Scientific Institute of Montescano

Montescano, Italy

Scientific Institute of Montescano

Montescano, Italy
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Frazzitta G.,Scientific Institute of Montescano | Bertotti G.,Scientific Institute of Montescano | Riboldazzi G.,Le Terrazze Hospital | Turla M.,Valle Camonica Hospital | And 7 more authors.
Neurorehabilitation and Neural Repair | Year: 2012

Background. Rehabilitation treatments have acute beneficial effects in Parkinson's disease (PD) patients, but whether the effects persist over time is unclear. Objective. To assess whether an intensive rehabilitation treatment (IRT) is effective in improving motor performance compared with a control group in a 12-month follow-up, to investigate whether a second cycle administered after 1 year has the same efficacy as the first treatment, and to determine whether IRT reduces the need for increasing levodopa dosage. Methods. A total of 50 PD patients were randomly assigned to 2 groups; 25 participants had 4 weeks of inpatient physical therapy that included treadmill and stabilometric platform training. At discharge, these patients were invited to continue doing the learned exercises. After 12 months, the same treatment was repeated. The control group of 25 patients received only pharmacological treatment and was invited to practice generic physical exercise at home. The rating scales used for the clinical evaluation were the Unified Parkinson's Disease Rating Scale Sections II and III (UPDRS II and III) and total (UPDRS tot). Results. The authors found that the beneficial effects of IRT persisted over time. A second rehabilitation cycle administered after 1 year was as effective as the first treatment. At the end of the study, daily medication dosage was reduced in treated patients, whereas it was significantly increased in control patients. Conclusion. These findings suggest that the natural worsening of symptoms associated with PD can be effectively counteracted by a properly designed IRT. © The Author(s) 2012.


Frazzitta G.,Moriggia Pelascini Hospital | Frazzitta G.,S Isidoro Hospital | Maestri R.,Scientific Institute of Montescano | Bertotti G.,Scientific Institute of Montescano | And 8 more authors.
Neurorehabilitation and Neural Repair | Year: 2015

Background. Although physical exercise improves motor aspects of Parkinson's disease (PD), it is not clear whether it may also have a neuroprotective effect. Objective. In this 2-year follow-up study, we determined whether intensive exercise in the early stages of the disease slows down PD progression. Methods. Forty newly diagnosed patients with PD were treated with rasagiline and randomly assigned to 2 groups: MIRT Group (two 28-day multidisciplinary intensive rehabilitation treatments [MIRT], at 1-year interval) and Control Group (only drug). In both groups, Unified Parkinson's Disease Rating Scale Section II (UPDRS II), UPDRS III, 6-minute walking test (6MWT), Timed Up-and-Go test (TUG); PD Disability Scale (PDDS), and l-dopa equivalents were assessed at baseline (T0), 6 months (T1), 1 year (T2), 18 months (T3), and 2 years (T4) later. Results. Over 2 years, UPDRS II, UPDRS III, TUG, and PDDS differentially progressed in the 2 groups: In the MIRT Group, all scores at T4 were better than at T0 (all Ps <.03). No changes were noted in the Control Group. l-dopa equivalent dosages increased significantly only in the Control Group (P =.0015), with a decrease in the percentages of patients in monotherapy (T1 40%; T2, T3, and T4 20%). In the MIRT Group, the percentages of such patients remained higher (T1 and T2 100%; T3 89%; T4 75%). Conclusions. These results suggest that MIRT might slow down the progression of motor decay, it might delay the need for increasing drug treatment, and thus, it might have a neuroprotective effect. © The Author(s) 2014.


Frazzitta G.,Scientific Institute of Montescano | Maestri R.,Scientific Institute of Montescano | Bertotti G.,Scientific Institute of Montescano | Uccellini D.,Tradate Hospital | And 3 more authors.
Movement Disorders | Year: 2010

Objective measurements to assess the efficacy of rehabilitation treatment in Parkinson's disease, suitable to be carried out routinely in the clinical setting, are lacking. Metabolic parameters, reflecting the recruitment and co-ordination of muscle fibers, might be simple instrumental measurements suitable for use as outcome markers. Twenty parkinsonian patients underwent a 4-week rehabilitation treatment. Functional evaluation was based on Unified Parkinson's Disease Rating Scale Motor Section (UPDRS III), Berg's scale, 6-minute walking test (6MWT), and the metabolic data recorded during the 6MWT namely the active energy expenditure (AEE), the kinetics of the energy consumption curve, and the peak value of energy consumption. Both rating scales and gait improved significantly (UPDRS III decreased by 32%, Berg increased by 21% and the 6MWT increased by 17%). We observed significant improvements also in metabolic measurements (35, 18, and 15 improvement in the kinetics of the energy consumption, AEE, and peak value of energy consumption, respectively). Hence, the rehabilitation protocol improved functional characteristics of the patients and these improvements were clearly reflected also by the metabolic measurements. The improvement in clinical scores corresponded with an increase in energy consumption during the 6MWT, indicating greater speed in the recruitment of motor units and of a capacity to maintain this recruitment over time. © 2010 Movement Disorder Society.


