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2. Interventional Pain Procedures: A Narrative Review Focusing on Safety and Complications. Part 1 Injections for Spinal Pain

Author

Lo Bianco G, Tinnirello A, Papa A, Torrano V, Russo G, Stogicza A, Mercadante S, Cortegiani A, Mazzoleni S, and Schatman ME

Subjects
chronic pain, pain management, analgesics, opioid, epidural injection, facet joints, Medicine (General), R5-920
Abstract

Giuliano Lo Bianco,1,2 Andrea Tinnirello,3 Alfonso Papa,4 Vito Torrano,5 Gianluca Russo,6 Agnes Stogicza,7 Sebastiano Mercadante,8 Andrea Cortegiani,9 Silvia Mazzoleni,3 Michael E Schatman10,11 1Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy; 2Department of Anesthesiology and Pain, Fondazione Istituto G. Giglio, Cefalù, Italy; 3Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Iseo, Italy; 4Department of Pain Management– AO “Ospedali dei Colli” – Monaldi Hospital, Naples, Italy; 5Department of Anesthesia, Critical Care and Pain Medicine, Asst Grande Ospedale Metropolitano Niguarda, Milan, Italy; 6Department of Anesthesia, Postoperative Intensive Care and Pain Therapy, Lodi Hospital, Lodi, Italy; 7Department of Anesthesiology Saint Magdolna Hospital, Budapest, Hungary; 8Department of Pain Relief and Supportive Care, Private Hospital La Maddalena, Palermo, Sicilia, Italy; 9Department of Anesthesiology and Intensive Care, Università degli Studi di Palermo, Palermo, Italy; 10Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU School of Medicine, New York, NY, USA; 11Department of Population Health – Division of Medical Ethics, NYU School of Medicine, New York, NY, USACorrespondence: Andrea Tinnirello, Department of Anesthesiology and Pain Medicine, ASST Franciacorta, Ospedale di Iseo, Via Giardini Garibaldi 4, Iseo, 25049, Italy, Tel +393392599568, Email andreatinny@libero.itAbstract: In recent years, there has been a considerable increase in the number of image-guided interventional procedures performed for the management of acute and chronic pain. Concomitantly, there has also been an increase in the complication rate related to these procedures. The aim of this narrative review is to summarize the primary complications associated with commonly performed image-guided (fluoroscopic- or ultrasound-guided) interventional procedures. We conclude that although complications from interventional pain procedures can be mitigated to a certain degree, they cannot be eliminated altogether. In order to avoid adverse events, patient safety should be given considerable attention and physicians should be constantly aware of the possibility of developing complications.Keywords: chronic pain, pain management, analgesics, opioid, epidural injection, facet joints

Published
2023

4. High-Intensity Robot-Assisted Hand Training in Individuals with Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial

Author

Gandolfi, M., Valè, N., Dimitrova, E., Mazzoleni, S., Battini, E., Benedetti, M. D., Gajofatto, A., Ferraro, F., Corradi, J., Castelli, M., Camin, M., Filippetti, M., De Paoli, C., Picelli, A., Chemello, E., Waldner, A., Smania, N., Guglielmelli, Eugenio, Series Editor, Masia, Lorenzo, editor, Micera, Silvestro, editor, Akay, Metin, editor, and Pons, José L., editor

Published
2019
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9. Windstorm disturbance triggers multiple species invasion in an urban Mediterranean forest

Author

Bonanomi G, Incerti G, Abd El-Gawad AM, Sarker TC, Stinca A, Motti R, Cesarano G, Teobaldelli M, Saulino L, Cona F, Chirico GB, Mazzoleni S, and Saracino A

Subjects
Invasive Plants, Microburst, Mediterranean Evergreen Woodland, Quercus ilex, Resources Fluctuation, Empty Niche, Forestry, SD1-669.5
Abstract

