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Papers by valentina varalta

European Journal of Physical and Rehabilitation Medicine

INTRODUCTION Postural instability is a cardinal feature of Parkinson's disease, together with... more INTRODUCTION Postural instability is a cardinal feature of Parkinson's disease, together with rest tremor, rigidity and bradykinesia. It is a highly disabling symptom that becomes increasingly common with disease progression and represents a major source of reduced quality of life in patients with Parkinson's disease. Rehabilitation aims to enable patients with Parkinson's disease to maintain their maximum level of mobility, activity and independence. To date, a wide range of rehabilitation approaches has been employed to treat postural instability in Parkinson's disease, including robotic training. Our main aim was to conduct a systematic review of current literature about the effects of robot-assisted gait training on postural instability in patients with Parkinson's disease. EVIDENCE ACQUISITION A systematic search using the following MeSH terms (Parkinson disease; postural balance; robotics; rehabilitation) and string {("robotics [mh]" OR "robot-assisted" OR "electromechanical") and ("rehabilitation [mh]" OR "training") and ("postural balance [mh]")} was conducted on PubMed, Cochrane Library and PEDro electronic databases. Full text articles in English published up to December 2020 were included. Data about patient characteristics, robotic devices, treatment procedures and outcome measures were considered. Every included article got checked for quality. Level of evidence was defined for all studies. EVIDENCE SYNTHESIS Three authors independently extracted and verified data. In total, 18 articles (2 systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies and 3 case series/case reports) were included. Both end-effector and exoskeleton devices were investigated as to robot-assisted gait training modalities. No clear relationship between treatment parameters and clinical conditions was observed. We found a high level of evidence about the effects of robot-assisted gait training on balance and freezing of gait in patients with Parkinson's disease. CONCLUSIONS This systematic review provides to the reader a complete overview of current literature and levels of evidence about the effects of robot-assisted gait training on postural instability issues (static and dynamic balance, freezing of gait, falls, confidence in activities of daily living and gait parameters related to balance skills) in patients with Parkinson's disease.

training in patients with unilateral spatial neglect variable and might have been due to a placeb... more training in patients with unilateral spatial neglect variable and might have been due to a placebo effect or fluctuating clinical conditions. However, robot-assisted J N E R JOURNAL OF NEUROENGINEERINGAND REHABILITATIONVaralta et al. Journal of NeuroEngineering and Rehabilitation 2014, 11:160http://www.jneuroengrehab.com/content/11/1/1602Neurological Rehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italyhemispatial neglect therapy might be useful in stroke patients. Larger-scale investigations are needed to confirm our preliminary findings.

Effect of eye patching in rehabilitation of hemispatial

Introduction. Spasticity is a disabling complication of stroke.1, Aim of this study was to assess... more Introduction. Spasticity is a disabling complication of stroke.1, Aim of this study was to assess the prognostic value of brain lesions location as a predictor of spasticity development after stroke. Materials and methods. 51 patients (first-ever unilateral ischemic stroke) were recruited. Each patient\u2019s T1 magnetic resonance imaging performed 1-4 weeks after the onset was collected. At 6 months after stroke we evaluated the muscle tone at the upper and lower limbs using the Modified Ashworth Scale (MAS).3 Brain lesions were mapped and located using MRIcro and MRIcroN software. For statistical purposes we described spasticity as absent/present. The affected limb was considered spastic if a score 65 1 and severely spastic if a score 65 3 was present in the MAS at any joint evaluated. Results. Brain lesions that showed a significant correlation with the development of spasticity after stroke involved the white matter (corona radiate, internal capsule), the basal ganglia (putamen, caudate, pallidum), the insula, the precentral gyrus, the Rolandic operculum, the frontal gyri, the frontal operculum, the thalamus. Lesions involving the subcortical white matter (corona radiate, internal capsule) and the basal ganglia (putamen, caudate, pallidum) showed a significant correlation with the development of severe spasticity after the onset. Conclusion. The present study shows that brain lesions\u2019 location could be a predictor of the development of spasticity after stroke. In particular lesions involving the corona radiata, the internal capsule and the basal ganglia are related with the development of spasticity and severe spasticity after the onset

Frontiers in Neurology, 2021

Background: Stroke is a leading cause of disability. Nonetheless, the care pathway for stroke reh... more Background: Stroke is a leading cause of disability. Nonetheless, the care pathway for stroke rehabilitation takes partially into account the needs of chronic patients. This is due in part to the lack of evidence about the mechanisms of recovery after stroke, together with the poor knowledge of related and influencing factors. Here we report on the study protocol “Rehabilitation and Biomarkers of Stroke Recovery,” which consists of 7 work-packages and mainly aim to investigate the effects of long-term neurorehabilitation on stroke patients and to define a related profile of (clinical-biological, imaging, neurophysiological, and genetic-molecular) biomarkers of long-term recovery after stroke. The work-package 1 will represent the main part of this protocol and aims to compare the long-term effects of intensive self-rehabilitation vs. usual (rehabilitation) care for stroke.Methods: We planned to include a total of 134 adult subacute stroke patients (no more than 3 months since onset)...

