Stefano Scarano
@unimi.it
Universita degli Studi di Milano
Scopus Publications
Scopus Publications
Antonio Caronni, Michela Picardi, Stefano Scarano, Viviana Rota, Giacomo Guidali, Nadia Bolognini, and Massimo Corbo
Springer Science and Business Media LLC
Abstract Background Tracking gait and balance impairment in time is paramount in the care of older neurological patients. The Minimal Detectable Change (MDC), built upon the Standard Error of the Measurement (SEM), is the smallest modification of a measure exceeding the measurement error. Here, a novel method based on linear mixed-effects models (LMMs) is applied to estimate the standard error of the measurement from data collected before and after rehabilitation and calculate the MDC of gait and balance measures. Methods One hundred nine older adults with a gait impairment due to neurological disease (66 stroke patients) completed two assessment sessions before and after inpatient rehabilitation. In each session, two trials of the 10-meter walking test and the Timed Up and Go (TUG) test, instrumented with inertial sensors, have been collected. The 95% MDC was calculated for the gait speed, TUG test duration (TTD) and other measures from the TUG test, including the angular velocity peak (ωpeak) in the TUG test’s turning phase. Random intercepts and slopes LMMs with sessions as fixed effects were used to estimate SEM. LMMs assumptions (residuals normality and homoscedasticity) were checked, and the predictor variable ln-transformed if needed. Results The MDC of gait speed was 0.13 m/s. The TTD MDC, ln-transformed and then expressed as a percentage of the baseline value to meet LMMs’ assumptions, was 15%, i.e. TTD should be < 85% of the baseline value to conclude the patient’s improvement. ωpeak MDC, also ln-transformed and expressed as the baseline percentage change, was 25%. Conclusions LMMs allowed calculating the MDC of gait and balance measures even if the test-retest steady-state assumption did not hold. The MDC of gait speed, TTD and ωpeak from the TUG test with an inertial sensor have been provided. These indices allow monitoring of the gait and balance impairment, which is central for patients with an increased falling risk, such as neurological old persons. Trial registration NA.
Stefano NEGRINI, Carlotte KIEKENS, William M. LEVACK, Thorsten MEYER-FEIL, Chiara ARIENTI, Pierre CÔTÉ, and
Edizioni Minerva Medica
The paper introduces the Special Sections of the European Journal of Physical and Rehabilitation Medicine dedicated to the 5th Methodological Meeting of Cochrane Rehabilitation. It introduces Cochrane Rehabilitation; its vision, mission and goals; discusses why the Methodological Meetings were created; and reports on their organisation and previous outcomes. The core content of this editorial is the 5th Methodological Meeting held in Milan in September 2023. The original title for this meeting was “The Rehabilitation Evidence Ecosystem: useful study designs.” The focus of the Milan meeting was informed by the lessons learned by Cochrane Rehabilitation in the past few years, by the new rehabilitation definition for research purposes, by the collaboration with the World Health Organization (WHO), and by the REH-COVER (Rehabilitation COVID-19 Evidence-Based Response) action. During the Meeting, participants discussed the current methodological evidence on the following: RCTs in rehabilitation coming from meta-epidemiological studies; observational study designs – specifically the IDEAL Framework (Idea, Development, Exploration, Assessment, Long-term study) and its potential implementation in rehabilitation and the Target Trial Emulation framework: Single Case Experimental Designs; complex intervention studies: health services research studies, and studies using qualitative approaches. The Meeting culminated in the development of a first version of a “road map” to navigate the evidence production in rehabilitation according to the previous discussions. The Special Sections’ papers present all topics discussed at the meeting, and a methodological paper about choosing the right research question, presenting final results and the “road map” for evidence production in rehabilitation.