Plant invasion in forest ecosystems is a serious ecological and economic issue, deserving attention by researchers, managers and policy-makers worldwide. Many invasive plants have been reported as early successional species able to colonize disturbed areas following abrupt changes in microhabitat and resource availability. We investigated disturbance effects of a severe windstorm generated by a wet microburst (hail and rain at 160 mm h-1) remarkably affecting the canopy cover of an old-growth Quercus ilex urban forest in Southern Italy. This stand-replacing disturbance produced a mosaic of 103 gaps, 5.6 to 1632 m2 in size, over an area of 1.53 ha, uprooting 76% of the trees and decreasing thereby 85% of the standing above-ground dry biomass into the gaps. By intensive monitoring we compared above- and below-ground microclimate, soil moisture and mineral N availability in paired disturbed and control areas of the study forest. Within newly formed gaps we observed a seasonally consistent 70% higher content of nitrate nitrogen, 29% and 47% decreases of ammonia nitrogen in summer and autumn, respectively, and a higher moisture in topsoil, in addition to different above- and below-ground microclimatic conditions, with canopy cover mitigating extreme temperatures. One year after the windstorm, the microhabitat shift promoted the establishment in gaps of 15 native and 10 alien taxa previously absent in both disturbed and control plots. In such conditions, the rarefaction of the dominant Q. ilex canopy cover and the occurrence of empty niches prone to invasion could dramatically affect the local community structure and diversity. Our data indicate that stand-replacing windstorm can transiently transform the studied urban evergreen forest to an early allogenic successional community dominated, in the medium and large gaps, by annual and perennial non-native species. This is particularly relevant under a perspective of possible increasing frequency of windstorm events in the Mediterranean region in the near future.

Published
2018
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14. Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews

Author

Straudi S., Baluardo L., Arienti C., Bozzolan M., Lazzarini S. G., Agostini M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Perrero L., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Cinnera AM, Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli C., Gandolfi M., Russo EF, Boetto V., Straudi, S., Baluardo, L., Arienti, C., Bozzolan, M., Lazzarini, S. G., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Perrero, L., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Cinnera, Am, Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, C., Gandolfi, M., Russo, Ef, and Boetto, V.

Subjects
Stroke, robot-assisted arm therapy, exoskeleton device, exoskeleton devices, end-effector device, arm rehabilitation, end-effector devices
Abstract

BACKGROUND: Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE: The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS: The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS: 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION: RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.

Published
2022

15. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review

Author

Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Andrenelli E., Carmignano, S, Fundaro, C, Bonaiuti, D, Calabro, R, Cassio, A, Mazzoli, D, Bizzarini, E, Campanini, I, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Andrenelli, E, Carmignano S. M., Fundaro C., Bonaiuti D., Calabro R. S., Cassio A., Mazzoli D., Bizzarini E., Campanini I., Cerulli S., Chisari C., Colombo V., Dalise S., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Andrenelli E.

Abstract

BACKGROUND: Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE: To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS: A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS: We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS: RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.

Published
2022

16. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review

Author

Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bizzarrini E., Stampacchia, G, Gazzotti, V, Olivieri, M, Andrenelli, E, Bonaiuti, D, Calabro, R, Carmignano, S, Cassio, A, Fundaro, C, Companini, I, Mazzoli, D, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Mazzoleni, D, Melegari, C, Merlo, A, Boldrini, P, Mazzoleni, S, Posteraro, F, Mazzucchelli, M, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bizzarrini, E, Stampacchia G., Gazzotti V., Olivieri M., Andrenelli E., Bonaiuti D., Calabro R. S., Carmignano S. M., Cassio A., Fundaro C., Companini I., Mazzoli D., Cerulli S., Chisari C., Colombo V., Dalise S., Mazzoleni D., Melegari C., Merlo A., Boldrini P., Mazzoleni S., Posteraro F., Mazzucchelli M., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bizzarrini E.

Abstract

BACKGROUND: Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function.OBJECTIVE: The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity.METHODS: Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale.RESULTS: Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved.CONCLUSION: Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.