Obiettivo dello studio \ue8 indagare le modificazioni delle funzioni linguistiche e cognitive in ... more Obiettivo dello studio \ue8 indagare le modificazioni delle funzioni linguistiche e cognitive in soggetti con Malattia di Alzheimer (AD) dopo stimolazione anodica con tDCS real o sham a carico della corteccia prefrontale dorsolaterale sinistra. Sono stati arruolati tre pazienti, di cui due con AD di grado lieve (soggetto 1: MMSE= 24/30; Soggetto 2: MMSE=23,8/30) e uno con AD di grado moderato (Soggetto 3: MMSE=15/30) che hanno effettuato sia sessione di stimolazione tDCS real sia sham, distanziate tra loro di almeno 48 ore. Prima, durante e a distanza di 48 ore dal termine della stimolazione i pazienti sono stati valutati con il test di BADA, Digit Span, Rivermead Behavioral Memory Test, Test delle Matrici Attentive e Fluenza Verbale Fonemica. I risultati mostrano come la metodica tDCS real si sia dimostrata pi\uf9 efficace nel migliorare le funzioni linguistiche nel soggetto con AD moderato rispetto ai pazienti con AD di grado liev

Introduzione - La disfagia \ue8 un disturbo frequente nell\u2019ictus cerebrale. Lo studio della ... more Introduzione - La disfagia \ue8 un disturbo frequente nell\u2019ictus cerebrale. Lo studio della correlazione tra localizzazione della lesione cerebrale e disfagia ha mostrato che lesioni in specifiche aree cerebrali determinano diversi pattern patologici della deglutizione. Gli scopi di questo studio sono valutare la relazione tra sede della lesione cerebrale e presenza di disfagia nella fase acuta dell\u2019ictus e tra sede della lesione e recupero della disfagia a un mese dall\u2019ictus. Materiali e Metodi - Sono stati arruolati nello studio 58 pazienti con esiti di ictus cerebrale unilaterale documentato alla RMN. Sono stati esclusi pazienti affetti da pregressa disfagia, pregressi eventi ictali, altre patologie neurologiche e decadimento cognitivo (MMSE< 24/30). I pazienti sono stati valutati al momento del ricovero e dopo un mese con le scale di valutazione National Institutes of Health Stroke Scale, Dysphagia Outcome and Severity Scale, Barthel Index. L\u2019analisi delle lesioni cerebrali \ue8 stata effettuata mediante Voxel-based Lesion Symptom Mapping. Risultati - Al ricovero 37 pazienti erano disfagici mentre 21 non avevano alcun disturbo deglutitorio. Le aree correlate con la presenza del disturbo disfagico erano Putamen, Insula, giro Temporale Superiore, Giro frontale inferiore, Talamo, area temporo mediale nell\u2019emisfero sinistro; insula, opercolo rolandico, area fronto- inferiore, giro frontale inferiore, area post centrale, talamo e amigadala nell\u2019emisfero destro. Le aree correlate con il mancato recupero della disfagia erano putamen, pallido, nucleo caudato, opercolo rolandico, talamo ed insula. Conclusioni - L\u2019analisi delle lesioni cerebrali in pazienti disfagici pu\uf2 contribuire alla definizione delle probabilit\ue0 di recuperare le competenze deglutitorie in pazienti affetti da disfagia in esiti di ictus

