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Introduction: In the evolving healthcare landscape, technology has emerged as a key component in enhancing system efficiency and offering new avenues for patient rehabilitation. Despite its growing importance, detailed information on technology's specific use, types, and applications in clinical rehabilitation settings, particularly within the Italian framework, remains unclear. This study aimed to explore the use of technology and its needs by Physical Medicine and Rehabilitation medical doctors in Italy., Methods: We conducted a cross-sectional online survey aimed at 186 Italian clinicians affiliated with the Italian Society of Physical and Rehabilitation Medicine (SIMFER). The online questionnaire consists of 71 structured questions designed to collect demographic and geographical data of the respondents, as well as detailed insights into the prevalence and range of technologies they use, together with their specific applications in clinical settings.", Results: A broad range of technologies, predominantly commercial medical devices, has been documented. These technologies are employed for various conditions, including common neurological diseases, musculoskeletal disorders, dementia, and rheumatologic issues. The application of these technologies indicates a broadening scope beyond enhancing sensorimotor functions, addressing both physical and social aspects of patient care., Discussion: In recent years, there's been a notable surge in using technology for rehabilitation across various disorders. The upcoming challenge is to update health policies to integrate these technologies better, aiming to extend their benefits to a wider range of disabling conditions, marking a progressive shift in public health and rehabilitation practices., Competing Interests: Declarations. Ethics approval and consent to participate: The paper was approved by the Local Ethics Committee of the IRCCS Centro Neurolesi “Bonino-Pulejo”; code number: IRCCSME 12/23. All participants gave informed consent to enter the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Functional motor disorders (FMDs) are prevalent and highly disabling conditions among young adults, leading to reduced independence. Despite advancements in diagnosis and treatment, the economic burden of FMDs remains largely unknown., Objective: This study evaluates the impact of accurate FMDs diagnosis on direct healthcare costs within the Italian National Health System by comparing healthcare utilization and costs before and after diagnosis., Methods: This before-after study included 40 patients with a definite diagnosis of FMDs. Retrospective data on healthcare utilization, including diagnostic tests, specialist visits, hospitalizations, Emergency Room (ER) visits, and rehabilitation services, were collected from diaries and documents two years before and after diagnosis., Results: Healthcare direct costs decreased by 67%, from an average of €4,467 [95% CI 3,604-5,329] to €1,461 [95% CI 945-1,976] after diagnosis. Hospitalization costs fell from €2,618 [95% CI 1,899-3,336] to €492 [95% CI 162-821], and ER costs dropped from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Diagnostic procedure costs decreased significantly, from €403 [95% CI 177-628] to €43 [95% CI 6-78]. Specialist visit costs remained unchanged. Rehabilitation costs increased from €371 [95% CI 194-547] to €635 [95% CI 318-915], but this rise was not statistically significant., Conclusions: Accurate diagnosis of FMDs significantly reduces healthcare costs by minimizing unnecessary tests, hospitalizations, and ER visits while emphasizing rehabilitation. This highlights the economic and clinical benefits of improved diagnostic accuracy and specific multidisciplinary intervention. Investing in cost-effective diagnostic tools is crucial for earlier diagnosis and reducing delays., Competing Interests: Declarations Ethics approval All investigations were carried out in accordance with the Helsinki Declaration and its later amendments. Approval was obtained from the local Institutional Ethics Committee (Project Number 132 1757CESC). Consent to participate The study was incorporated within the Verona dataset of RI-FMDs, so informed consent for participation in the registry sufficed. Competing interests The authors declare no competing interests., (© 2024. Fondazione Società Italiana di Neurologia.)