Published
2022

17. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review

Author

Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Mazzucchelli, M, Mazzoleni, D, Campanini, I, Merlo, A, Mazzoli, D, Melegari, C, Colombo, V, Cerulli, S, Piscitelli, D, Perin, C, Andrenelli, E, Bizzarini, E, Calabro, R, Carmignano, S, Cassio, A, Chisari, C, Dalise, S, Fundaro, C, Gazzotti, V, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Mazzucchelli M., Mazzoleni D., Campanini I., Merlo A., Mazzoli D., Melegari C., Colombo V., Cerulli S., Piscitelli D., Perin C., Andrenelli E., Bizzarini E., Calabro R. S., Carmignano S. M., Cassio A., Chisari C., Dalise S., Fundaro C., Gazzotti V., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Background: The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. Objective: This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. Methods: The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. Results: Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. Conclusion: It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.

Published
2022

18. Forest fires in 2017: a useful lesson

Author

Battipaglia G, Tognetti R, Valese E, Ascoli D, De Luca PF, Basile S, Ottaviano M, Mazzoleni S, Marchetti M, and Esposito A

Subjects
Forest Fire, Forest Management, Silviculture, Prescribed Fire, Forestry, SD1-669.5
Abstract

Forest fires in 2017: a useful lesson. Forest fires, together with the decline of silviculture practice, are one of the most important natural disturbances affecting Mediterranean forests. The year 2017 is shaping up to be a record breaking fire season all around Southern Europe and especially in Italy for the sheer amount of hectares burned. Here we discuss about the importance of forest fire management, highlighting the role of prescribed burning and mechanical treatment (e.g., manual removal, thinning) in reducing the risk of high-intensity wildfires. We report on the successful applications of those fire management techniques on the pinewoods of Vesuvio National Park and Castel Fusano Natural Reserve. The information compiled in the present article aims to demonstrate the potential relevance and impact of forest resources management for fire hazard reduction and shows the necessity of strong interaction among not only the scientific community, but also forest managers, decision makers and the civic responsibility of society at large.

Published
2017
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20. High-Intensity Robot-Assisted Hand Training in Individuals with Multiple Sclerosis: A Randomized, Controlled, Single-Blinded Trial

Author

Gandolfi, M., primary, Valè, N., additional, Dimitrova, E., additional, Mazzoleni, S., additional, Battini, E., additional, Benedetti, M. D., additional, Gajofatto, A., additional, Ferraro, F., additional, Corradi, J., additional, Castelli, M., additional, Camin, M., additional, Filippetti, M., additional, De Paoli, C., additional, Picelli, A., additional, Chemello, E., additional, Waldner, A., additional, and Smania, N., additional

Published
2018
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22. Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit

Author

Ludovichetti, F S, Zuccon, A, Positello, P, Zerman, N, Gracco, A, Stellini, E, and Mazzoleni, S

Subjects
Paediatric dentistry, Oral hygiene, Paediatric intensive care unit, Ventilator-associated pneumonia
Abstract

Data indicate a tendency towards an increased incidence through the last decades of various forms of pneumonia. Among these, nosocomial pneumonia in patients who have been on mechanical ventilation support (increased after the Covid-19 pandemic) is a condition that must be addressed as soon as possible to avoid complications. Current literature lacks an in-depth analysis of the potential correlation between ventilator-associated pneumonia and poor oral hygiene, especially in children. The aim of this literature review is to investigate if improving oral hygiene could affect the onset of nosocomial pneumonia in children.A search was performed in Pubmed, Medline, and Scopus for the keywords: oral care, children, neonates, ventilator-associated pneumonia, combined with 'AND' or 'OR' Boolean Operators.The relevant papers retrieved in the scientific literature emphasised the importante of good oral care bundles to mitigate the bacteria proliferation in the bloodstream, and to prevent the development of ventilator-associated pneumonia.