L\u2019estinzione visiva \ue8 un disturbo spazio-temporale di visual awareness. Pazienti con lesi... more L\u2019estinzione visiva \ue8 un disturbo spazio-temporale di visual awareness. Pazienti con lesioni all\u2019emisfero destro che presentano estinzione visiva spesso mostrano difficolt\ue0 nel rilevare lo stimolo controlesionale quando presentato contemporaneamente ad uno stimolo ipsilesionale (condizione di stimolazione bilaterale). In questi pazienti spesso inoltre lo stimolo di sinistra deve essere presentato con un vantaggio temporale per poter essere percepito come simultaneo a quello di destra. Nel presente lavoro, sono stati condotti tre esperimenti al fine di indagare le basi funzionali e neurali dei disturbi spazio-temporali di visual awareness. Attraverso il primo esperimento abbiamo indagato i correlati neurali di tali disturbi in pazienti con ictus in fase cronica con estinzione visiva. I deficit di visual awareness potrebbero in linea di principio dipendere da una disfunzione della corteccia parietale posteriore dovuta alla lesione della giunzione temporo-parietale, area tipicamente danneggiata nei pazienti con disturbi di visual awareness. Infatti la corteccia visiva ipsilesionale che risulta strutturalmente intatta potrebbe essere funzionalmente normale ma la sua attivit\ue0 viene modulata in maniera patologica a causa delle influenze top-down che derivano dalla corteccia parietale posteriore, e questo creerebbe asimmetria interemisferica. Tuttavia, non \ue8 ancora chiaro se l'effetto di una modulazione top-down disfunzionale influenzi esclusivamente le risposte del paziente o se induca cambiamenti neurali nelle aree visive. In questo esperimento, abbiamo cercato di indagare tale aspetto utilizzando la tomografia ad emissione di posizione (PET) a riposo in pazienti post-ictus. Nello specifico attraverso tale metodica abbiamo comparato il metabolismo corticale di un paziente che mostra estinzione visiva in fase cronica con quello di due pazienti che hanno recuperato il disturbo in fase acuta e che al momento dell\u2019esame PET non evidenziavano deficit di visual awareness. Dai risultati si evidenzia che nel paziente con estinzione la corteccia visiva ipsilesionale, seppur strutturalmente intatta, risulta ipometabolica rispetto alla corteccia visiva controlesionale, mentre nessuna asimmetria interemisferica nelle aree visive \ue8 stata trovata nei pazienti senza estinzione. Questi dati suggeriscono che i cambiamenti neurali nelle aree occipitali strutturalmente intatte potrebbero essere cruciali per spiegare il disturbo di visual awareness per stimoli controlesionale in pazienti con estinzione in fase cronica. Nel secondo e nel terzo esperimento abbiamo studiato il possibile contributo dei meccanismi di cattura contingente dell\u2019attenzione nell\u2019elaborazione spazio-temporale delle informazioni visive, sia in pazienti con disturbi dell'attenzione (esperimento 2) sia in soggetti sani (esperimento 3). Dalla letteratura emerge che il deficit attentivo dei pazienti con lesioni parietali destre pu\uf2 essere determinato dalla difficolt\ue0 di disancorare l\u2019attenzione da stimoli ipsilesionale per riorientarla verso stimoli controlesionali. \uc8 stato tuttavia dimostrato che il deficit di disancoraggio dipende della rilevanza che gli stimoli ipsilesionali assumono sulla base della richiesta del compito e/o delle aspettative del paziente. Anche studi su soggetti sani suggeriscono che l\u2019aspettativa per una modalit\ue0 sensoriale pu\uf2 accelerare la relativa percezione dello stimolo presentato in quella modalit\ue0 piuttosto che in un\u2019altra, riducendo il tempo necessario per la rilevazione dello stimolo stesso (ipotesi del \u201cprior entry\u201d). Il secondo esperimento si \ue8 concentrato sull\u2019indagine delle basi funzionali dei disturbi spazio-temporali di visual awareness nei pazienti con estinzione visiva. Nello specifico abbiamo indagato se la richiesta del compito influenza l'elaborazione spazio-temporale delle informazioni visive in questi pazienti. Sono state valutate le prestazioni di un paziente con estinzione visiva in un compito di giudizio di ordine temporale. Il compito era eseguito in 2 diverse condizioni: in un caso s\u2019istruiva il paziente ad eseguire il compito focalizzando la propria attenzione su un particolare stimolo (focused condition) mentre in un altro si chiedeva di eseguire il compito senza focalizzare l\u2019attenzione su uno specifico stimolo (non-focused condition). Le prestazioni del paziente sono state confrontate con quelle di un paziente cerebroleso destro senza estinzione visiva e di quattro soggetti sani comparabili per et\ue0. Nella condizione non-focused il paziente con estinzione ha mostrato un bias spazio-temporale (PSS = -255), mentre si \ue8 evidenziata una riduzione importante di tale bias nella condizione focused (PSS = -44). Questi risultati indicano una chiara modulazione delle prestazioni del paziente sulla base del set attentivo utilizzato. Al contrario, nessuna modulazione \ue8 stata trovata sia nel paziente cerebroleso…