The aggressions suffered by healthcare personnel (HCP) is a growing problem in the field of public health in Spain that negatively affects the quality of care. The objective is to analyze the causes of the aggressions towards the HCP and what implications they have for the healthcare service and its personnel. The methodology is based on a systematic review in PubMed, Scopus, Web of Science and Medes. The triggers of the aggressions are multifactorial and can lead to post-traumatic stress disorder in the HCP. The most affected services are primary care, emergency care, emergencies, and psychiatry. Women are the most assaulted, while men are responsible for most of the assaults. Although professional associations, autonomous communities and the Ministry of Health and Social Services are making efforts to prevent the problem, it continues to be invisible due to the under-reporting of complaints, the lack of academic research and society in general., (Copyright © 2024 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Background and Aims: Functional motor disorders (FMD) present a prevalent, yet misunderstood spectrum of neurological conditions characterized by abnormal movements (i.e., functional limb weakness, tremor, dystonia, gait impairments), leading to substantial disability and diminished quality of life. Despite their high prevalence, FMD often face delayed diagnosis and inadequate treatment, resulting in significant social and economic burdens. The old concept of psychological factors as the primary cause (conversion disorder) has been abandoned due to the need for more evidence about their causal role. According to a predictive coding account, the emerging idea is that symptoms and disability may depend on dysfunctions of a specific neural system integrating interoception, exteroception, and motor control. Consequently, symptoms are construed as perceptions of the body's state. Besides the main pathophysiological features (abnormal attentional focus, beliefs/expectations, and sense of agency), the lived experience of symptoms and their resulting disability may depend on an altered integration at the neural level of interoception, exteroception, and motor control., Methods and Materials: Our proposal aims to elucidate the pathophysiological mechanisms of FMD through a three-stage research approach. Initially, a large cohort study will collect behavioral, neurophysiological, and MRI biomarkers from patients with FMD and healthy controls, employing eXplainable Artificial Intelligence (XAI) to develop a diagnostic algorithm. Subsequently, validation will occur using patients with organic motor disorders. Finally, the algorithm's prognostic value will be explored post-rehabilitation in one subgroup of patients with FMD., Results: Data collection for the present study started in May 2023, and by May 2025, data collection will conclude., Discussion: Our approach seeks to enhance early diagnosis and prognostication, improve FMD management, and reduce associated disability and socio-economic costs by identifying disease-specific biomarkers., Trial Registration: This trial was registered in clinicaltrials.gov (NCT06328790)., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: E. Sarasso and E. Canu have received research support from the Italian Ministry of Health. M. Filippi is Editor-in-Chief of the Journal of Neurology, Associate Editor of Human Brain Mapping, Neurological Sciences, and Radiology, received compensation for consulting services from Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi, speaking activities from Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA, participation in Advisory Boards for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi-Genzyme, Takeda, scientific direction of educational events for Biogen, Merck, Roche, Celgene, Bristol-Myers Squibb, Lilly, Novartis, Sanofi-Genzyme, he receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla. F. Agosta is Associate Editor of NeuroImage: Clinical, has received speaker honoraria from Biogen Idec, Italfarmaco, Roche, Zambon and Ely Lilli, and receives or has received research supports from the Italian Ministry of Health, the Italian Ministry of University and Research, AriSLA (Fondazione Italiana di Ricerca per la SLA), the European Research Council, the EU Joint Programme – Neurodegenerative Disease Research (JPND), and Foundation Research on Alzheimer Disease (France). The other authors have declared that no competing interests exist., (Copyright: © 2024 Gandolfi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Functional gait disorders (FGDs) are a disabling subset of Functional Neurological Disorders in which presenting symptoms arise from altered high-level motor control. The dual-task paradigm can be used to investigate mechanisms of high-level gait control. The study aimed to determine the objective measures of gait that best discriminate between individuals with FGDs and healthy controls and the relationship with disease severity and duration. High-level spatiotemporal gait outcomes were analyzed in 87 patients with FGDs (79.3% women, average age 41.9±14.7 years) and 48 healthy controls (60.4% women, average age 41.9±15.7 years) on single and motor, cognitive, and visual-fixation dual tasks. The area under the curve (AUC) from the receiver operator characteristic plot and the dual-task effect (DTE) were calculated for each measure. Dual-task interference on the top single-task gait characteristics was determined by two-way repeated measures ANOVA. Stride time variability and its standard deviation (SD) failed to discriminate between the two groups in single and dual-task conditions (AUC<0.80 for all). Significant group x task interactions were observed for swing time SD and stride time on the cognitive dual tasks (p<0.035 for all). Longer disease duration was associated with poor gait performance and unsteadiness in motor and cognitive DTE (p<0.003) but improvement in stride length and swing time on the visual dual tasks (p<0.041). Our preliminary findings shed light on measures of gait automaticity as a diagnostic and prognostic gait biomarker and underline the importance of early diagnosis and management in individuals with FGDs., (© 2024. The Author(s).)