Published
2022

25. 284MO Targeting the tumor microenvironment of glioblastoma multiforme using a macrophage-based treatment for the local delivery of immune-therapeutic payload: The TEM-GBM study (NCT03866109)

Author

Finocchiaro, G., primary, Eoli, M., additional, Farina, F., additional, Gentner, B., additional, Capotondo, A., additional, Anghileri, E., additional, Bruzzone, M., additional, D'Alessandris, Q.G., additional, Franzin, A., additional, Ferroli, P., additional, Gagliardi, F., additional, Legnani, F., additional, Mazzoleni, S., additional, Olivi, A., additional, Pallini, R., additional, Saini, M., additional, Zambanini, A., additional, Naldini, L., additional, Russo, C., additional, and Ciceri, F., additional

Published
2022
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27. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review

Author

Bressi F., Cricenti L., Campagnola B., Bravi M., Miccinilli S., Santacaterina F., Sterzi S., Straudi S., Agostini M., Paci M., Casanova E., Marino D., La Rosa G., Giansanti D., Perrero L., Battistini A., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Gallotti M., Germanotta M., Aprile I., Bressi, F., Cricenti, L., Campagnola, B., Bravi, M., Miccinilli, S., Santacaterina, F., Sterzi, S., Straudi, S., Agostini, M., Paci, M., Casanova, E., Marino, D., La Rosa, G., Giansanti, D., Perrero, L., Battistini, A., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Gallotti, M., Germanotta, M., and Aprile, I.

Subjects
Stroke, robotic, cognitive outcome, rehabilitation, robotic rehabilitation, systematic review, upper limb
Abstract

BACKGROUND: Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE: To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS: The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS: Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION: Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.

Published
2022

28. Robot-Assisted Upper Limb Training for Patients with Multiple Sclerosis: An Evidence-Based Review of Clinical Applications and Effectiveness

Author

Straudi S., Tramontano M., Russo E. F., Perrero L., Agostini M., Gandolfi M., Aprile I., Paci M., Casanova E., Marino D., La Rosa G., Bressi F., Sterzi S., Giansanti D., Battistini A., Miccinilli S., Filoni S., Sicari M., Petrozzino S., Solaro C. M., Gargano S., Benanti P., Boldrini P., Bonaiuti D., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzoleni S., Mazzon S., Molteni F., Petrarca M., Picelli A., Posteraro F., Senatore M., Turchetti G., Morone G., Palomba A., Arienti C., Baluardo L., Cinnera A. M., Desilvestri M., Bravi M., Bruno D., Santacaterina F., Pecchioli P., Boetto V., Straudi, S., Tramontano, M., Russo, E. F., Perrero, L., Agostini, M., Gandolfi, M., Aprile, I., Paci, M., Casanova, E., Marino, D., La Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Morone, G., Palomba, A., Arienti, C., Baluardo, L., Cinnera, A. M., Desilvestri, M., Bravi, M., Bruno, D., Santacaterina, F., Pecchioli, P., and Boetto, V.

Subjects
robotics, Fluid Flow and Transfer Processes, Exoskeleton, Multiple sclerosis, Rehabilitation, Robotic devices, Technology, QH301-705.5, Process Chemistry and Technology, Physics, QC1-999, General Engineering, Multiple sclerosis, robotics, rehabilitation, exoskeleton, Engineering (General). Civil engineering (General), Computer Science Applications, NO, Chemistry, General Materials Science, Multiple sclerosi, TA1-2040, Biology (General), Instrumentation, QD1-999
Abstract

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusions.

Published
2022

29. What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations

Author

Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., Bonaiuti D., Calabro, R, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Morone, G, Bonaiuti, D, Calabro R. S., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Petrarca M., Picelli A., Senatore M., Turchetti G., Morone G., and Bonaiuti D.

Abstract

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robot

Published
2021

30. robotic-assisted gait rehabilitation following stroke: A systematic review of current guidelines and practical clinical recommendations

Author

Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., Bonaiuti D., Calabro, R, Sorrentino, G, Cassio, A, Mazzoli, D, Andrenelli, E, Bizzarini, E, Campanini, I, Carmignano, S, Cerulli, S, Chisari, C, Colombo, V, Dalise, S, Fundaro, C, Gazzotti, V, Mazzoleni, D, Mazzucchelli, M, Melegari, C, Merlo, A, Stampacchia, G, Boldrini, P, Mazzoleni, S, Posteraro, F, Benanti, P, Castelli, E, Draicchio, F, Falabella, V, Galeri, S, Gimigliano, F, Grigioni, M, Mazzon, S, Molteni, F, Morone, G, Petrarca, M, Picelli, A, Senatore, M, Turchetti, G, Bonaiuti, D, Calabro R. S., Sorrentino G., Cassio A., Mazzoli D., Andrenelli E., Bizzarini E., Campanini I., Carmignano S. M., Cerulli S., Chisari C., Colombo V., Dalise S., Fundaro C., Gazzotti V., Mazzoleni D., Mazzucchelli M., Melegari C., Merlo A., Stampacchia G., Boldrini P., Mazzoleni S., Posteraro F., Benanti P., Castelli E., Draicchio F., Falabella V., Galeri S., Gimigliano F., Grigioni M., Mazzon S., Molteni F., Morone G., Petrarca M., Picelli A., Senatore M., Turchetti G., and Bonaiuti D.

