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1. 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

2. 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

3. 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

4. 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

5. The Era of Nerve Transfers in Tetraplegic Patients: Our Multidisciplinary Experience

Author

Lavorato A, Titolo P, Negri S, Giuseppe Massazza, G. Isoardo, Giulia Colzani, Garbossa D, Francesca Vincitorio, Battiston B, Minetto Ma, Petrozzino S, Morini S, and Dimanico U

Subjects
medicine.medical_specialty, business.industry, General Medicine, medicine.disease, Spinal cord, Annual incidence, medicine.anatomical_structure, Multidisciplinary approach, medicine, Physical therapy, Young adult, Upper limb rehabilitation, business, Pre-operative evaluation, human activities, Tetraplegia
Abstract

The annual incidence of Spinal Cord Injuries (SCI) is estimated around 40 to 100 cases per million worldwide, and mainly affects young adults involved in sports or road accidents...

Published
2021

6. Identifying clinical complexity in patients affected by severe acquired brain injury in neurorehabilitation: a cross sectional survey

Author

Scarponi F., Zampolini M., Zucchella C., Bargellesi S., Fassio C., Pistoia F., Bartolo M, Raggi R, Beatrici M, Macchetta C, Cocchini L, Benedetti A, Bianconi F, Bramanti P, Marino S, Corallo F, Brambilla M, Carboncini M C., Spina V, Cervigni G, Cimenti F, Previaio C, Semerjian M, Colombari M, De Cicco D, De Tanti A, Iardella L, Diverio M), Grifoni C, Carl V, Pasqualone E, Estraneo A, Formisano R, Ciurli M P., Galardi M, Santangelo A, Giorgini T, Biasutti E, Iaia V, Intiso D, Lamberti G, Antoniono E, Lanfranchi M, Lavezzi S, Chiavaroli R, Lucca L F., Maggioni G, Mancuso M, Canova S, Mandala G, Melizza G, Montis A, Pilia F, Mulè C., Navarro J, Lanzillotti C, Perin C, Petrozzino S, Schierano G, Battistini A, Premoselli S, Salvi P, Simonini M, Sara M Pardo M, Serafini P, Fortuna R, Sergio M A., Volanti P, Scarponi, F, Zampolini, M, Zucchella, C, Bargellesi, S, Fassio, C, Pistoia, F, Bartolo, M, Raggi, R, Beatrici, M, Macchetta, C, Cocchini, L, Benedetti, A, Bianconi, F, Bramanti, P, Marino, S, Corallo, F, Brambilla, M, Carboncini M, C, Spina, V, Cervigni, G, Cimenti, F, Previaio, C, Semerjian, M, Colombari, M, De Cicco, D, De Tanti, A, Iardella, L, Diverio, M, Grifoni, C, Carl, V, Pasqualone, E, Estraneo, A, Formisano, R, Ciurli M, P, Galardi, M, Santangelo, A, Giorgini, T, Biasutti, E, Iaia, V, Intiso, D, Lamberti, G, Antoniono, E, Lanfranchi, M, Lavezzi, S, Chiavaroli, R, Lucca L, F, Maggioni, G, Mancuso, M, Canova, S, Mandala, G, Melizza, G, Montis, A, Pilia, F, Mulè, C, Navarro, J, Lanzillotti, C, Perin, C, Petrozzino, S, Schierano, G, Battistini, A, Premoselli, S, Salvi, P, Simonini, M, Sara, M, Serafini, P, Fortuna, R, Sergio M, A, and Volanti, P

Subjects
Patient admission, Male, 030506 rehabilitation, medicine.medical_specialty, Cross-sectional study, medicine.medical_treatment, Population, Glasgow Outcome Scale, Physical Therapy, Sports Therapy and Rehabilitation, Comorbidity, Brain injuries, Rehabilitation Centers, Brain injurie, Disability Evaluation, 03 medical and health sciences, 0302 clinical medicine, Acute care, medicine, Humans, education, Paroxysmal sympathetic hyperactivity, Acquired brain injury, Neurorehabilitation, Cross-Sectional Studie, Rehabilitation Center, Inpatients, Health Services Needs and Demand, education.field_of_study, Rehabilitation, business.industry, Neurological Rehabilitation, Middle Aged, medicine.disease, Brain Injuries, Cross-Sectional Studies, Female, Physical therapy, Inpatient, 0305 other medical science, business, 030217 neurology & neurosurgery, Human
Abstract