Gait disorders are the most frequent symptoms associated to multiple sclerosis (MS). Robot-assisted gait training (RAGT) in people with MS (PwMS) has been proposed as a possible effective treatment option for severe motor disability without significant superiority when compared to intensive overground gait training (OGT). Furthermore, RAGT at high intensity may enhance fatigue and spasticity. This study aims to evaluate the effects of a low-intensity RAGT at progressively increasing intensity compared to conventional RAGT and OGT in PwMS and moderate to severe walking impairment. 24 PwMS will be recruited and assigned to one of the three treatment groups: low-intensity RAGT at progressively increasing intensity, conventional RAGT and OGT. All participants will receive 3-weekly treatment sessions of 3 hours each for 4 weeks. In the first 2 hours of treatment, all participants will receive a rehabilitation programme based on stretching exercises, muscle strengthening and educational interventions. During the last hour, subjects will undergo specific gait training according to the assignment group. Outcomes will be assessed before and after treatment and at 3-month follow-up. The primary outcome is walking speed. Secondary outcomes include mobility and balance, psychological measures, muscle oxygen consumption, electrical and haemodynamic brain activity, urinary biomarkers, usability, and acceptability of robotic devices for motor rehabilitation. The results of this study will provide a safe, affordable and non-operator-dependent, intervention for PwMS. Results in terms of functional, psychological, neurophysiological and biological outcomes will confirm our hypothesis. The study's trial registration number: NCT06381440., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Axial postural abnormalities (APAs), characterized by their frequency, disabling nature, and resistance to pharmacological treatments, significantly impact Parkinson's disease and atypical Parkinsonism patients. Despite advancements in diagnosing, assessing, and understanding their pathophysiology, managing these complications remains a significant challenge. Often underestimated by healthcare professionals, these disturbances can exacerbate disability. This systematic review assesses botulinum toxin treatments' effectiveness, alone and with rehabilitation, in addressing APAs in Parkinson's disease, utilizing MEDLINE (PubMed), Web of Science, and SCOPUS databases for source material. Of the 1087 records retrieved, 16 met the selection criteria. Most research has focused on botulinum toxin (BoNT) as the primary treatment for camptocormia and Pisa syndrome, utilizing mostly observational methods. Despite dose and injection site variations, a common strategy was using electromyography-guided injections, occasionally enhanced with ultrasound. Patients with Pisa syndrome notably saw consistent improvements in APAs and pain. However, studies on the combined effects of botulinum toxin and rehabilitation are limited, and antecollis is significantly under-researched. These findings recommend precise BoNT injections into hyperactive muscles in well-selected patients by skilled clinicians, avoiding compensatory muscles, and underscore the necessity of early rehabilitation. Rehabilitation is crucial in a multidisciplinary approach to managing APAs, highlighting the importance of a multidisciplinary team of experts.

Background: Motor symptoms in functional motor disorders (FMDs) refer to involuntary, but learned, altered movement patterns associated with aberrant self-focus, sense of agency, and belief/expectations. These conditions commonly lead to impaired posture control, raising the likelihood of falls and disability. Utilizing visual and cognitive tasks to manipulate attentional focus, virtual reality (VR) integrated with posturography is a promising tool for exploring postural control disorders., Objectives: To investigate whether postural control can be adapted by manipulating attentional focus in a 3D immersive VR environment., Methods: We compared postural parameters in 17 FMDs patients and 19 age-matched healthy controls over a single session under four increasingly more complex and attention-demanding conditions: simple fixation task (1) in the real room and (2) in 3D VR room-like condition; complex fixation task in a 3D VR city-like condition (3) avoiding distractors and (4) counting them. Dual-task effect (DTE) measured the relative change in performance induced by the different attention-demanding conditions on postural parameters., Results: Patients reduced sway area and mediolateral center of pressure displacement velocity DTE compared to controls (all, P < 0.049), but only under condition 4. They also showed a significant reduction in the sway area DTE under condition 4 compared to condition 3 (P = 0.025)., Conclusions: This study provides novel preliminary evidence for the value of a 3D immersive VR environment combined with different attention-demanding conditions in adapting postural control in patients with FMDs. As supported by quantitative and objective posturographic measures, our findings may inform interventions to explore FMDs pathophysiology., (© 2023 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Axial postural abnormalities (PA) are frequent, highly disabling, and drug-refractory motor complications affecting patients with Parkinson's disease (PD) or atypical parkinsonism. Over the past few years, advances have been reached across diagnosis, assessment, and pathophysiological mechanisms of PA. Nonetheless, their management remains a challenge, and these disturbances are generally overlooked by healthcare professionals, potentially resulting in their worsening and impact on patients' disabilities. From shared consensus-based assessment and diagnostic criteria, PA calls for interdisciplinary management based on the complexity and multifactorial pathogenesis. In this context, we conducted a systematic literature review to analyze the available pharmacological and non-pharmacological treatment options for PA in PD according to the new expert-based classification of axial PA in Parkinsonism. Different multidisciplinary approaches, including dopaminergic therapy adjustment, physiotherapy, botulinum toxin injection, and deep brain stimulation, can improve PA depending on its type and severity. An early, interdisciplinary approach is recommended in PD patients to manage PA., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