Abstract

Introduction: Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. EVidEncE acQuisition: We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and october 31, 2020. We explored electronic databases (n.=4), guideline repositories and professional rehabilitation networks (n.=12). two independent reviewers used the appraisal of Guidelines for research and Evaluation (aGrEE) ii instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. EVIDENCE SYNTHESIS: From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. conclusions: our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. however, robot assisted gait training (raGt) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.

Published
2021

35. P1359: USING GENE-MODIFIED AUTOLOGOUS STEM CELLS PROGENY TO REEDUCATE THE TUMOR IMMUNE MICROENVIRONMENT OF SOLID TUMORS (TEM-GBM STUDY)

Author

Farina, F., primary, Gentner, B., additional, Eoli, M., additional, Finocchiaro, G., additional, Capotondo, A., additional, Cuccarini, V., additional, Naldini, M. M., additional, Barcella, M., additional, Anghileri, E., additional, Brambilla, V., additional, Bruzzone, M. G., additional, Carrabba, M., additional, D’Alessandris, G., additional, Di Meco, F., additional, Ferla, V., additional, Franzin, A., additional, Ferroli, P., additional, Gagliardi, F., additional, Legnani, F., additional, Mazzoleni, S., additional, Mortini, P., additional, Olivi, A., additional, Pallini, R., additional, Patanè, M., additional, Paterra, R., additional, Pollo, B., additional, Saini, M., additional, Snider, S., additional, Naldini, L., additional, Russo, C., additional, and Ciceri, F., additional

Published
2022
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37. MEchatronic REspiratory System SImulator for Neonatal Applications (MERESSINA) project: a novel bioengineering goal

Author

Scaramuzzo RT, Ciantelli M, Baldoli I, Bellanti L, Gentile M, Cecchi F, Sigali E, Tognarelli S, Ghirri P, Mazzoleni S, Menciassi A, Cuttano A, Boldrini A, Laschi C, and Dario P

Subjects
Medical technology, R855-855.5
Abstract

Rosa T Scaramuzzo,1,2 Massimiliano Ciantelli,1 Ilaria Baldoli,3 Lisa Bellanti,3 Marzia Gentile,1 Francesca Cecchi,3 Emilio Sigali,1 Selene Tognarelli,3 Paolo Ghirri,1–4 Stefano Mazzoleni,3 Arianna Menciassi,3 Armando Cuttano,1 Antonio Boldrini,1–4 Cecilia Laschi,3 Paolo Dario3 1Centro di Formazione e Simulazione Neonatale "NINA," UO Neonatologia, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy; 2Istituto di Scienze della Vita, 3The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy; 4Università di Pisa, Pisa, Italy Abstract: Respiratory function is mandatory for extrauterine life, but is sometimes impaired in newborns due to prematurity, congenital malformations, or acquired pathologies. Mechanical ventilation is standard care, but long-term complications, such as bronchopulmonary dysplasia, are still largely reported. Therefore, continuous medical education is mandatory to correctly manage devices for assistance. Commercially available breathing function simulators are rarely suitable for the anatomical and physiological realities. The aim of this study is to develop a high-fidelity mechatronic simulator of neonatal airways and lungs for staff training and mechanical ventilator testing. The project is divided into three different phases: (1) a review study on respiratory physiology and pathophysiology and on already available single and multi-compartment models; (2) the prototyping phase; and (3) the on-field system validation. Keywords: simulation, lung, newborn, continuous medical education, respiratory system