Laura Perucca, Stefano Scarano, Giovanna Russo, Antonio Robecchi Majnardi, and Antonio Caronni
Frontiers Media SA
IntroductionFatigue and poor balance are frequent and severe problems in multiple sclerosis (MS) that may interact. Endurance training is known to be effective on fatigue. This study aims to test if balance training is more effective against MS fatigue.MethodsA randomised crossover trial was run, recruiting 31 MS people (21 women; median age: 46 years, range: 30–64; median EDSS: 4, range: 2.5–5). Participants received balance and endurance training alternately (15 one-to-one sessions, 5 days/week) and were assessed before (T0), after (T1), and 30 days after treatment ended (T2). The Modified Fatigue Impact Scale (MFIS) with scores linearised through Rasch analysis was the primary outcome (the lower the measure, the better the condition, i.e., the lower the fatigue symptoms). The Equiscale balance scale and posturography (EquiTest) were used to assess balance. Linear mixed-effects models with ANOVA were used for significance testing.ResultsThirteen participants had no carryover effect and were included in the primary analysis. Fatigue significantly changed across the three time points (F2,58 = 16.0; p &lt; 0.001), but no difference across treatments was found. Altogether, both treatments significantly improved the MFIS measure at T1 (95%CI: −1.24 logits; mean: −1.67 to −0.81 logits) and T2 (95%CI: −1.04; mean: −1.49 to −0.60) compared to T0 (95%CI: −0.51; mean: −0.95 to −0.08; p ≤ 0.001). Equiscale and posturography highlighted balance improvement after balance training but not after endurance training.ConclusionBalance and endurance training could similarly reduce fatigue in MS patients in the short term. However, only balance training also improved balance in MS.
Luigi Tesio, Antonio Caronni, Anna Simone, Dinesh Kumbhare, and Stefano Scarano
Informa UK Limited
Purpose: The present paper presents developments and advanced practical applications of Rasch's theory and statistical analysis to construct questionnaires for measuring a person's traits. The flaws of questionnaires providing raw scores are well known. Scores only approximate objective, linear measures. The Rasch Analysis allows you to turn raw scores into measures with an error estimate, satisfying fundamental measurement axioms (e.g., unidimensionality, linearity, generalizability). A previous companion article illustrated the most frequent graphic and numeric representations of results obtained through Rasch Analysis. A more advanced description of the method is presented here.Conclusions: Measures obtained through Rasch Analysis may foster the advancement of the scientific assessment of behaviours, perceptions, skills, attitudes, and knowledge so frequently faced in Physical and Rehabilitation Medicine, not less than in social and educational sciences. Furthermore, suggestions are given on interpreting and managing the inevitable discrepancies between observed scores and ideal measures (data-model "misfit"). Finally, twelve practical take-home messages for appraising published results are provided.
Luigi Tesio, Antonio Caronni, Dinesh Kumbhare, and Stefano Scarano
Informa UK Limited
Purpose: The present article summarises the characteristics of Rasch's theory, providing an original metrological model for persons' measurements. Properties describing the person "as a whole" are key outcome variables in Medicine. This is particularly true in Physical and Rehabilitation Medicine, targeting the person's interaction with the outer world. Such variables include independence, pain, fatigue, balance, and the like. These variables can only be observed through behaviours of various complexity, deemed representative of a given "latent" person's property. So how to infer its "quantity"? Usually, behaviours (items) are scored ordinally, and their "raw" scores are summed across item lists (questionnaires). The limits and flaws of scores (i.e., multidimensionality, non-linearity) are well known, yet they still dominate the measurement in Medicine.Conclusions: Through Rasch's theory and statistical analysis, scores are transformed and tested for their capacity to respect fundamental measurement axioms. Rasch analysis returns the linear measure of the person's property ("ability") and the item's calibrations ("difficulty"), concealed by the raw scores. The difference between a person's ability and item difficulty determines the probability that a "pass" response is observed. The discrepancy between observed scores and the ideal measures (i.e., the residual) invites diagnostic reasoning. In a companion article, advanced applications of Rasch modelling are illustrated.
Fabio Zaina, Irene Ferrario, Antonio Caronni, Stefano Scarano, Sabrina Donzelli, and Stefano Negrini
MDPI AG
Idiopathic scoliosis is common in adulthood and can impact patients’ physical and psychological health. The Scoliosis Research Society-22 Questionnaire (SRS-22) has been designed to assess health-related quality of life (HRQOL) in idiopathic scoliosis, and it is the most used disease-specific outcome tool from adolescence to adulthood. More recently, the Italian Spine Youth Quality of Life (ISYQOL) international questionnaire was developed, which performs better than SRS-22 in adolescent spinal deformities. However, the ISYQOL questionnaire has never been tested in adults. This study compares the construct validity of ISYQOL and SRS-22 with the Rasch analysis (partial credit model). We recruited 150 adults and 50 adolescents with scoliosis (≥30° Cobb). SRS-22, but not ISQYOL, showed disordered categories and one item not fitting the Rasch model. A 21-item SRS-22 version with revised categories was arranged and further compared to ISYQOL. Both questionnaires showed multidimensionality, and some items (SRS-22 in a greater number) functioned differently in persons of different ages. However, the artefacts caused by multidimensionality and differential functioning had a low impact on the questionnaires’ measures. The construct validity of ISYQOL International and the revised SRS-22 are comparable. Both questionnaires (but not the original SRS-22) can return measures of disease burden in adults with scoliosis.