Compact power splitters are essential components in integrated optics. While 1 × 2 power splitters with uniform splitting are widely used, a 1 × N splitter with arbitrary number N of ports and arbitrary splitting ratio is yet to be demonstrated. In this work we address this problem. We fabricate and characterise 1 × N integrated power splitters that provide fully arbitrary splitting ratios. The core of our design is represented by an array of N non-equally spaced waveguides fabricated on a silicon nitride-on-insulator wafer. Any arbitrary 1 × N splitting ratio can be achieved by properly setting the array length and the dimension of the ( N -1) nano-gaps between the adjacent waveguides. Most importantly, at variance with state-of-the-art solutions, our devices can be designed for arbitrary splitting of higher-order modes. In this manuscript we provide the first experimental demonstration of 1 × N arbitrary splitting ratio for both the fundamental modes (TE00 and TM00) and the TE01 mode, here up to N = 5 ports. With a footprint of 20 μm 2 /port, a bandwidth up to 70 nm and an excess losses <0.2 dB, our devices set a new benchmark for optical power splitters in both standard single-mode photonics as well as in the emerging integrated multimode photonics technology, and may therefore boost key photonic applications, from optimal power distribution and equalization up to signal processing operations., Competing Interests: Conflict of interest: Authors state no conflicts of interest., (© 2024 the author(s), published by De Gruyter, Berlin/Boston.)

Introduction: Wearable devices and telemedicine are increasingly used to track health-related parameters across patient populations. Since gait and postural control deficits contribute to mobility deficits in persons with movement disorders and multiple sclerosis, we thought it interesting to evaluate devices in telemedicine for gait and posture monitoring in such patients., Methods: For this systematic review, we searched the electronic databases MEDLINE (PubMed), SCOPUS, Cochrane Library, and SPORTDiscus. Of the 452 records retrieved, 12 met the inclusion/exclusion criteria. Data about (1) study characteristics and clinical aspects, (2) technical, and (3) telemonitoring and teleconsulting were retrieved, The studies were quality assessed., Results: All studies involved patients with Parkinson's disease; most used triaxial accelerometers for general assessment ( n  = 4), assessment of motor fluctuation ( n  = 3), falls ( n  = 2), and turning ( n  = 3). Sensor placement and count varied widely across studies. Nine used lab-validated algorithms for data analysis. Only one discussed synchronous patient feedback and asynchronous teleconsultation., Conclusions: Wearable devices enable real-world patient monitoring and suggest biomarkers for symptoms and behaviors related to underlying gait disorders. thus enriching clinical assessment and personalized treatment plans. As digital healthcare evolves, further research is needed to enhance device accuracy, assess user acceptability, and integrate these tools into telemedicine infrastructure., Prospero Registration: CRD42022355460.

Objective: People exhibiting post-stroke lateropulsion actively push their body across the midline to the more affected side and/or resist weight shift toward the less affected side. Despite its prevalence and associated negative rehabilitation outcomes, no clinical practice guidelines exist for the rehabilitation of post-stroke lateropulsion. We aimed to develop consensus-based clinical practice recommendations for managing post-stroke lateropulsion using an international expert panel., Design: This Delphi panel process conformed with Guidance on Conducting and Reporting Delphi Studies recommendations., Participants: Panel members had demonstrated clinical and/or scientific background in the rehabilitation of people with post-stroke lateropulsion., Main Measures: The process consisted of four electronic survey rounds. Round One consisted of 13 open questions. Subsequent rounds ascertained levels of agreement with statements derived from Round One. Consensus was defined a priori as ≥75% agreement (agree or strongly agree), or ≥70% agreement after excluding 'unsure' responses., Results: Twenty participants completed all four rounds. Consensus was achieved regarding a total of 119 recommendations for rehabilitation approaches and considerations for rehabilitation delivery, positioning, managing fear of falling and fatigue, optimal therapy dose, and discharge planning. Statements for which 'some agreement' (50%-74% agreement) was achieved and those for which recommendations remain to be clarified were recorded., Conclusions: These recommendations build on existing evidence to guide the selection of interventions for post-stroke lateropulsion. Future research is required to elaborate specific rehabilitation strategies, consider the impact of additional cognitive and perceptual impairments, describe positioning options, and detail optimal therapy dose for people with lateropulsion.