Published
2013

42. Prescribed burning experiences in Italy: an integrated approach to prevent forest fires

Author

Ascoli D, Catalanotti A, Valese E, Cabiddu S, Delogu G, Driussi M, Esposito A, Leone V, Lovreglio R, Marchi E, Mazzoleni S, Rutigliano FA, Strumia S, and Bovio G

Subjects
Prescribed burning, Wildfire prevention, Habitat conservation, Grazing management, Fire professional training, Forestry, SD1-669.5
Abstract

Prescribed burning is used in many geographical areas for multiple and integrated objectives (wildfire prevention, habitat conservation, grazing management). In Europe the collaboration between researchers and fire professionals has brought to implement this technique over increasing areas (~104 ha year-1), effectively and efficiently. In Italy prescribed burning has not been much studied and it is rarely applied. A new interest is recently rising. Some Regions particularly threatened by wildfires have updated their legislation and set up procedures to authorize prescribed fire experiments and interventions. From 2004 to 2011 several scientific, operative and training experiences have been carried out at a regional level (Basilicata, Campania, Friuli Venezia Giulia, Piemonte, Sardegna, Toscana). The present paper aims to: (i) document and compare these regional programs; (ii) discuss their frameworks and limitations; (iii) provide information about objectives, prescriptions, methods and results. The study has involved Universities, Forest Corps, Civil Protection, Municipalities, Parks and professionals from Italy and other Countries. Interventions have regarded integrated objectives (fire hazard reduction; habitat conservation; forest and grazing management), and involved several vegetation types (broadleaved and conifer forests; Mediterranean and Continental shrublands; grasslands). Studies on fire behaviour and ecology have helped to set prescriptions for specific objectives and environments. Results have been transferred to professionals through training sessions. Several common elements are outlined: integrated objectives, multidisciplinary character, training and research products. Ecological questions, certification to the use of fire, communication to local communities and the proposal of new studies, are some of the issues outlined in the discussion. The present study is the first review at national level and we hope it will help to deepen the meaning and limitations of a technique which is an effective tool to prevent wildfires when integrated in the forest and land planning process.

Published
2012
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44. Robot-assisted arm therapy in neurological health conditions: Rationale and methodology for the evidence synthesis in the CICERONE Italian Consensus Conference

Author

Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., Santacaterina, F., Gimigliano, F., Palomba, A., Arienti, C., Morone, G., Perrero, L., Agostini, M., Aprile, I., Paci, M., Casanova, E., Marino, D., la Rosa, G., Bressi, F., Sterzi, S., Giansanti, D., Battistini, A., Miccinilli, S., Filoni, S., Sicari, M., Petrozzino, S., Solaro, C. M., Gargano, S., Benanti, P., Boldrini, P., Bonaiuti, D., Castelli, E., Draicchio, F., Falabella, V., Galeri, S., Grigioni, M., Mazzoleni, S., Mazzon, S., Molteni, F., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Straudi, S., Baluardo, L., Boetto, V., Bravi, M., Bruno, D., Desilvestri, M., Gandolfi, M., Martino Cinnera, A., Pecchioli, C., Russo, E. F., and Santacaterina, F.

Subjects
Upper extremity, Consensus, Robot, medicine.medical_treatment, Population, Psychological intervention, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Consensu, Robotic surgical procedure, Consensus development conference, Neurological rehabilitation, Rehabilitation, Robotic surgical procedures, Arm, Humans, Italy, Disabled Persons, Robotics, NO, Nursing, medicine, education, Upper limb, education.field_of_study, Rehabilitation, Robotics, Upper extremity, Neurological rehabilitation, Consensus conference, business.industry, Consensus conference, Neurological health conditions, Data extraction, Electromechanical devices, Disabled Person, Working group, business, Evidence synthesis, Human
Abstract

BACKGROUND: Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions. AIM: The aim of this paper was to explain the methodology used by the working group dedicated to synthesizing evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference. DESIGN: The methodological approach of the working group. SETTING: All rehabilitation settings. POPULATION: Patients with disability following a neurological health condition. METHODS: Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions. RESULTS: WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed. CONCLUSIONS: This paper summarized the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions. CLINICAL REHABILITATION IMPACT: WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.