Crotti L.,University of Pavia | Crotti L.,Helmholtz Center Munich | Spazzolini C.,Fondazione IRCCS Policlinico S. Matteo | Porretta A.P.,Cardiovascular Research Unit | And 14 more authors.
Journal of the American College of Cardiology | Year: 2012

Objectives: The study assessed whether heart rate (HR) reduction following an exercise stress test (ExStrT), an easily quantifiable marker of vagal reflexes, might identify high- and low-risk long QT syndrome (LQTS) type 1 (LQT1) patients. Background: Identification of LQTS patients more likely to be symptomatic remains elusive. We have previously shown that depressed baroreflex sensitivity, an established marker of reduced vagal reflexes, predicts low probability of symptoms among LQT1. Methods: We studied 169 LQTS genotype-positive patients < 50 years of age who performed an ExStrT with the same protocol, on and off β-blockers including 47 South African LQT1 patients all harboring the KCNQ1-A341V mutation and 122 Italian LQTS patients with impaired (IKs-, 66 LQT1) or normal (IKs+, 50 LQT2 and 6 LQT3) IKs current. Results: Despite similar maximal HR and workload, by the first minute after cessation of exercise the symptomatic patients in both IKs- groups had a greater HR reduction compared with the asymptomatic (19 ± 7 beats/min vs. 13 ± 5 beats/min and 27 ± 10 beats/min vs. 20 ± 8 beats/min, both p = 0.009). By contrast, there was no difference between the IKs+ symptomatic and asymptomatic patients (23 ± 9 beats/min vs. 26 ± 9 beats/min, p = 0.47). LQT1 patients in the upper tertile for HR reduction had a higher risk of being symptomatic (odds ratio: 3.28, 95% confidence interval: 1.3 to 8.3, p = 0.012). Conclusions: HR reduction following exercise identifies LQT1 patients at high or low arrhythmic risk, independently of β-blocker therapy, and contributes to risk stratification. Intense exercise training, which potentiates vagal reflexes, should probably be avoided by LQT1 patients. © 2012 American College of Cardiology Foundation.


Frazzitta G.,Moriggia Pelascini Hospital | Frazzitta G.,Scientific Institute of Montescano | Balbi P.,Scientific Institute of Milan | Maestri R.,Scientific Institute of Montescano | And 3 more authors.
American Journal of Physical Medicine and Rehabilitation | Year: 2013

In the last decade, a considerable number of articles has shown that exercise is effective in improving motor performance in Parkinson disease. In particular, recent studies have focused on the efficacy of intensive exercise in achieving optimal results in the rehabilitation of patients with Parkinson disease. The effects of intensive exercise in promoting cell proliferation and neuronal differentiation in animal models are reported in a large cohort of studies, and these neuroplastic effects are probably related to increased expression of a variety of neurotrophic factors. The authors outline the relation between intensive exercises and neuroplastic activity on animal models of Parkinson disease and discuss the clinical results of different intensive strategies on motor performance and disease progression in patients with Parkinson disease. Copyright © 2013 by Lippincott Williams & Wilkins.


Frazzitta G.,Scientific Institute of Montescano | Pezzoli G.,Parkinson Institute | Bertotti G.,Scientific Institute of Montescano | Maestri R.,Scientific Institute of Montescano
Journal of Neurology | Year: 2013