We propose a numerical technique to accurately simulate the vibrations of organic molecules in the gas phase, when pairs of atoms (or, in general, groups of degrees of freedom) are artificially decoupled, so that their motion is instantaneously decorrelated. The numerical technique we have developed is a symplectic integration algorithm that never requires computation of the force but requires estimates of the Hessian matrix. The theory we present to support our technique postulates a pair-decoupling Hamiltonian function, which parametrically depends on a decoupling coefficient α ∈ [0, 1]. The closer α is to 0, the more decoupled the selected atoms. We test the correctness of our numerical method on small molecular systems, and we apply it to study the vibrational spectroscopic features of salicylic acid at the Density Functional Theory ab initio level on a fitted potential. Our pair-decoupled simulations of salicylic acid show that decoupling hydrogen-bonded atoms do not significantly influence the frequencies of stretching modes, but enhance enormously the out-of-plane wagging and twisting motions of the hydroxyl and carboxyl groups to the point that the carboxyl and hydroxyl groups may overcome high potential energy barriers and change the salicylic acid conformation after a short simulation time. In addition, we found that the acidity of salicylic acid is more influenced by the dynamical couplings of the proton of the carboxylic group with the carbon ring than with the hydroxyl group.

AlGaAs-on-insulator (AlGaAs-OI) has recently emerged as a promising platform for nonlinear optics at the nanoscale. Among the most remarkable outcomes, second-harmonic generation (SHG) in the visible/near infrared spectral region has been demonstrated in AlGaAs-OI nanoantennas (NAs). In order to extend the nonlinear frequency generation towards the short wave infrared window, in this work we propose and demonstrate via numerical simulations difference frequency generation (DFG) in AlGaAs-OI NAs. The NA geometry is finely adjusted in order to obtain simultaneous optical resonances at the pump, signal and idler wavelengths, which results in an efficient DFG with conversion efficiencies up to 0.01%. Our investigation includes the study of the robustness against random variations of the NA geometry that may occur at fabrication stage. Overall, these outcomes identify what we believe to be a new potential and yet unexplored application of AlGaAs-OI NAs as compact devices for the generation and control of the radiation pattern in the near to short infrared spectral region.

Lateral trunk flexion (LTF) and its severe form, called Pisa syndrome (PS), are highly invalidating axial postural abnormalities associated with Parkinson's disease (PD). Management strategies for LTF lack strong scientific evidence. We present a real-life, longitudinal study evaluating long-term efficacy of botulinum toxin (BoNT) injections in axial muscles to reduce LTF and PS in PD. A total of 13 PD patients with LTF > 5° received ultrasound- and electromyography-guided BoNT injections every 4 months. Seven untreated matched PD patients with LTF served as controls and their changes in posture after 18 months were compared with those of seven patients continuing BoNT over 12 months. 53.8% of patients continued the BoNT injections for at least 12 months. Various individual LTF responses were observed. Overall, BoNT-treated patients obtained a not statistically significant improvement of LTF of 17 ± 41% ( p = 0.237). In comparison, the seven untreated PD patients suffered a deterioration in LTF over 12 months by 36 ± 45% ( p = 0.116), showing a significantly different trajectory of posture change ( p = 0.026). In conclusion, repeated BoNT injections in axial muscles showed varying effects in managing PD-associated LTF, suggesting that: (a) a relevant number of patients with LTF can benefit from BoNT; (b) long-term treatment could prevent LTF worsening; (c) an instrumented, personalized approach is important; and (d) there is a need for prospective, long-term studies.

There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium-high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) ( n = 13), and the majority of them focused exclusively on adult patients with FMS ( n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based ( n = 19), mobile application (m-Health) ( n = 3), virtual reality (VR) ( n = 2), and video consulting ( n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach ( n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions.