Published
2021

45. What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials

Author

Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., Taglione, E., Bowman, T., Gervasoni, E., Amico, A. P., Antenucci, R., Benanti, P., Boldrini, P., Bonaiuti, D., Burini, A., Castelli, E., Francesco, Draicchio, Falabella, V., Galeri, S., Gimigliano, F., Grigioni, M., Mazzon, S., Mazzoleni, S., Mestanza Mattos, F. G., Molteni, F., Morone, G., Petrarca, M., Picelli, A., Posteraro, F., Senatore, M., Turchetti, G., Crea, S., Cattaneo, D., Carrozza, M. C., Baricich, A., Bissolotti, L., Capecci, M., Cavalli, L., Di Stefano, G., Jonsdottir, J., Lentino, C., Massai, P., Morelli, S., Nardone, A., Panzeri, D., and Taglione, E.

Subjects
medicine.medical_specialty, medicine.medical_treatment, Physical Therapy, Sports Therapy and Rehabilitation, Context (language use), Walk Test, Cochrane Library, law.invention, Multiple sclerosis, Disability Evaluation, Physical medicine and rehabilitation, Gait training, Randomized controlled trial, law, Multiple Sclerosi, Neurologic, Medicine, Humans, Gait Disorders, Gait, Gait Disorders, Neurologic, Randomized Controlled Trials as Topic, Rehabilitation, Robotics, Combined Modality Therapy, Multiple Sclerosis, Exoskeleton Device, business.industry, Evidence-based medicine, Robotic, Berg Balance Scale, business, human activities, Human
Abstract

Introduction In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described. Evidence acquisition As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies. Evidence synthesis The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed. Conclusions In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.

