Mistretta, Italy
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Zucchella C.,IRCCS Neurological National Institute | Zucchella C.,University of Pavia | Bartolo M.,Neurorehabilitation Unit | Bernini S.,IRCCS Neurological National Institute | And 2 more authors.
Alzheimer Disease and Associated Disorders | Year: 2015

Unlike in other chronic diseases, the Quality of Life (QoL) of patients affected by Alzheimer Disease (AD) has not been well established, primarily because of the difficulties stemming from the study of patients with cognitive disorders. Because no cure is currently available for AD, the optimization of QoL represents the best possible outcome attainable in all stages of disease, making QoL assessment mandatory. This study identified variables related to patients' QoL and examined the agreement between patients' and caregivers' QoL ratings. A total of 135 dyads (patient and principal caregiver) were enrolled in the study. Patients' QoL evaluations showed a negative relationship with depressive mood and a positive relationship with Activities of Daily Living (ADL), whereas caregivers' QoL ratings showed a negative relationship with patients' depressive mood and behavioral disturbances. Caregivers tended to underestimate patients' QoL compared with the patients' own self-evaluations, with patients' dependency in performing ADL and behavioral disorders as well as caregivers' burdens and depression being the main factors associated with the discrepancy in these evaluations. These findings suggest that the use of proxies as a substitute for the self-report of QoL data should be treated with caution, always accounting for the presence of potential bias. © 2014 Wolters Kluwer Health, Inc. All rights reserved.


Di Perri C.,National Neurological Institute C Mondino | Di Perri C.,University of Liège | Di Perri C.,Maastricht University | Bastianello S.,University of Pavia | And 11 more authors.
Neurology | Year: 2013

Objective: To investigate functional connectivity between the default mode network (DMN) and other networks in disorders of consciousness. Methods: We analyzedMRI data from 11 patients in a vegetative state and 7 patients in a minimally conscious state along with age- And sex-matched healthy control subjects. MRI data analysis included nonlinear spatial normalization to compensate for disease-related anatomical distortions. We studied brain connectivity data from resting-state MRI temporal series, combining noninferential (independent component analysis) and inferential (seed-based general linear model) methods. Results: In DMN hypoconnectivity conditions, a patient's DMN functional connectivity shifts and paradoxically increases in limbic structures, including the orbitofrontal cortex, insula, hypothalamus, and the ventral tegmental area. Conclusions: Concurrently with DMN hypoconnectivity, we report limbic hyperconnectivity in patients in vegetative and minimally conscious states. This hyperconnectivity may reflect the persistent engagement of residual neural activity in self-reinforcing neural loops, which, in turn, could disrupt normal patterns of connectivity. © 2013 American Academy of Neurology.


Pizzi A.,Neurorehabilitation Unit | Falsini C.,Neurorehabilitation Unit | Martini M.,Neurorehabilitation Unit | Rossetti M.A.,Neurorehabilitation Unit | And 3 more authors.
Neurourology and Urodynamics | Year: 2014

Aims To investigate the frequency, the prognostic effect on functional status and the urodynamic patterns of post-stroke urinary incontinence (UI) in a sample of in-patients affected by ischemic stroke. Methods One hundred six patients with recent ischemic stroke admitted to a neurorehabilitation unit were enrolled. Stroke localization was made according to the Oxfordshire Community Stroke Project (OCSP) stroke subtypes and assessment of stroke severity using the National Institute of Health Stroke Scale (NIHSS). The presence of UI was associated with functional status, measured with Barthel Index and Functional Independence Measure (FIM). At admission, urodynamic studies were performed on all the patients and repeated in 63 patients after 30 days. Results Eighty-four patients (79%) were incontinent. Incontinence was associated with age (P-<-0.05) and functional disability (P-=-0.01), but not with sex, side of stroke, or time from stroke to entry in the study. Urodynamic studies, performed on all 106 patients at admission, showed normal studies in 15%, detrusor overactivity (DO) in 56%, detrusor overactivity with impaired contractility (DOIC) in 14%, and detrusor underactivity (DU) in 15%. After 1 month urodynamic studies, repeated on 63 patients, showed normal studies in 30%, DO in 48%, DOIC in 6%, and DU in 16%. Conclusions Incontinent patients showed a worse functional outcome compared to continent patients. Post-stroke incontinence may be associated with different urodynamic patterns, each of which may necessitate different treatment strategies. Urodynamic findings in patients with ischemic stroke vary depending upon timing of the study. © 2014 Wiley Periodicals, Inc.