We investigate transient, photo-thermally induced metasurface effects in a planar thin-film multilayer based on a phase-transition material. Illumination of a properly designed multilayer with two obliquely incident and phase-coherent pulsed pumps induces a transient and reversible temperature pattern in the phase-transition layer. The deep periodic modulation of the refractive index, caused by the interfering pumps, produces a transient Fano-like spectral feature associated with a guided-mode resonance. A coupled opto-thermal model is employed to analyze the temporal dynamics of the transient metasurface and to evaluate its speed and modulation capabilities. Using near-infrared pump pulses with peak intensities of the order of 100 MW/cm 2 and duration of a few picoseconds, we find that the characteristic time scale of the transient metasurface is of the order of nanoseconds. Our results indicate that inducing transient metasurface effects in films of phase-transition materials can lead to new opportunities for dynamic control of quality (Q)-factor in photonic resonances, and for light modulation and switching.

The ability to perform two tasks simultaneously is essential for daily activities. In older adults, this ability is markedly reduced, as evidenced by the dual-task cost on gait. Preliminary evidences indicate that the dual-task cost can be influenced by different types of manipulations. Here, we explored the effectiveness of a new approach to reduce the dual-task cost, based on the placebo effect, a psychobiological phenomenon whereby a positive outcome follows the administration of an inert device thought to be effective. Thirty-five healthy older adults were asked to walk on a sensorized carpet (single-task condition) and to walk while counting backward (dual-task condition) in two sessions (pre-test and post-test). A placebo group, randomly selected, underwent sham transcranial direct current stimulation over the supraorbital areas between sessions, along with information about its positive effects on concentration and attention. A control group did not receive any intervention between sessions. The dual-task cost was significantly reduced in the placebo group at the post-test session compared to the pre-test for several gait parameters (Cohen's d > 1.43). At the post-test session, the dual-task cost was also lower in the placebo group than in the control group (d > 0.73). Cognitive (number of subtractions and number of errors) and subjective (perceived mental fatigability) variables remained stable across sessions. The reduced dual-task cost in the placebo group could indicate the ability to re-establish the allocation of attentional resources between tasks. These findings could contribute to the development of cognitive strategies that leverage positive expectations to boost motor control in older adults., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Functional gait disorders (FGDs) are disabling symptoms of Functional Motor Disorders. Clinical observations show improvement with distraction suggesting an association with higher-level control mechanisms. Dual tasking is a valuable tool for exploring the interplay between gait and cognition. Our research question was: how do different dual task paradigms shape spatio-temporal gait parameters in FGDs?., Methods: In all, 29 patients with FGDs (age 43.48 ± 15.42 years; female 75%) and 49 healthy controls (age 43.33 ± 15.41 years; female 62%) underwent spatio-temporal gait analysis during a single task and during performance on a motor, a cognitive, and a visual-fixation dual-task. The dual-task effect was a measure of interference of the concurrent task on gait speed, stride length (a measure of gait performance), and stride time variability (a measure of automaticity and steadiness)., Results: Overall lower gait speed, shorter stride length, and higher stride time variability were noted in FGDs compared to healthy controls (for all, p < 0.019). The was a significant effect of group and Task × Group interaction for the dual-task effect on gait speed (p = 0.023) and stride length (p = 0.01) but not for stride time variability., Conclusion: Poorer gait performance and less automaticity and steadiness were noted in FGDs. However, dual tasking affected gait performance but, unlike different neurological diseases, not automaticity and steadiness compared to controls. Our findings shed light on higher-level gait control mechanisms in FGDs and suggest stride time variability could be a diagnostic and prognostic biomarker., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: The aims of this study were to compare the central corneal thickness (CCT) measured by an ultrasonic pachymeter (SP-100, Tomey, Japão) versus the Galilei G6™ (Ziemer Ophthalmics System AG, Port, Switzerland) and to compare the simulated keratometry (SimK) measured by an autokeratometer (KM 500 Nidek) versus the Galilei G6™., Animal Studied: Eighteen mixed-breed cats, 10 males, and eight females, aged between 18 and 48 months, were evaluated (n = 36 eyes)., Procedure(s): The cats were manually restrained using a blanket. The operator held the autokeratometer close to the eye and measured the SimK. Next, one anesthetic eye drop was applied; the operator lightly touched the corneal using the ultrasound pachymeter and measured the CCT. At another moment, the cats were sedated using meperidine and xylazine and then evaluated using the Galilei. Student's t-test was employed to perform the statistical analyzes., Results: Considering the CCT, the ultrasound pachymeter provided mean ± SD of 623.03 ± 48.17 μm and the Galilei 617.34 ± 53.38 μm. The autokeratometer produced a SimK of 38.20 ± 0.84D (8.84 ± 0.20 mm) and the Galilei 38.37 ± 0.83D (8.80 ± 0.19 mm). The CCT and SimK did not differ statistically regardless of the device used., Conclusion: To the best of the authors' knowledge, this is the first work to compare the CCT measured by the Galilei versus the ultrasonic pachymeter and to compare the SimK measured by the Galilei versus the keratometer in cats. No statistical difference was found considering the CCT and the SimK measured by the different devices., (© 2022 American College of Veterinary Ophthalmologists.)