Published
2021

50. Plant–environment interactions through a functional traits perspective: a review of Italian studies

Author

Chelli, S, Marignani, M, Barni, E, Petraglia, A, Puglielli, G, Wellstein, C, Acosta, A, Bolpagni, R, Bragazza, L, Campetella, G, Chiarucci, A, Conti, L, Nascimbene, J, Orsenigo, S, Pierce, S, Ricotta, C, Tardella, F, Abeli, T, Aronne, G, Bacaro, G, Bagella, S, Benesperi, R, Bernareggi, G, Bonanomi, G, Bricca, A, Brusa, G, Buffa, G, Burrascano, S, Caccianiga, M, Calabrese, V, Canullo, R, Carbognani, M, Carboni, M, Carranza, M, Catorci, A, Ciccarelli, D, Citterio, S, Cutini, M, Dalle Fratte, M, De Micco, V, Del Vecchio, S, Di Martino, L, Di Musciano, M, Fantinato, E, Filigheddu, R, Frattaroli, A, Gentili, R, Gerdol, R, Giarrizzo, E, Giordani, P, Gratani, L, Incerti, G, Lussu, M, Mazzoleni, S, Mondoni, A, Montagnani, C, Montagnoli, A, Paura, B, Petruzzellis, F, Pisanu, S, Rossi, G, Sgarbi, E, Simonetti, E, Siniscalco, C, Slaviero, A, Stanisci, A, Stinca, A, Tomaselli, M, Cerabolini, B, Chelli S., Marignani M., Barni E., Petraglia A., Puglielli G., Wellstein C., Acosta A. T. R., Bolpagni R., Bragazza L., Campetella G., Chiarucci A., Conti L., Nascimbene J., Orsenigo S., Pierce S., Ricotta C., Tardella F. M., Abeli T., Aronne G., Bacaro G., Bagella S., Benesperi R., Bernareggi G., Bonanomi G., Bricca A., Brusa G., Buffa G., Burrascano S., Caccianiga M., Calabrese V., Canullo R., Carbognani M., Carboni M., Carranza M. L., Catorci A., Ciccarelli D., Citterio S., Cutini M., Dalle Fratte M., De Micco V., Del Vecchio S., Di Martino L., Di Musciano M., Fantinato E., Filigheddu R., Frattaroli A. R., Gentili R., Gerdol R., Giarrizzo E., Giordani P., Gratani L., Incerti G., Lussu M., Mazzoleni S., Mondoni A., Montagnani C., Montagnoli A., Paura B., Petruzzellis F., Pisanu S., Rossi G., Sgarbi E., Simonetti E., Siniscalco C., Slaviero A., Stanisci A., Stinca A., Tomaselli M., Cerabolini B. E. L., Chelli, S, Marignani, M, Barni, E, Petraglia, A, Puglielli, G, Wellstein, C, Acosta, A, Bolpagni, R, Bragazza, L, Campetella, G, Chiarucci, A, Conti, L, Nascimbene, J, Orsenigo, S, Pierce, S, Ricotta, C, Tardella, F, Abeli, T, Aronne, G, Bacaro, G, Bagella, S, Benesperi, R, Bernareggi, G, Bonanomi, G, Bricca, A, Brusa, G, Buffa, G, Burrascano, S, Caccianiga, M, Calabrese, V, Canullo, R, Carbognani, M, Carboni, M, Carranza, M, Catorci, A, Ciccarelli, D, Citterio, S, Cutini, M, Dalle Fratte, M, De Micco, V, Del Vecchio, S, Di Martino, L, Di Musciano, M, Fantinato, E, Filigheddu, R, Frattaroli, A, Gentili, R, Gerdol, R, Giarrizzo, E, Giordani, P, Gratani, L, Incerti, G, Lussu, M, Mazzoleni, S, Mondoni, A, Montagnani, C, Montagnoli, A, Paura, B, Petruzzellis, F, Pisanu, S, Rossi, G, Sgarbi, E, Simonetti, E, Siniscalco, C, Slaviero, A, Stanisci, A, Stinca, A, Tomaselli, M, Cerabolini, B, Chelli S., Marignani M., Barni E., Petraglia A., Puglielli G., Wellstein C., Acosta A. T. R., Bolpagni R., Bragazza L., Campetella G., Chiarucci A., Conti L., Nascimbene J., Orsenigo S., Pierce S., Ricotta C., Tardella F. M., Abeli T., Aronne G., Bacaro G., Bagella S., Benesperi R., Bernareggi G., Bonanomi G., Bricca A., Brusa G., Buffa G., Burrascano S., Caccianiga M., Calabrese V., Canullo R., Carbognani M., Carboni M., Carranza M. L., Catorci A., Ciccarelli D., Citterio S., Cutini M., Dalle Fratte M., De Micco V., Del Vecchio S., Di Martino L., Di Musciano M., Fantinato E., Filigheddu R., Frattaroli A. R., Gentili R., Gerdol R., Giarrizzo E., Giordani P., Gratani L., Incerti G., Lussu M., Mazzoleni S., Mondoni A., Montagnani C., Montagnoli A., Paura B., Petruzzellis F., Pisanu S., Rossi G., Sgarbi E., Simonetti E., Siniscalco C., Slaviero A., Stanisci A., Stinca A., Tomaselli M., and Cerabolini B. E. L.

Abstract

Italy is among the European countries with the greatest plant diversity due to both a great environmental heterogeneity and a long history of man–environment interactions. Trait-based approaches to ecological studies have developed greatly over recent decades worldwide, although several issues concerning the relationships between plant functional traits and the environment still lack sufficient empirical evaluation. To draw insights on the association between plant functional traits and direct and indirect human and natural pressures on the environmental drivers, this article summarizes the existing knowledge on this topic by reviewing the results of studies performed in Italy adopting a functional trait approach on vascular plants, bryophytes and lichens. Although we recorded trait measurements for 1418 taxa, our review highlighted some major gaps in plant traits knowledge: Mediterranean ecosystems are poorly represented; traits related to belowground organs are still overlooked; traits measurements for bryophytes and lichens are lacking. Finally, intraspecific variation has been little studied at community level so far. We conclude by highlighting the need for approaches evaluating trait–environment relationship at large spatial and temporal scales and the need of a more effective contribution to online databases to tie more firmly Italian researchers to international scientific networks on plant traits.

Published
2019

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