It has been hypothesized that freezing of gait (FOG) in parkinsonian patients (PD) might be triggered by a breakdown in the normal symmetry of gait. In this study, we evaluated the relationship between asymmetry of gait and FOG and the effects of intensive treadmill treatment on asymmetry. We studied 30 patients with (FOG+) and 30 without (FOG-) freezing in "on" stage. Patients underwent a 4-week rehabilitation treatment using a treadmill with auditory and visual cues and were evaluated at enrolment and at the end of rehabilitation. Outcome measures were gait speed, stride length, asymmetry of gait, Six-minute walking test (6MWT), Unified Parkinson's Disease Rating Scale (UPDRS) II-III, Berg Balance Scale, Timed Up and Go Test, comfortable-fast gait speeds, freezing of gait questionnaire (FOGQ). At enrolment, no differences in gait parameters were observed between the two groups, which differed only in UPDRS-II and BBS. Both FOG+ and FOG- patients spent more time on the left foot (time on left/time on right foot 1.37, p = 0.002, 1.18, p = 0.016, respectively). Rehabilitation determined a homogeneous improvement in both groups of patients for all variables except UPDRS-II and balance, for which a better improvement was observed in FOG+ patients. The improvement in FOGQ in FOG+ patients was significantly correlated to the improvement in asymmetry of gait (Spearman R = 0.46, p = 0.013). Our data support a direct involvement of the asymmetry of gait in the development of FOG in PD. Treadmill training is effective in improving gait and balance in PD FOG+ patients and this might be related to a reduction of asymmetric gait. © 2012 Springer-Verlag.


Volpe D.,S Raffaele Arcangelo Fatebenefratelli Hospital | Giantin M.G.,S Raffaele Arcangelo Fatebenefratelli Hospital | Maestri R.,Scientific Institute of Montescano | Frazzitta G.,Moriggia Pelascini Hospital
Clinical Rehabilitation | Year: 2014

Objective: Our aim was to evaluate the feasibility of a hydrotherapy treatment in patients with Parkinsons disease and the effectiveness of this treatment on balance parameters in comparison to a traditional landbased physical therapy. Design: A randomized single-blind controlled trial. Setting: Outpatients. Subjects: Thirty-four patients with Parkinsons disease in Hoehn-Yahr stage 2.5-3. Intervention: Group 1 hydrotherapy treatment, group 2 land-based rehabilitation treatment. The two groups underwent the same rehabilitation period (60 minutes of treatment, five days a week for two months). Main measures: The primary outcome measures were the centre of the pressure sway area recorded with open and closed eyes, using a stabilometric platform. Secondary outcome measures were Unified Parkinsons Disease Rating Scale II and III, Timed Up and Go Test, Berg Balance Scale, Activities-specific Balance Confidence Scale, Falls Efficacy Scale, Falls diary and Parkinsons Disease Questionnaire-39. Results: Hydrotherapy treatment proved to be feasible and safe. Patients in both groups had a significant improvement in all outcome variables. There was a better improvement in patients who underwent hydrotherapy than in patients treated with land-based therapy in the centre of pressure sway area closed eyes (mean SD change: 45.4 SD64.9 vs. 6.9 SD45.3, p = 0.05), Berg Balance Scale (51.2 SD3.1 vs. 6.0 SD3.1, p = 0.005), Activities-specific Balance Confidence Scale (16.8 SD10.6 vs. 4.1 SD5.4, p = 0.0001), Falls Efficacy Scale (-5.9 SD4.8 vs. -1.9 SD1.4, p = 0.003), Parkinsons Disease Quetionnaire-39 (-18.4 SD12.9 vs. -8.0 SD7.0, p = 0.006) and falls diary (-2.4 SD2.2 vs. -0.4 SD0.5, p = 0.001). Conclusion: Our study suggests that hydrotherapy may constitute a possible treatment for balance dysfunction in Parkinsonian patients with moderate stage of disease. © 2014 The Author(s).


Pinna G.D.,Scientific Institute of Montescano | Robbi E.,Scientific Institute of Montescano | La Rovere M.T.,Scientific Institute of Montescano | Maestri R.,Scientific Institute of Montescano
Journal of Sleep Research | Year: 2012