Luigi Tesio, Antonio Caronni, Cristina Russo, Giorgio Felisari, Elisabetta Banco, Anna Simone, Stefano Scarano, and Nadia Bolognini
MDPI AG
In mirror training (MIT), stroke patients strive to move their hands while looking at the reflected image of the unaffected one. The recruitment of the mirror neurons and visual-proprioceptive conflict are expected to facilitate the paretic voluntary movement. Here, a reversed MIT (REMIT) is presented, which requires moving hands while looking at the reflected image of the paretic one, giving the illusion of being unable to move the unimpaired hand. This study compares MIT and REMIT on post-stroke upper-limb recovery to gain clues on the mechanism of action of mirror therapies. Eight chronic stroke patients underwent two weeks of MIT and REMIT (five sessions each) in a crossover design. Upper-limb Fugl-Meyer, Box and Block and handgrip strength tests were administered at baseline and treatments end. The strength of the mirror illusion was evaluated after each session. MIT induced a larger illusory effect. The Fugl-Meyer score improved to the same extent after both treatments. No changes occurred in the Box and Block and the handgrip tests. REMIT and MIT were equally effective on upper-limb dexterity, challenging the exclusive role of mirror neurons. Contrasting learned nonuse through an intersensory conflict might provide the rationale for both forms of mirror-based rehabilitation after stroke.
Valeria Cerina, Luigi Tesio, Chiara Malloggi, Viviana Rota, Antonio Caronni, and Stefano Scarano
MDPI AG
Neck proprioception is commonly assessed with head repositioning tests. In such a test, an operator rotates the head of a blindfolded individual to a target position. After returning to the rest position, the participant actively repositions the head to the target. Joint Position Error (JPE) is the angular difference between the target angle (however oriented in a 3D space) and the actively reached positions (the smaller the difference, the better the proprioception). This study aimed to validate a head-to-target (HTT) repositioning test using an optoelectronic system for also measuring the components of the JPE in the horizontal, frontal, and sagittal planes. The head movements requested by the operator consisted of 30° left-right rotations and 25° flexion-extension. The operators or subjects could not obtain these movements without modest rotations in other planes. Two operators were involved. Twenty-six healthy participants (13 women) were recruited (mean (SD): 33.4 (6.3) years). The subjects’ JPE in the requested (intended) plane of motion (JPEint-component) was a few degrees only and smaller for flexion-extensions than for left-right rotations (right rotation: 5.39° (5.29°); left rotation: 5.03° (4.51°), extension: 1.79° (3.94°); flexion: 0.54° (4.35°)). Participants’ average error in unintended planes was around 1° or less. Inter-operator consistency and agreement were high. The smallest detectable change, at p < 0.05, for JPEint-component ranged between 4.5° and 6.98°. This method of optoelectronic measurement in HTT repositioning tests provides results with good metric properties, fostering application to clinical studies.
Antonio Caronni, Michela Picardi, Stefano Scarano, Peppino Tropea, Giulia Gilardone, Nadia Bolognini, Valentina Redaelli, Giuseppe Pintavalle, Evdoxia Aristidou, Paola Antoniotti,et al.
MDPI AG
The Mini-Balance Evaluation Systems Test (Mini-BESTest), a 14-item scale, has high content validity for balance assessment. This study further examines the construct validity of the Mini-BESTest with an emphasis on its measurement invariance. The Mini-BESTest was administered to 292 neurological patients in two sessions (before and after rehabilitation) and evaluated with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, sessions). Categories’ order and fit to the model were assessed. Next, maps, dimensionality, and differential item functioning (DIF) were examined for construct validity evaluation. DIF was inspected for several clinically important variables, including session, diagnosis, and assistive devices. Mini-BESTest items had ordered categories and fitted the Rasch model. The item map did not flag severe construct underrepresentation. The dimensionality analysis showed that another variable extraneous to balance affected the score of a few items. However, this multidimensionality had only a modest impact on measures. Session did not cause DIF. DIF for assistive devices affected six items and caused a severe measurement artefact. The measurement artefact caused by DIF for diagnosis was negligible. The Mini-BESTest returns interval measures with robust construct validity and measurement invariance. However, caution should be used when comparing Mini-BESTest measures obtained with and without assistive devices.
