Michela Agostini - Academia.edu (original) (raw)

Papers by Michela Agostini

Healthcare

A single-blind randomized controlled trial was conducted to compare whether the continuous visual... more A single-blind randomized controlled trial was conducted to compare whether the continuous visualization of a virtual teacher, during virtual reality rehabilitation, is more effective than the same treatment provided without a virtual teacher visualization, for the recovery of arm motor function after stroke. Teacher and no-teacher groups received the same amount of virtual reality therapy (i.e., 1 h/d, 5 dd/w, 4 ww) and an additional hour of conventional therapy. In the teacher group, specific feedback (“virtual-teacher”) showing the correct kinematic to be emulated by the patient was always displayed online during exercises. In the no-teacher group patients performed the same exercises, without the virtual-teacher assistance. The primary outcome measure was Fugl-Meyer Upper Extremity after treatment. 124 patients were enrolled and randomized, 62 per group. No differences were observed between the groups, but the same number of patients (χ2 = 0.29, p = 0.59) responded to experiment...

Rehabilitacja Medyczna, 2014

The motor function impairment resulting from a stroke injury has a negative impact on autonomy, t... more The motor function impairment resulting from a stroke injury has a negative impact on autonomy, the activities of daily living thus the individuals affected by a stroke need long-term rehabilitation. Several studies have demonstrated that learning new motor skills is important to induce neuroplasticity and functional recovery. Innovative technologies used in rehabilitation allow one the possibility to enhance training throughout generated feedback. It seems advantageous to combine traditional motor rehabilitation with innovative technology in order to promote motor re-learning and skill re-acquisition by means of enhanced training. An environment enriched by feedback involves multiple sensory modalities and could promote active patient participation. Exercises in a virtual environment contain elements necessary to maximize motor learning, such as repetitive and diffe-rentiated task practice and feedback on the performance and results. The recovery of the limbs motor function in post...

Many applications of virtual reality appeared in different fields of the rehabilitation medicine.... more Many applications of virtual reality appeared in different fields of the rehabilitation medicine. Nevertheless poor evidences of their effectiveness still exist. The aim of this original paper was to present the results of a retrospective analysis of 10 years of a non-immersive VR system application, for the treatment of the motor upper limb impairment in stroke patients. We observed a significant improvement in the motor outcomes, compared to standard rehabilitation, nevertheless a translation of the same effect on harder outcome such as independence wasn't observed.

Neurorehabilitation and Neural Repair, 2010

Background. Six months after a stroke, the hemiplegic arm often remains compromised. More innovat... more Background. Six months after a stroke, the hemiplegic arm often remains compromised. More innovative approaches to motor rehabilitation are needed. Objective. The authors compared a motor learning-based approach in a virtual environment with more conventional upper extremity therapy in a pilot trial. Methods. This prospective, single-blinded, randomized controlled trial compared reinforced feedback in a virtual environment (RFVE; n = 27) with a control intervention (n = 20) of progressive therapy for the affected upper extremity. Both treatments were provided for 4 weeks, 5 days per week, with 1-hour treatment sessions daily. The primary outcomes were the Fugl-Meyer Upper Extremity (F-M UE) and Functional Independence Measure (FIM) scores. Kinematic outcomes included mean duration (MD), mean linear velocity (MLV), and number of submovements to measure the motor performance. Analyses of the primary outcomes were performed per protocol and by intention to treat. Results. F-M UE scores improved significantly in the RFVE group compared with the conventional therapy group ("intention to treat" = 5.10 points, P = .004; ANCOVA = 4.26 points, P < .01). Several of the kinematic parameters improved in the RFVE group (MD, P < .01; MLV, P < .01). FIM improvements did not differ. Conclusions. Both rehabilitation therapies improved arm motor performance and functional activity, but the RFVE therapy induced more robust results in patients exposed to late rehabilitation treatment.