Introduction: Robotic-assisted upper limb rehabilitation might improve upper limb recovery in people with multiple sclerosis (PwMS) with moderate-to-severe disability. In the few existing studies, the training effects have been related to the type of intervention, if intensive, repetitive, or task-oriented training might promote neuroplasticity and recovery. Notably, most of these devices operate within a serious game context providing different feedback. Since feedback is a key component of motor control and thus involved in motor and cognitive rehabilitation, clinicians cannot desist from considering the potential contribution of feedback in the upper limb robot-assisted rehabilitation effects., Area Covered: In this systematic review, we reported the rehabilitation protocols used in the robot-assisted upper limb training in PwMS to provide state-of-the-art on the role of feedback in robotic-assisted Upper Limb rehabilitation. PubMed, the Cochrane Library, and the Physiotherapy Evidence Database databases were systematically searched from inception to March 2022. After a literature search, the classification systems for feedback and the serious game were applied., Expert Opinion: There is a need for sharing standard definitions and components of feedback and serious game in technologically assisted upper limb rehabilitation. Indeed, improving these aspects might further improve the effectiveness of such training in the management of PwMS.

While stroke is one of the leading causes of disability, the prediction of upper limb (UL) functional recovery following rehabilitation is still unsatisfactory, hampered by the clinical complexity of post-stroke impairment. Predictive models leading to accurate estimates while revealing which features contribute most to the predictions are the key to unveil the mechanisms subserving the post-intervention recovery, prompting a new focus on individualized treatments and precision medicine in stroke. Machine learning (ML) and explainable artificial intelligence (XAI) are emerging as the enabling technology in different fields, being promising tools also in clinics. In this study, we had the twofold goal of evaluating whether ML can allow deriving accurate predictions of UL recovery in sub-acute patients, and disentangling the contribution of the variables shaping the outcomes. To do so, Random Forest equipped with four XAI methods was applied to interpret the results and assess the feature relevance and their consensus. Our results revealed increased performance when using ML compared to conventional statistical approaches. Moreover, the features deemed as the most relevant were concordant across the XAI methods, suggesting good stability of the results. In particular, the baseline motor impairment as measured by simple clinical scales had the largest impact, as expected. Our findings highlight the core role of ML not only for accurately predicting the individual outcome scores after rehabilitation, but also for making ML results interpretable when associated to XAI methods. This provides clinicians with robust predictions and reliable explanations that are key factors in therapeutic planning/monitoring of stroke patients.

Background: Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need., Aim: To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs., Methods: The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2)., Results: Improvement at 3-month follow-up assessment of motor symptoms (p < 0.001), physical fatigue (p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control., Conclusions: Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change., (© 2022. The Author(s).)

Generation of ultra high frequency acoustic waves in water is key to nano resolution sensing, acoustic imaging and theranostics. In this context water immersed carbon nanotubes (CNTs) may act as an ideal optoacoustic source, due to their nanometric radial dimensions, peculiar thermal properties and broad band optical absorption. The generation mechanism of acoustic waves in water, upon excitation of both a single-wall (SW) and a multi-wall (MW) CNT with laser pulses of temporal width ranging from 5 ns down to ps, is theoretically investigated via a multiscale approach. We show that, depending on the combination of CNT size and laser pulse duration, the CNT can act as a thermophone or a mechanophone. As a thermophone, the CNT acts as a nanoheater for the surrounding water, which, upon thermal expansion, launches the pressure wave. As a mechanophone, the CNT acts as a nanopiston, its thermal expansion directly triggering the pressure wave in water. Activation of the mechanophone effect is sought to trigger few nanometers wavelength sound waves in water, matching the CNT acoustic frequencies. This is at variance with respect to the commonly addressed case of water-immersed single metallic nano-objects excited with ns laser pulses, where only the thermophone effect significantly contributes. The present findings might be of impact in fields ranging from nanoscale non-destructive testing to water dynamics at the meso to nanoscale., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Author(s).)