Edoardo Nicolò Aiello, Veronica Pucci, Lorenzo Diana, Alessia Corvaglia, Aida Niang, Silvia Mattiello, Alice Naomi Preti, Giorgia Durante, Adele Ravelli, Lucia Consonni,et al.
Springer Science and Business Media LLC
Abstract Background This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. Methods The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients—who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test–retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. Results The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald’s ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). Discussion The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.
Antonio Caronni, Michela Picardi, Stefano Scarano, Chiara Malloggi, Peppino Tropea, Giulia Gilardone, Evdoxia Aristidou, Giuseppe Pintavalle, Valentina Redaelli, Paola Antoniotti,et al.
Frontiers Media SA
BackgroundBalance, i.e., the ability not to fall, is often poor in neurological patients and this impairment increases their risk of falling. The Mini-Balance Evaluation System Test (Mini-BESTest), a rating scale, the Timed Up and Go (TUG) test, and gait measures are commonly used to quantify balance. This study assesses the criterion validity of these measures as balance measures.MethodsThe probability of being a faller within nine months was used as the balance criterion. The Mini-BESTest, TUG (instrumented with inertial sensors), and walking test were administered before and after inpatient rehabilitation. Multiple and LASSO logistic regressions were used for the analysis. The diagnostic accuracy of the model was assessed with the area under the curve (AUC) of the receiver operating characteristic curve. Mobility measure validity was compared with the Akaike Information Criterion (AIC).ResultsTwo hundred and fourteen neurological patients (stroke, peripheral neuropathy, or parkinsonism) were recruited. In total, 82 patients fell at least once in the nine-month follow-up. The Mini-BESTest (AUC = 0.69; 95%CI: 0.62–0.76), the duration of the TUG turning phase (AUC = 0.69; 0.62–0.76), and other TUG measures were significant faller predictors in regression models. However, only the turning duration (AIC = 274.0) and Mini-BESTest (AIC = 276.1) substantially improved the prediction of a baseline model, which only included fall risk factors from the medical history (AIC = 281.7). The LASSO procedure selected gender, disease chronicity, urinary incontinence, the Mini-BESTest, and turning duration as optimal faller predictors.ConclusionThe TUG turning duration and the Mini-BESTest predict the chance of being a faller. Their criterion validity as balance measures in neurological patients is substantial.
Antonio Caronni, Marina Ramella, Pietro Arcuri, Claudia Salatino, Lucia Pigini, Maurizio Saruggia, Chiara Folini, Stefano Scarano, and Rosa Maria Converti
MDPI AG
This study aims to test the construct validity and reliability of the Quebec User Evaluation of Satisfaction with assistive Technology 2.0 (QUEST)–device, an eight-item questionnaire for measuring satisfaction with assistive devices. We collected 250 questionnaires from 79 patients and 32 caregivers. One QUEST was completed for each assistive device. Five assistive device types were included. QUEST was tested with the Rasch analysis (Many-Facet Rating Scale Model: persons, items, and device type). Most patients were affected by neurological disabilities, and most questionnaires were about mobility devices. All items fitted the Rasch model (InfitMS range: 0.88–1.1; OutfitMS: 0.84–1.28). However, the ceiling effect of the questionnaire was large (15/111 participants totalled the maximum score), its targeting poor (respondents mean measure: 1.90 logits), and its reliability was 0.71. The device classes had different calibrations (range: −1.18 to 1.26 logits), and item 3 functioned differently in patients and caregivers. QUEST satisfaction measures have low reliability and weak construct validity. Lacking invariance, the QUEST total score is unsuitable for comparing the satisfaction levels of users of different device types. The differential item functioning suggests that the QUEST could also be problematic for comparing satisfaction in patients and caregivers.