Introduction. La Sclerosi Multipla (SM) \ue8 una patologia neurologica cronica, degenerativa, inf... more Introduction. La Sclerosi Multipla (SM) \ue8 una patologia neurologica cronica, degenerativa, infiammatoria e disabilitante che solitamente colpisce persone con et\ue0 compresa tra i 20 e 50 anni (1). Si stima che la prevalenza della SM nella popolazione italiana sia compresa tra 10 e 80 pazienti ogni 100.000 abitanti (2). Questa malattia provoca inoltre anche deficit cognitivi, soprattutto di tipo attentivo. Scopo. di tale studio \ue8 quello di indagare gli effetti di due differenti tipologie di trattamento motorio integrato sul tono dell\u2019umore e sullo stato cognitivo, analizzando in particolar modo le abilit\ue0 attentive e la flessibilit\ue0 mentale. Materials and methods. Sono stati arruolati 35 pazienti (14 maschi, 21 femmine) affetti da Sclerosi Multipla. I pazienti sono stati randomizzati in due gruppi, sottoposti a due tipi differenti di training motorio: il primo gruppo eseguiva training del passo con strumentazione robotica (Gang Trainer), mentre il secondo training della deambulazione convenzionale. Ciascun paziente \ue8 stato sottoposto a 12 sessioni di trattamento della durata di 50 minuti ciascuna. La terapia ha avuto frequenza bisettimanale (2 gg/sett) per la durata complessiva di 6 settimane consecutive. I pazienti sono stati sottoposti a valutazione neuropsicologica prima (35 pz) e dopo il trattamento motorio (32 pz) e ad un follow-up a distanza di due mesi (20 pz). La batteria psicometrica somministrata \ue8 costituita da MMSE, PASAT, SART, STROOP, Associazione di simboli a numeri, Test di Fluenza Fonemica, Hamilton Rating Scale for Depression. Results. Tutti i soggetti, indipendentemente dalla tipologia di trattamento motorio somministrato, successivamente al training, mostrano un miglioramento significativo delle prestazioni cognitive ai test somministrati. Inoltre dall\u2019analisi between group emerge una differenza significativa tra i due gruppi ad un test atto a valutare la memoria di lavoro e l\u2019attenzione sostenuta. Conclusions. Dai risultati del nostro studio sembra quindi che programmi di esercizio fisico contribuiscano ad incrementare lo stato cognitivo globale, la flessibilit\ue0 mentale, la velocit\ue0 di reazione e la coordinazione oculo-manuale; inoltre portano beneficio all\u2019attenzione sostenuta e la memoria di lavoro. Queste ultime sembrano nello specifico migliorare maggiormente nei soggetti sottoposti a trattamento motorio con strumentazione robotica. Tali effetti si mantengono nel tempo

Aging, 2019

Cognitive and physical activity treatments (CT and PT) are two non-pharmacological approaches fre... more Cognitive and physical activity treatments (CT and PT) are two non-pharmacological approaches frequently used in patients with Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD). The aim of this study was to compare CT and PT in these diseases. Eighty-seven patients were randomly assigned to CT (n=30), PT (n=27) or control group (CTRL; n=30) for 6 months. The global cognitive function was measured by Mini Mental State Examination (MMSE). Specific neuropsychological tests explored attention, memory, executive functions, behavioral disorders. Cardiovascular risk factors (CVD) were collected. All measures were performed before (T0), after treatments (T1), and at three-months follow-up (T2). MMSE did not change from T0 to T1 and T2 in patients assigned to PT and CT, while CTRL patients showed a decline MCI:-11.8%, AD:-16.2%). Between group differences (MCI vs AD) were not found at T1 and T2. Significant worsening was found for CTRL in MCI (T0-T1: P=.039; T0-T2: P<.001) and AD (T0-T1: P<.001; T0-T2: P<.001), and amelioration was found for CT in AD (T0-T2: P<.001). Attention, executive functions and behavioral disorders were unaffected by either PT or CT. Memory was increased in patients with MCI assigned to PT (+6.9%) and CT (+8.5%).. CVD were ameliorated in the PT group. CTRL patients of both groups, revealed significant decline in all functions and no between groups differences were detected. PT appear to ameliorate CVD. Although between groups differences were not found, results suggest a major retention in MCI compared with AD, suggesting that the latter might benefit better of constant rather than periodic treatments. This study confirms the positive effects of CT and PT in mitigating the cognitive decline in MCI and AD patients, and it is the first to demonstrate their similar effectiveness on maintaining cognitive function.