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Published
2019

7. Incidence of traumatic spinal cord injury in Italy during 2013-2014: a population-based study

Author

Ferro, S., Cecconi, L., Bonavita, J., Pagliacci, M. C., Biggeri, A., Franceschini, M., Bellentani, M., Cavina, A., De Iure, F., Gordini, G., Redaelli, T., Actis, M. V., Del Popolo, G., Bertagnoni, G., Avesani, R., Falabella, V., Stillittano, M., Petrozzino, S., Cisari, C., Salvini, M., Tosi, R., Borghi, C. M., Bava, A., Pistarini, C., Molinero, G., Signorelli, A., Sandri, S., Simeoni, F., Brambilla, M., Banchero, M. A., Olivero, A., Zanaboni, G., Leucci, M., Lain, L., Saia, M., Zampa, A., Del Fabro, P., Saccavini, M., Fanzutto, A., Massone, A., Gaddoni, D., Olivi, S., Musumeci, G., Pederzini, R., Bazo, H. C., Nicolotti, D., Nora, M., Brianti, R., Iaccarino, C., Volpi, A., Lombardi, A., Cavazza, S., Casoni, F., Piperno, R., Teodorani, G., Naldi, A., Vergoni, G., Maietti, E., Botti, A., Pagoto, G., Moresi, M., Postiglione, M., Bini, C., Tagliaferri, M., Recchioni, M. A., Pelaia, P., Di Furia, L., Maschke, R., Caruso, L., Speziali, L., Zenzeri, M., Fiore, P., Marvulli, R., Nardulli, R., Lanzillotti, C., Ruccia, M., Onesta, M. P., Di Gregorio, T., Franchina, F., Furnari, M. G., Pilati, C., Merafina, M., Crescia, F., Fletzer, D., Scivoletto, G., and Di Lallo, N.

Subjects
Adult, Male, 030506 rehabilitation, medicine.medical_specialty, Pediatrics, Adolescent, Population, 03 medical and health sciences, Young Adult, 0302 clinical medicine, statistica medica, Sex Factors, Epidemiology, medicine, Humans, Prospective Studies, Prospective cohort study, education, Tetraplegia, Spinal cord injury, Spinal Cord Injuries, Aged, Aged, 80 and over, education.field_of_study, business.industry, Incidence (epidemiology), Incidence, Age Factors, General Medicine, Middle Aged, medicine.disease, Neurology, Italy, Etiology, Physical therapy, Female, Neurology (clinical), 0305 other medical science, Paraplegia, business, 030217 neurology & neurosurgery
Abstract

Observational prospective population-based incidence study. The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4–16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies.

Published
2017

10. Upper Limb Robotic Rehabilitation for Patients With Cervical Spinal Cord Injury: A Comprehensive Review

Author

Serena Filoni, Alberto Battistini, Francesca Gimigliano, Sofia Straudi, Silvia Sterzi, Michele Senatore, Irene Aprile, Donatella Bonaiuti, Marialuisa Gandolfi, Federico Posteraro, Enrico Castelli, Stefano Gargano, Vincenzo Falabella, Lorenzo Lippi, Dario Marino, Federica Bressi, Stefano Mazzon, Marco Invernizzi, Salvatore Petrozzino, Giuseppe La Rosa, Silvia Galeri, Paolo Boldrini, Luca Perrero, Monica Sicari, Michela Agostini, Francesco Draicchio, Franco Molteni, Paolo Benanti, Mauro Grigioni, Claudio Solaro, Matteo Paci, Stefano Mazzoleni, Giuseppe Turchetti, Alex Martino Cinnera, Sandra Miccinilli, Alessandro de Sire, Emanuela Casanova, Giovanni Morone, Maurizio Petrarca, Alessandro Picelli, Daniele Giansanti, Morone, G., de Sire, A., Cinnera, A. M., Paci, M., Perrero, L., Invernizzi, M., Lippi, L., Agostini, M., Aprile, I., 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., Gandolfi, M., Posteraro, F., Senatore, M., Turchetti, G., and Straudi, S.

Subjects
medicine.medical_specialty, medicine.medical_treatment, clinical_neurology, Neurosciences. Biological psychiatry. Neuropsychiatry, Robotic rehabilitation, NO, robotic therapy, rehabilitation, robot-assisted therapy, Physical medicine and rehabilitation, Arm function, medicine, cervical spinal cord injury, Robotic therapy, Rehabilitation, business.industry, General Neuroscience, exoskeleton, Exoskeleton, Cervical spinal cord injury, Robot-assisted therapy, medicine.anatomical_structure, Upper limb, arm function, Systematic Review, business, RC321-571
Abstract

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on “Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin” (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.

Published
2021

11. 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 CM, 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
Humans, Activities of Daily Living, Upper Extremity, Cognition, Recovery of Function, Stroke complications, Stroke therapy, Stroke Rehabilitation
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
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12. Upper Limb Robotic Rehabilitation for Patients with Cervical Spinal Cord Injury: A Comprehensive Review.

Author

Morone G, de Sire A, Martino Cinnera A, Paci M, Perrero L, Invernizzi M, Lippi L, Agostini M, Aprile I, Casanova E, Marino D, La Rosa G, Bressi F, Sterzi S, Giansanti D, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, 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, Gandolfi M, Posteraro F, Senatore M, Turchetti G, and Straudi S

Abstract

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on "Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin" (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.

Published
2021
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13. 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 CM, 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, and Straudi S

Subjects
Arm, Consensus, Humans, Italy, Disabled Persons, Robotics
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
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14. Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke.