Luigi Tesio, Stefano Scarano, Samah Hassan, Dinesh Kumbhare, and Antonio Caronni
Ovid Technologies (Wolters Kluwer Health)
ABSTRACT
Any person is provided by characteristics that can be neither located in body parts nor directly observed (so-called "latent" variables): these may be behaviors, attitudes, perceptions, motor and cognitive skills, knowledge, emotions, and the like. PRM frequently faces variables of this kind, the target of many interventions. Latent variables can only be observed through representative behaviors (e.g., walking for independence, moaning for pain, social isolation for depression, etc.). To measure them, behaviors are often listed and summated as items in cumulative questionnaires ("scales"). Questionnaires ultimately provide observations ("raw scores") with the aspect of numbers. Unfortunately, they are only a rough and often misleading approximation to true measures for various reasons. Measures should satisfy the same measurement axioms of physical sciences. In the present article, the flaws hidden in questionnaires' scores are summarised, and their consequences in outcome assessment are highlighted. The report should inspire a critical attitude in the readers and foster the interest in modern item response theory, with reference to Rasch analysis.
Stefano Scarano, Valeria Ada Sansone, Carola Rita Ferrari Aggradi, Elena Carraro, Luigi Tesio, Maurizio Amadei, Viviana Rota, Alice Zanolini, and Antonio Caronni
Frontiers Media SA
Falls are frequent in Myotonic Dystrophy type 1 (DM1), but the pathophysiology of the balance impairment needs further exploration in this disease. The current work aims to provide a richer understanding of DM1 imbalance. Standing balance in 16 patients and 40 controls was tested in two posturographic tests (EquiTest™). In the Sensory Organization Test (SOT), standstill balance was challenged by combining visual (eyes open vs. closed) and environmental conditions (fixed vs. sway-tuned platform and/or visual surround). In the “react” test, reflexes induced by sudden shifts in the support base were studied. Oscillations of the body centre of mass (COM) were measured. In the SOT, COM sway was larger in patients than controls in any condition, including firm support with eyes open (quiet standing). On sway-tuned support, COM oscillations when standing with closed eyes were larger in patients than controls even after taking into account the oscillations with eyes open. In the “react” paradigm, balance reflexes were delayed in patients. Results in both experimental paradigms (i.e., SOT and react test) are consistent with leg muscle weakness. This, however, is not a sufficient explanation. The SOT test highlighted that patients rely on vision more than controls to maintain static balance. Consistently enough, evidence is provided that an impairment of proprioceptive and vestibular systems contributes to falls in DM1. Rehabilitation programs targeted at reweighting sensory systems may be designed to improve safe mobility in DM1.
Edoardo Nicolò Aiello, Veronica Pucci, Lorenzo Diana, Aida Niang, Alice Naomi Preti, Adriana Delli Ponti, Gaia Sangalli, Stefano Scarano, Luigi Tesio, Stefano Zago,et al.
Springer Science and Business Media LLC
Abstract Background Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). Methods The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. Results In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC = .78–.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). Discussion The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.
Stefano Scarano, Viviana Rota, Luigi Tesio, Laura Perucca, Antonio Robecchi Majnardi, and Antonio Caronni
Frontiers Media SA
Fahr’s disease is a rare idiopathic degenerative disease characterized by calcifications in the brain, and has also been associated with balance impairment. However, a detailed analysis of balance in these patients has not been performed. A 69-year-old woman with Fahr’s disease presented with a long-lasting subjective imbalance. Balance was analyzed using both clinical (EquiScale, Timed Up and Go test, and Dizziness Handicap Inventory-short form) and instrumented tests (the sway of the body center of mass during quiet, perturbed, and self-perturbed stance, and the peak curvature of the center of mass during single stance while walking on a force-treadmill). The patient’s balance was normal during clinical tests and walking. However, during standing, a striking impairment in vestibular control of balance emerged. The balance behavior displayed mixed parkinsonian (e.g., slowness and reduced amplitude of movement) and cerebellar (e.g., increased sway during standing in all conditions and decomposition of movement) features, with a discrepancy between the high severity of the static and the low severity of the dynamic balance impairment. The balance impairment characteristics outlined in this study could help neurologists and physiatrists detect, stage, and treat this rare condition.