Previous studies have shown that the motor training in a virtual-environment with the augmented f... more Previous studies have shown that the motor training in a virtual-environment with the augmented feedback promotes motor learning in normal subjects and in long-term post-stroke patients. We evaluated whether this approach could be useful also for treating patients with arm motor deficits due to a recent stroke. Thirty-eight patients were included in the study within 3 months from an ischemic stroke in the territory of the middle cerebral artery. Twenty-five subjects received training with the Reinforced Feedback in Virtual Environment (RFVE) therapy for the arm, and thirteen patients received an equal amount of a conventional rehabilitation (CR) therapy focused to the upper limb. Before and after therapy, the autonomy of daily living activities were assessed with the Functional Independence Measure (FIM) and the degree of motor impairment was measured with the Fugl-Meyer scale for the upper extremity (FM-UE). The RFVE therapy group showed significant improvements in the FM-UE and the FIM scale mean scores. The conventional therapy determined smaller and not statistically significant scores improvements. These data indicate that the recovery of arm motor function in patients after a recent stroke appear to be speeded up by an augmented feedback provided in a virtual-environment.

Enhanced feedback provided by a virtual reality system has been shown to promote motor learning i... more Enhanced feedback provided by a virtual reality system has been shown to promote motor learning in normal subjects. We evaluated whether this approach could be useful for treating patients with motor deficits following brain lesions. Thirty subjects with mild to intermediate arm impairments due to stroke were selected for the study. They were randomly divided into two groups: the patients assigned to the study group received an hour of reinforced feedback in virtual-environment (RFVE) therapy daily for one month. The patients assigned to the control group received the same amount of treatment in time, consisting of traditional physical therapy (Conventional Therapy, CT). In both groups, before and after the therapy, we assessed the degree of motor impairment and autonomy in daily living activities using the Fugl-Meyer scale for the upper extremities and Functional Independence Measure, respectively. Both therapies yielded significant improvements over baseline values in the mean scores on the Fugl-Meyer Upper Extremity and Functional Independence Measure scales. These data indicate that motor recovery in post-stroke patients may be promoted by the enhanced feedback provided in a virtual environment.

A five-bar linkage mechanism with two active and three passive degrees-of-freedom (rotations) at ... more A five-bar linkage mechanism with two active and three passive degrees-of-freedom (rotations) at the end-effector was used as a haptic device and integrated inside a Mat- lab/Simulink general framework, in which Handshake proSENSE toolbox was chosen for the haptic and graphic rendering, con- ceiving a virtual reality based rehabilitation system. Such device can generate forces at the fingertip up to

Proceedings of The National Academy of Sciences, 2009

Production of voluntary movements relies critically on the functional integration of several moto... more Production of voluntary movements relies critically on the functional integration of several motor cortical areas, such as the primary motor cortex, and the spinal circuitries. Surprisingly, after almost 40 years of research, how the motor cortices specify descending neural signals destined for the downstream interneurons and motoneurons has remained elusive. In light of the many recent experimental demonstrations that the motor system may coordinate muscle activations through a linear combination of muscle synergies, we hypothesize that the motor cortices may function to select and activate fixed muscle synergies specified by the spinal or brainstem networks. To test this hypothesis, we recorded electromyograms (EMGs) from 12-16 upper arm and shoulder muscles from both the unaffected and the stroke-affected arms of stroke patients having moderate-to-severe unilateral ischemic lesions in the frontal motor cortical areas. Analyses of EMGs using a nonnegative matrix factorization algorithm revealed that in seven of eight patients the muscular compositions of the synergies for both the unaffected and the affected arms were strikingly similar to each other despite differences in motor performance between the arms, and differences in cerebral lesion sizes and locations between patients. This robustness of muscle synergies that we observed supports the notion that descending cortical signals represent neuronal drives that select, activate, and flexibly combine muscle synergies specified by networks in the spinal cord and/or brainstem. Our conclusion also suggests an approach to stroke rehabilitation by focusing on those synergies with altered activations after stroke. motor control ͉ motor modules ͉ neurorehabilitation ͉ motor primitives ͉ electromyography