Author

Morone G, Palomba A, Martino Cinnera A, Agostini M, Aprile I, Arienti C, Paci M, Casanova E, Marino D, LA Rosa G, Bressi F, Sterzi S, Gandolfi M, Giansanti D, Perrero L, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, 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, and Straudi S

Subjects
Combined Modality Therapy, Guidelines as Topic, Humans, Stroke Rehabilitation instrumentation, Robotics methods, Stroke Rehabilitation methods, Upper Extremity physiopathology
Abstract

Introduction: Upper limb motor impairment is one of the most frequent stroke consequences. Robot therapy may represent a valid option for upper limb stroke rehabilitation, but there are still gaps between research evidence and their use in clinical practice. The aim of this study was to determine the quality, scope, and consistency of guidelines clinical practice recommendations for upper limb robotic rehabilitation in stroke populations., Evidence Acquisition: We searched for guideline recommendations on stroke published between January 1st, 2010 and January 1st, 2020. Only the most recent guidelines for writing group were selected. Electronic databases (N.=4), guideline repertories and professional rehabilitation networks (N.=12) were searched. We systematically reviewed and assessed guidelines containing recommendation statements about upper limb robotic rehabilitation for adults with stroke (PROSPERO registration number: CRD42020173386)., Evidence Synthesis: Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 1324 papers that were screened, eight eligible guidelines were identified from six different regions/countries. Half of the included guidelines focused on stroke management, the other half on stroke rehabilitation. Rehabilitation assisted by robotic devices is generally recommended to improve upper limb motor function and strength. The exact characteristics of patients who could benefit from this treatment as well as the correct timing to use it are not known., Conclusions: This systematic review has identified many opportunities to modernize and otherwise improve stroke patients' upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.

Published
2021
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15. Cardiorespiratory comorbidity: a new challenge for physical and rehabilitation medicine specialist.

Author

Massucci M, Perrero L, Mantellini E, Petrozzino S, Gamna F, Nocella A, Sciarrini F, Antenucci R, and Bonaiuti D

Subjects
Activities of Daily Living, Adult, Aged, Aged, 80 and over, Comorbidity trends, Female, Heart Diseases rehabilitation, Humans, Italy epidemiology, Male, Middle Aged, Respiratory Tract Diseases rehabilitation, Retrospective Studies, Workforce, Disability Evaluation, Heart Diseases epidemiology, Length of Stay statistics & numerical data, Outcome Assessment, Health Care, Patient Discharge statistics & numerical data, Rehabilitation Centers, Respiratory Tract Diseases epidemiology
Abstract

Background: The cardiorespiratory comorbidity can reduce the participation in the rehabilitation project of patients with motor disorders., Aim: The first aim of the study was to assess the frequency of cardiopulmonary comorbidity in inpatient rehabilitation units in Italy. The second aim was to evaluate the influence of cardiorespiratory comorbidity on some process and outcome indicators., Design: Data collection with a questionnaire sent to Physical and Rehabilitation Medicine specialists., Setting: Inpatient Rehabilitation Units., Population: Patients admitted to Rehabilitation Units with neurological and orthopedic disability., Methods: A questionnaire was sent to 33 Rehabilitation Units in Italy., Outcome: Length of stay in hospital (LOS), percentage of transfer to acute wards, level of satisfaction of the Physicians related to the degree of functional recovery of patients with cardiopulmonary comorbidity. In a subgroup of patients with and without cardiopulmonary comorbidity indicators were also used to retrospectively assess functional recovery during the hospitalization., Results: Analysis were made on 16 complete responses received. Data of 909 subjects were evaluated. The mean incidence of cardiovascular and respiratory diseases is high: 61.50%. The length of hospitalization (LOS) in patients with cardiac and respiratory comorbidity is significantly longer than in subjects without associated disease (46.55, SD 21.00 days vs. 37.26, SD 18.97; P<0.05). The number of transfers to acute wards is significantly higher in subjects with cardiorespiratory comorbidity (8.62% vs. 2.44%; P<0.05). Eleven out of 16 medical doctors (69%) said they were "quite satisfied" for the degree of functional recovery of patients with comorbidity. A group of patients with neurological disabilities associated with cardiorespiratory disease had significantly lower Functional Independence Measure (FIM) score at admission (55.36, SD 20.62, vs. 73.72, SD 22.15; P<0.05) than these without comorbidity. At discharge the subjects of the two groups assessed, independently from the presence of cardiorespiratory comorbidity, present no statistically significant difference of FIM scale values., Conclusion: The high frequency of cardiorespiratory comorbidity in patients with motor disorders negatively influenced the LOS and percentage of transfer to acute wards but not necessarily the functional results. It is, therefore, necessary to train the medical doctor who specializes in physical and rehabilitation medicine also in the clinical management of complex patients., Clinical Rehabilitation Impact: The results of the survey suggest that rehabilitation is useful even in patients with motor disorders and cardiorespiratory comordibity.

Published
2012

16. [A case of post-traumatic aneurysm of the thoracic aorta].

Author

Petrozzino S, Bardon G, Locatelli A, Cardinali G, Salvato L, Viganò G, and Bianchi G

Subjects
Adult, Aorta, Thoracic, Humans, Male, Radiography, Accidents, Traffic, Aortic Rupture diagnostic imaging, Aortic Rupture etiology, Aortic Rupture surgery
Published
1988

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