Chiara Malloggi, Matteo Zago, Manuela Galli, Chiarella Sforza, Stefano Scarano, and Luigi Tesio
Elsevier BV
The relative displacements of body segments during walking can be reduced to a small number of multi-joint kinematic patterns, pmk, through Principal Component Analysis (PCA). These patterns were extracted from two groups of children (n = 8, aged 6-9 years, 4 males, and n = 8, aged 10-13 years, 4 males) and 7 adults (21-29 years, 1 male), walking on a treadmill at various velocities, normalized to body stature (adimensional Froude number, Fr). The three-dimensional coordinates of body markers were captured by an optoelectronic system. Five components (pm1 to pm5) explained 99.1% of the original dataset variance. The relationship between the variance explained ("size") of each pmk and the Fr velocity varied across movement components and age groups. Only pm1 and pm2, which described kinematic patterns in the sagittal plane, showed significant differences (at p < 0.05) across pairs of age groups. The time course of the size of all the five components matched various mechanical events of the step cycle at the level of both body system and lower limb joints. Such movement components appeared clinically interpretable and lend themselves as potential markers of neural development of walking.
Laura Perucca, Antonio Robecchi Majnardi, Silvia Frau, and Stefano Scarano
Frontiers Media SA
Aging is known to increase the risk of falling. In older people, whose share in the total population is rising sharply, the Sensory Organization Test (SOT, Equitest NeuroCom) is a useful tool during rehabilitation and in clinical research for assessing postural stability, risk of falling, and balance improvement. Normative data for the SOT in the healthy population older than 79 years have not been previously published. We recruited 53 recreationally active healthy subjects aged 80 years and older from the general population in a cross-sectional study. We presented the normative data for SOT for the 80–84 and 85–89 years groups. Our results showed that the “vestibular” balance control tended to be affected by aging more than the vision and proprioception-based systems. A striking reduction in performance after the age of 85 years was observed. These findings will be useful for clinical and research purposes.
Calogero Malfitano, Angela Rossetti, Stefano Scarano, Chiara Malloggi, and Luigi Tesio
Frontiers Media SA
Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. Repetitive transcranial magnetic stimulation (rTMS) has been reported to be effective in chronic cases. However, there are no data on the effects in the acute and subacute phases after stroke. In this study, we present a case of a patient with thalamic stroke with acute onset of pain and paresthesia who was responsive to rTMS. After a right thalamic stroke, a 32-year-old woman presented with drug-resistant pain and paresthesia on the left side of the body. There were no motor or sensory deficits, except for blunted thermal sensation and allodynia on light touch. Ten daily sessions were performed, where 10 Hz rTMS was applied to the hand area of the right primary motor cortex, 40 days after stroke. Before rTMS treatment (T0), immediately after treatment conclusion (T1), and 1 month after treatment (T2), three pain questionnaires were administered, and cortical responses to single and paired-pulse TMS were assessed. Eight healthy participants served as controls. At T0, when the patient was experiencing the worst pain, the excitability of the ipsilesional motor cortex was reduced. At T1 and T2, the pain scores and paresthesia' spread decreased. The clinical improvement was paralleled by the recovery in motor cortex excitability of the affected hemisphere, in terms of both intra- and inter-hemispheric connections. In this subacute central post-stroke pain case, rTMS treatment was associated with decreased pain and motor cortex excitability changes.
Chiara Malloggi, Stefano Scarano, Valeria Cerina, Luigi Catino, Viviana Rota, and Luigi Tesio
Elsevier BV
During walking, falling is most likely to occur towards the side of the supporting lower limb during the single stance. Timely lateral redirection of the centre of mass (CoM) preceding the no-return position is necessary for balance. We analysed the curvature peaks (the inverse of the radius of curvature) of the three-dimensional path of the CoM during the entire stride. Twelve healthy adults walked on a force-sensorized treadmill at constant velocities from 0.4 to 1.2 m s-1, in 0.2 m s-1 increments. The three-dimensional displacements of the CoM, the muscular power sustaining the CoM motion with respect to the ground, and the efficiency of the pendulum-like transfer of the CoM were computed via the double integration of the ground reaction forces. The curvatures of the CoM trajectory were measured (Frenet-Serret formula). During the single stance, the curvature showed a bell-shaped increment, lasting a few tenths of a millisecond, and peaking at 365-683 m-1 (radius of 2.7-1.4 mm, respectively), the higher the walking velocity. The CoM was redirected towards the swinging lower limb. The curvature increment was sustained by muscle-driven braking of the CoM. Smoother increments of curvature (peaking at approximately 37-150 m-1), further orienting the CoM towards the leading lower limb, were observed during the double stance. The peaks of the curvatures were symmetric between the two sides. The high curvature peaks during the single stance may represent an index of dynamic balance during walking. This index might be useful for both rehabilitation and sports training purposes.
