. Gnocchi Foundation, IRCCS; Florence Italy
| | - Aldo Tosto
- Neurorehabilitation Unit; Don C. Gnocchi Foundation, IRCCS; Florence Italy
- Urological Department; Florence University; A. O. U. Careggi Florence Italy
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Grippo A, Carrai R, Hawamdeh Z, Falsini C, Aito S, Pinto F, de Scisciolo G, Pizzi A. Biomechanical and electromyographic assessment of spastic hypertonus in motor complete traumatic spinal cord-injured individuals. Spinal Cord 2010; 49:142-8. [PMID: 20531358 DOI: 10.1038/sc.2010.56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Between-groups design with repeated measures. OBJECTIVE To quantify spastic hypertonia in spinal cord-injured (SCI) individuals. SETTING Rehabilitative Center, Italy. SUBJECTS 29 individuals with a motor complete SCI (American Spinal Injury Association impairment scale grade A or B) and 22 controls. METHODS According to the modified Ashworth scale (MAS), patients were subgrouped as SCI-1 (MAS=1, 1+) and SCI-2 (MAS=2, 3). Passive flexo-extensions of the knee were applied using an isokinetic device (LIDO Active) at 30°, 60°, 90° and 120° s(-1). We measured the peak torque, mean torque (MT) and work. Simultaneous electromyography (EMG) was recorded from leg muscles. RESULTS At the speed of 120° s(-1) all SCI-2 patients presented EMG reflex activities in the hamstring muscle. All biomechanical parameter values increased significantly according to speed, but analysis of variance revealed a significant interaction between the angular velocity and group (F(d.f. 6, 138) = 8.89, P < 0.0001); post hoc analysis showed significantly greater torque parameter values in the SCI-2 group compared with the SCI-1 group and the control group at 90° and 120° s(-1). Receiver operating characteristic curves showed that using peak torque values the probability of correctly classifying a patient into SCI-1 and SCI-2 was 95%, compared with 70% for MT and 68% for work. CONCLUSIONS The isokinetic device is useful for distinguishing individuals with a high level of spastic hypertonus. Examination of EMG activity may help ascertain whether increased muscle tone is caused by reflex hyper excitability and to determine whether muscle spasm is present. Peak torque and simultaneous EMG assessment should be considered for the evaluation of individuals with SCI in the rehabilitative context, that is, in measuring therapeutic interventions.
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Affiliation(s)
- A Grippo
- SOD Neurofisiologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
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Abstract
OBJECTIVE The aim of the study is to evaluate different aspects in the quality of life (QoL) in a group of patients affected by hereditary neuromuscular disease. MATERIAL AND METHODS Forty-five consecutive outpatients (mean age 49.46 +/- 17.07 years, range 19-80 years) with hereditary neuromuscular disease underwent the Brooke scale and functional independent measure to assess the functional status, the Sickness Impact Profile (SIP) and Psychological General Well-Being Index (PGWBI), as a measure of the QoL. RESULTS AND CONCLUSIONS All patients had a poor QoL assessment with SIP. The higher disability level was not related to a worse QoL perception with the exception of the physical area. Females and patients above 49 years showed the worst QoL profile. The discomfort linked to the emotional and affective sphere, assessed with PGWBI, appeared low in the study sample. Therefore psychosocial aspects and economical and environmental factors may influence the QoL.
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Affiliation(s)
- M Piccininni
- Fondazione Don Carlo Gnocchi-ONLUS, Centro Santa Maria agli Ulivi, Pozzolatico Florence, Italy
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