Medicina, 2019

Background and objectives: Hemispatial neglect is a common consequence of stroke, with an estimat... more Background and objectives: Hemispatial neglect is a common consequence of stroke, with an estimated incidence of 23%. Interventions for treating hemispatial neglect may be categorized as either top-down or bottom-up processing. The aim of top-down approaches is to train the person to voluntarily compensate for their neglect. Such approaches require awareness of the disorder and a high level of active participation by the patient. Differently, bottom-up approaches are based on manipulation of a patient’s sensory environment and so require less awareness of behavioral bias. In line with the latter, it is conceivable that elastic therapeutic taping applied to the left neck surface may provide bottom-up inputs that reduce hemispatial neglect symptoms. The aim of this study was to assess the effect of therapeutic neck taping on visuo-spatial abilities, neck motion, and kinesthetic sensibility in chronic stroke patients with hemispatial neglect. Materials and Methods: After randomization,...

Frontiers in neurology, 2018

The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive... more The Oxford Cognitive Screen (OCS) was recently developed with the aim of describing the cognitive deficits after stroke. The scale consists of 10 tasks encompassing five cognitive domains: attention and executive function, language, memory, number processing, and praxis. OCS was devised to be inclusive and un-confounded by aphasia and neglect. As such, it may have a greater potential to be informative on stroke cognitive deficits of widely used instruments, such as the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment, which were originally devised for demented patients. The present study compared the OCS with the MMSE with regards to their ability to detect cognitive impairments post-stroke. We further aimed to examine performance on the OCS as a function of subtypes of cerebral infarction and clinical severity. 325 first stroke patients were consecutively enrolled in the study over a 9-month period. The OCS and MMSE, as well as the Bamford classification an...

Neuropsychologia, Jan 5, 2017

Hemianopia is a visual field defect characterized by decreased vision or blindness in the contral... more Hemianopia is a visual field defect characterized by decreased vision or blindness in the contralesional visual field of both eyes. The presence of well documented above-chance unconscious behavioural responses to visual stimuli presented to the blind hemifield (blindsight) has stimulated a great deal of research on the neural basis of this important phenomenon. The present study is concerned with electrophysiological responses from the blind field. Since previous studies found that transient Visual Evoked Potentials (VEPs) are not entirely suitable for this purpose here we propose to use Steady-State VEPs (SSVEPs). A positive result would have important implications for the understanding of the neural bases of conscious vision. We carried out a passive SSVEP stimulation with healthy participants and hemianopic patients. Stimuli consisted of four black-and-white sinusoidal Gabor gratings presented one in each visual field quadrant and flickering one at a time at a 12Hz rate. To asse...

Minerva medica, Jan 16, 2016

Pusher behaviour (PB) is a little-known postural controlf disorder characterized by alterations i... more Pusher behaviour (PB) is a little-known postural controlf disorder characterized by alterations in the perception of body orientation in the coronal (roll) plane. Post-stroke PB poses many short- and long-term concerns in clinical practice leading to the longer length of hospital stay and slower functional recovery. The literature on specific rehabilitation training in PB is scant. The aim of this pilot study was to compare the outcomes after postural orientation training using visual and somatosensory cues versus conventional physiotherapy in patients with post-stroke PB. Sixteen patients with PB were enrolled. Eight patients received postural orientation training employing visual and somatosensory cues. Seven patients received conventional physiotherapy. Each patient underwent 20 (50 min/d) individual treatment sessions (5 d/week for 4 weeks). Primary outcome measure was the Scale for Contraversive Pushing (SCP). Secondary outcome measures were the European Stroke Scale (ESS), and...

Neurological Sciences, 2016

Cognitive deficits occur in most stroke patients and cognitive impairment is an important predict... more Cognitive deficits occur in most stroke patients and cognitive impairment is an important predictor of adverse long term outcome. However, current screening measures, such as the Mini Mental State Examination or the Montreal Cognitive Assessment, do not provide information tuned for evaluating the impact of cognitive impairment in the early phase after stroke. The Oxford Cognitive Screen (OCS) represents an important new development in this regard. The OCS is now available for assessment of Italian individuals and the aim of this study is to standardize the OCS on a large sample of healthy Italian participants stratified for age, gender and education level. Results confirmed the influence of these factors in several of the OCS tasks. Age-, education-and gender-adjusted norms are provided for the ten sub-tests of the test. The availability of normative data represents an important prerequite for the reliable use of OCS with stroke patients.