Farina E.,Neurorehabilitation Unit | Raglio A.,University of Ferrara | Raglio A.,Fondazione Irccs Instituto Neurologico C Besta | Giovagnoli A.R.,Fondazione Irccs Instituto Neurologico C Besta
Epilepsy Research | Year: 2015

To review the modalities of cognitive rehabilitation (CR), outcome endpoints, and the levels of evidence of efficacy of different interventions. Methods: A systematic research in Pubmed, Psychinfo, and SCOPUS was performed assessing the articles written in the entire period covered by these databases till December 2013. Articles in English, Spanish or French were evaluated. A manual research evaluated the references of all of the articles. The experimental studies were classified according to the level of evidence of efficacy, using a standardized Italian method (SPREAD, 2007), adopting the criteria reported by Cicerone et al. (2000, 2011). Results: Eighteen papers were classified into two reviews, four papers dealing with the principles and efficacy of CR in epilepsy, a methodological paper, a single-case report, a multiple-case report, and nine experimental papers. Most studies involved patients with temporal lobe epilepsy. Different types of CR were used to treat patients with epilepsy. A holistic rehabilitation approach was more useful than selective interventions to treat memory and attention disturbances. Conclusions: CR may be a useful tool to treat cognitive impairment in patients with epilepsy. However, the modalities of treatment and outcome endpoints are important concerns of clinical care and research. Controlled studies are needed to determine the efficacy of rehabilitation in well-defined groups of patients with epilepsy. © 2014 Elsevier B.V.


Frisoli A.,Piaggio | Procopio C.,Piaggio | Procopio C.,Neurorehabilitation Unit | Chisari C.,Neurorehabilitation Unit | And 5 more authors.
Journal of NeuroEngineering and Rehabilitation | Year: 2012

This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 066 points), Modified Ashworth scale (MA, 060 pts) and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion) and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA) parameters, as a result of the increased active ranges of motion and improved cocontraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement) and position of target to be reached (ipsilateral, central and contralateral peripersonal space). These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow and shoulder joints. © 2012 Frisoli et al.; licensee BioMed Central Ltd.


De Vecchis R.,Presidio | Esposito C.,The Second University of Naples | Di Biase G.,Neurorehabilitation Unit | Ariano C.,Neurorehabilitation Unit | And 2 more authors.
Journal of Cardiovascular Medicine | Year: 2014

PURPOSE: It has been asserted that serial measurements of natriuretic peptides, specifically B-type natriuretic peptide (BNP) or the amino-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP), may serve as an objective practical guide to better tailor the drug treatment for patients with chronic heart failure (CHF), and especially to detect the cases of subclinical congestion that would require an increase in drug dosing. However, considerable uncertainty remains about the alleged useful role of natriuretic peptide-guided therapy in this context. Therefore, we decided to execute a meta-analysis of published randomized controlled trials (RCTs) to test the hypothesis that an improvement of clinical outcomes in outpatients with CHF may be achieved by adjustment of pharmacologic dosing performed according to natriuretic peptide determinations. METHODS: The relevant studies were collected through a search across the PubMed database (January 1996 to September 2012). For our meta-analysis, parallel-group RCTs were eligible for inclusion if they met the following criteria: they enrolled patients with CHF, they randomized patients to a strategy of titrating drug therapy based on the level of a circulating natriuretic peptide (BNP or NT-proBNP) compared to a parallel control group treated according to the clinical conventional criteria, and they reported all-cause mortality. In addition, it was established that each RCT to be incorporated in the evaluation should have included more than 60 participants and its follow-up should have been longer than 90 days. The primary endpoint of the meta-analysis was all-cause mortality and hospitalization related to heart failure (combined endpoint). RESULTS: In the six pooled RCTs subjected to final meta-analysis (total of included patients=1775), natriuretic peptide-guided therapy for outpatients with CHF was shown to be associated with a decreased risk of death and heart failure hospitalizations during follow-up (odds ratio-random effect model: 0.64; 95% confidence interval: 0.43-0.95; P=0.026). CONCLUSION: This meta-analysis supports the hypothesis that natriuretic peptide-guided therapy is superior to symptom-guided therapy for improving clinical outcomes in CHF outpatients. However, some large RCTs failed to document significant clinical improvement in terms of mortality and morbidity using a natriuretic peptide-guided strategy; thus, any attempt to clarify this still unresolved issue by means of further basic and clinical research is recommended in the future. © 2014 Italian Federation of Cardiology.