Fluctuations in sleep/wake state have been proposed as an important mechanism contributing to the development of oscillatory breathing patterns, including Cheyne-Stokes respiration in patients with heart failure. In order to properly assess the interactions between changes in state and changes in ventilatory parameters, a methodology capable of continuously and reliably detecting state transitions is needed. Traditional fixed-epoch analysis of polysomnographic recordings is not suitable for this purpose. Moreover, visual identification of changes in the dominant electroencephalogram activity at the transition from wakefulness to sleep and vice versa is often very subjective. We have therefore developed a hybrid approach - including both visual scoring and computer-based procedures - for continuous analysis of state transitions from polysomnographic recordings, specifically tailored for fluctuations between wakefulness and non-rapid eye movement-1 and -2 sleep. The overall analysis process comprises three major phases: (1) manual identification of relevant electroencephalogram/electrooculogram features and events, including a sample of unequivocal alpha and theta-delta activity; (2) automatic statistical discrimination of dominant electroencephalogram activity; and (3) state classification (wakefulness, non-rapid eye movement-1 and -2). The latter is carried out by merging information from visual scoring with the output of the discriminator. Validation has been carried out in 16 patients with heart failure during daytime Cheyne-Stokes respiration, using a training and testing set of electroencephalogram polysomnograms. The statistical discriminator correctly classified 99.1±1.4% and 99.2±1.1% of unequivocal alpha and theta-delta activity. This approach has therefore the potential to be used to reliably measure the incidence and location of sleep-wake transitions during abnormal breathing patterns, as well as their temporal relationship with major ventilatory events. © 2011 European Sleep Research Society.


Maestri R.,Scientific Institute of Montescano | Bruschi C.,Scientific Institute of Montescano | Pinna G.D.,Scientific Institute of Montescano
Computer Methods and Programs in Biomedicine | Year: 2013

The assessment of chemoreflex sensitivity (CRS) is of major importance in studies investigating the adaptation of ventilation to the needs of human body. Increased sensitivity of chemoreceptors to both hypoxia and hypercapnia has recently been shown to be a powerful and independent prognosticator in heart failure (HF) patients, thus highlighting the importance of the assessment of CRS also in the clinical setting. In spite of this, the measurement of CRS is currently limited to the research setting. One possible reason might be the lack of suitable commercial equipments.On the basis of these considerations, we designed a system to carry out a comprehensive assessment of CRS, including both central and peripheral chemoreceptors. The system is based on the integration of different commercial devices and is entirely managed by a custom software written in Matlab language. The main features of our system are: (1) the implementation of standard methods (the Read's rebreathing test, the CO2 single breath test and the transient hypoxia test) suitable for both pathological and healthy subjects, (2) data quality assurance and reduction of subjective judgment in the analysis through advanced analysis procedures and statistical outliers rejection, and (3) full interactive control of every step of the recording and analysis procedures.The system is currently used in our Institution in the assessment of CRS in HF patients, chronic obstructive pulmonary disease patients and healthy subjects. It has proven to be very effective and easy to use even by clinical personnel without a specific background in respiratory function assessment. © 2012 Elsevier Ireland Ltd.


Baldi S.,Scientific Institute of Montescano | Aquilani R.,Scientific Institute of Montescano | Pinna G.D.,Scientific Institute of Montescano | Poggi P.,Scientific Institute of Montescano | And 2 more authors.
International Journal of COPD | Year: 2010

Background: Fat-free mass (FFM) depletion marks the imbalance between tissue protein synthesis and breakdown in chronic obstructive pulmonary disease (COPD). To date, the role of essential amino acid supplementation (EAAs) in FFM repletion has not been fully acknowledged. A pilot study was undertaken in patients attending pulmonary rehabilitation. Methods: 28 COPD patients with dynamic weight loss > 5% over the last 6 months were ran-domized to receive EAAs embedded in a 12-week rehabilitation program (EAAs group n = 14), or to the same program without supplementation (C group n = 14). Primary outcome measures were changes in body weight and FFM, using dual X-ray absorptiometry (DEXA). Results: At the 12th week, a body weight increment occurred in 92% and 15% of patients in the EAAs and C group, respectively, with an average increase of 3.8 ± 2.6 kg (P = 0.0002) and -.1 ± 1.1 kg (P = 0.81), respectively. A FFM increment occurred in 69% and 15% of EAAs and C patients, respectively, with an average increase of 1.5 ± 2.6 kg (P = 0.05) and -.1 ± 2.3 kg (P = 0.94), respectively. In the EAAs group, FFM change was significantly related to fasting insulin (r2 0.68, P < 0.0005), C-reactive protein (C-RP) (r2 = 0.46, P < 0.01), and oxygen extraction tension (PaO2x) (r2 = 0.46, P < 0.01) at end of treatment. These three variables were highly correlated in both groups (r > 0.7, P < 0.005 in all tests). Conclusions: Changes in FFM promoted by EAAs are related to cellular energy and tissue oxygen availability in depleted COPD. Insulin, C-RP, and PaO2x must be regarded as clinical markers of an amino acid-stimulated signaling to FFM accretion. © 2010 Baldi et al, publisher and licensee Dove Medical Press Ltd.

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