Dysphagia is a common debilitating symptom in people with Parkinson's Disease (PD), adequate screening of swallowing disorders is fundamental. The DYMUS questionnaire has shown very good characteristics for the screening of dysphagia in Multiple Sclerosis, and it might also prove useful for screening dysphagia in PD. The primary aim was to test and validate the DYMUS questionnaire in PD patients. This is an observational multicentric study involving 103 patients affected by PD. All subjects filled in the DYMUS and the Eating Assessment Tool (EAT-10) questionnaires. A subgroup of patients (n = 53) underwent a fiber-optic endoscopic evaluation of swallowing (FEES) and their dysphagia was scored by means of the Dysphagia Outcome Severity Scale (DOSS). DYMUS showed a relatively high level of internal consistency (Cronbach's alpha 0.79). A significant positive correlation was found between the DYMUS and the EAT-10 scores (p < 0.001), while a negative correlation was found between the DYMUS and the DOSS scores (p < 0.001). DYMUS showed a good sensitivity and specificity compared to FEES for detecting dysphagia (area under the curve: 0.82, p < 0.001). The ROC curve analysis showed that a DYMUS score ≥ 6 represents a reliable cut-off for the risk of dysphagia. The DYMUS questionnaire proved to be a reliable screening tool to detect dysphagia in patients suffering from PD. It is easy to understand, it can be self-administered and therefore adequate for adoption in the clinical practice with the more convenient name of DYPARK., (© 2021. The Author(s).)

Background and Objective: People with functional motor disorder (FMD) report triggers-sensory or motor-induced stimuli that exacerbate or initiate paroxysmal occurrences of their movement disorder. These are a distinct phenomenon from precipitating factors occurring at the initial onset of the disorder. We aimed to assess triggers in FMD and understand their relevance to paroxysmal variability often seen in FMD., Methods: We enrolled consecutive outpatients with a definite diagnosis of FMD. Each patient underwent a detailed clinical evaluation also including the presence of trigger factors and video-recordings both during neurological examination and physiotherapy treatment. Patients were classified as having "triggers" (T-FMD) or "not having triggers" (NoT-FMD) as well as "paroxysmal" compared to "persistent with paroxysmal variability"., Results: The study sample was 100 patients (82% female) with FMD; the mean age at onset was 41 years. Triggers were observed in 88% of patients and in 65 of these the FMD was pure paroxysmal. The most common triggers were movement or physical exercise, followed by emotional, visual, touch, and auditory stimuli; 39 (44%) were isolated and 49 (56%) were combined triggers. Among the T-FMD patients, FMD were paroxysmal in 74% (n = 65) and persistent with paroxysmal variability in 26% (n = 23). The T-FMD patients were younger (p = 0.016) and had a gait disorder (p = 0.035) more frequently than the NoT-FMD patients., Discussion: Triggers are frequent in FMD and may have diverse overlapping clinical presentations. In this sample, FMD was most often paroxysmal, suggesting the value of noting triggers as clinical clues in the diagnosis and rehabilitation of FMD., (© 2022. The Author(s).)

This paper explores the chemistry of mercury as described in ancient alchemical literature. Alchemy's focus on the knowledge and manipulation of natural substances is not so different from modern chemistry's purposes. The great divide between the two is marked by the way of conceptualizing and recording their practices. Our interdisciplinary research group, composed of chemists and historians of science, has set off to explore the cold and hot extraction of mercury from cinnabar. The ancient written records have been perused in order to devise laboratory experiments that could shed light on the material reality behind the alchemical narratives and interpret textual details in a unique perspective. In this way, it became possible to translate the technical lore of ancient alchemy into the modern language of chemistry. Thanks to the replication of alchemical practices, chemistry can regain its centuries-long history that has fallen into oblivion.