Tramonti F.,Neurorehabilitation Unit | Bongioanni P.,Neurorehabilitation Unit | Leotta R.,Neurorehabilitation Unit | Puppi I.,Neurorehabilitation Unit | Rossi B.,Neurorehabilitation Unit
Psychology, Health and Medicine | Year: 2015

Amyotrophic lateral sclerosis is a neurodegenerative disease that affects the motor neurons and causes progressive physical impairment. Also, other functions, such as breathing, swallowing and speech are compromised, and the loss of independence makes caregiver burden extremely high. The present study aimed at evaluating the differences in the caregiver burden due to age, gender and kinship. Women reported a higher physical and social burden than men, and partners scored higher in several dimensions of the caregiver burden when compared to sons and daughters. With respect to adult child caregivers, daughters reported higher levels of developmental burden than sons. Age has a significant impact on the caregiver burden, especially for the time dedicated to assistance and physical burden; disease severity is significantly related to the physical burden as well, and also with the developmental burden. © 2014 Taylor & Francis.


Frank M.,Neurorehabilitation Unit | Conzelmann M.,Neurorehabilitation Unit | Engelter S.,Neurorehabilitation Unit | Engelter S.,University of Basel
European Neurology | Year: 2010

Background/Aims: Returning home is one of the most important aims of stroke patients when admitted to rehabilitation. Methods: A single-center prospectively ascertained database study was conducted. Results: Among 1,332 eligible patients (median age = 76.5 years), 828 (62.2%) returned home. Multiple logistic regression revealed 5 independent predictors: independent sitting balance, higher motor and social-cognitive functional independence measure subscores (all on admission to rehabilitation), living with a partner and younger age. The area under the curve (AUC) of this model was 0.86 (95% confidence interval (CI) 0.84-0.88). When age was excluded from the model, the AUC remained virtually the same (AUC = 0.85, 95% CI = 0.83-0.87). Conclusion: The discharge destination could be predicted in a majority of patients with easily available parameters. Availability of a partner as well as parameters linked to severity of the neurological and functional deficit were both important. Age alone adds very little to the predictive power of these variables, therefore access to rehabilitation should not be denied on grounds of age. Copyright © 2010 S. Karger AG, Basel.


Engelter S.T.,Neurorehabilitation Unit | Engelter S.T.,University of Basel
European Journal of Physical and Rehabilitation Medicine | Year: 2013

Pharmacological enhancement of neurorehabilitation is based on the concept of neuroplasticity. Agents with probably unfavourable effects on recovery (e.g. classical antiepileptic drugs, butyrophenones) should be avoided. The findings of experimental studies in animal models, investigations in healthy subjects and the findings of neurophysiological studies indicate that there is scope for benefit from pharmacological enhancement in stroke rehabilitation in the clinical setting - in addition to rehabilitative therapies. Randomized controlled clinical trials have shown benefit of pharmacological enhancement in stroke rehabilitation for some agents. Nevertheless, the clinical evidence regarding benefits of this treatment approach is still considered weak for the following reason: First, the beneficial findings of some studies were not confirmed by others. Second, several studies were limited by small patient populations and narrow inclusion criteria. Third, there were concerns regarding safety of some agents (i.e., piracetam, and amphetamines). Dopaminergic agents, Selective Serotonin-Reuptake-Inhibitors (SSRI) and acetylcholinesterase- inhibitors are promising candidates. Their safety and efficacy should be further investigated; ideally in - sufficiently powered - large randomized controlled trials.


Calabro R.S.,Neurorehabilitation Unit | Polimeni G.,Neurorehabilitation Unit | Bramanti P.,Neurorehabilitation Unit
Recent Patents on CNS Drug Discovery | Year: 2011

Erection is a neurovascular event characterized by the tumescence of the cavernous bodies that relies upon integration of neural and humoral mechanisms requiring the participation of autonomic and somatic nerves and the integration of numerous spinal and supraspinal sites. Erectile dysfunction (ED) is a highly prevalent problem increasing with age, as well as the major men's sexual concern. Significant advances in the pharmacological treatment of ED have occurred in recent years, most notably after the introduction of sildenafil, the first oral selective phosphodiesterase type 5 inhibitor. Nevertheless, many other oral, local and surgical treatments are available and their efficacy and safety depend on the specific cases. This review provides a comprehensive description of both currently available neurogenic ED treatments and most promising future therapies, including assigned patents. © 2011 Bentham Science Publishers Ltd.

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