Stefano Scarano, Luigi Tesio, Viviana Rota, Valeria Cerina, Luigi Catino, and Chiara Malloggi
MDPI AG
While walking on split-belt treadmills (two belts running at different speeds), the slower limb shows longer anterior steps than the limb dragged by the faster belt. After returning to basal conditions, the step length asymmetry is transiently reversed (after-effect). The lower limb joint dynamics, however, were not thoroughly investigated. In this study, 12 healthy adults walked on a force-sensorised split-belt treadmill for 15 min. Belts rotated at 0.4 m s−1 on both sides, or 0.4 and 1.2 m s−1 under the non-dominant and dominant legs, respectively. Spatiotemporal step parameters, ankle power and work, and the actual mean velocity of the body’s centre of mass (CoM) were computed. On the faster side, ankle power and work increased, while step length and stance time decreased. The mean velocity of the CoM slightly decreased. As an after-effect, modest converse asymmetries developed, fading within 2–5 min. These results may help to decide which belt should be assigned to the paretic and the unaffected lower limb when split-belt walking is applied for rehabilitation research in hemiparesis.
Luigi Tesio, Stefano Scarano, Valeria Cerina, Chiara Malloggi, and Luigi Catino
Ovid Technologies (Wolters Kluwer Health)
Abstract Walking on split-belt treadmills (each belt rotating at a different velocity) has inspired a growing number of researchers to study gait adaptation and rehabilitation. An overlooked peculiarity of this artificial form of gait is that the mean velocity adopted by the participant, considered as a whole system represented by the body Center of Mass, can be different from the mean velocity of the two belts. Twelve healthy adults (21–34 yrs) were requested to walk for 15 mins on a treadmill with belts rotating at 0.4 and 1.2 m sec−1, respectively (mean = 0.8 m sec−1). Each belt was supported by four 3-dimensional force sensors. For each participant, six strides were analyzed during the 1st and the 15th minute of the trial. The mean Center of Mass velocity was computed as the sum of the velocities of each belt weighted by the percentage of time during which the resulting forces, underlying the accelerations of the Center of Mass, originated from each belt. Across early and late observations, the median Center of Mass velocities were 0.72 and 0.67 m sec−1, respectively (P < 0.05). Therefore, the real velocity of the Center of Mass and its time course should be individually assessed when studying walking on split-belt treadmills.
Luigi Tesio and Stefano Scarano
Ovid Technologies (Wolters Kluwer Health)
Luigi Catino, Chiara Malloggi, Stefano Scarano, Valeria Cerina, Viviana Rota, and Luigi Tesio
IOS Press
BACKGROUND: A method of measurement of voluntary activation (VA, percent of full muscle recruitment) during isometric and isokinetic concentric contractions of the quadriceps femoris (QF) at 60∘/s and 120∘/s was previously validated. OBJECTIVE: This study aimed to quantify the test-retest minimal real difference (MRD) of VA during isometric (ISOM) and isokinetic concentric contractions of QF (100∘/s, ISOK) in a sample of healthy individuals. METHODS: VA was measured through the interpolated twitch technique. Pairs of electrical stimuli were delivered to the QF at 40∘ of knee flexion during maximal voluntary contractions. Twenty-five healthy participants (20–38 years, 12 women, 13 men) completed two testing sessions with a 14-day interval. VA values were linearized through logit transformation (VAl). The MRD was estimated from intraclass correlation coefficients (model 2.1). RESULTS: The VA (median, range) was 84.20% (38.2–99.9%) in ISOM and 94.22% (33.8–100%) in ISOK. MRD was 0.78 and 1.12 logit for ISOM and ISOK, respectively. As an example, in terms of percent VA these values correspond to a change from 76% to 95% and from 79% to 98% in ISOM and in ISOK, respectively. CONCLUSIONS: The provided MRD values allow to detect significant individual changes in VA, as expected after training and rehabilitation programs.
Luigi Tesio, Stefano Scarano, and Laura Perucca
Ovid Technologies (Wolters Kluwer Health)