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Article ; Online: Recovery of activities of daily living in COVID-19 patients requiring intensive care unit or medical care unit: an observational study on the role of rehabilitation in the subacute phase.

Notarstefano, Chiara / Bertolucci, Federica / Miccoli, Mario / Posteraro, Federico

Frontiers in rehabilitation sciences

2023 Volume 4, Page(s) 1256999

Abstract: Purpose: This study aims to describe the functional status of a cohort of subacute COVID-19 patients treated in a dedicated rehabilitation unit and to compare functional outcomes between patients previously hospitalized in the intensive care unit (ICU ... ...

Abstract	Purpose: This study aims to describe the functional status of a cohort of subacute COVID-19 patients treated in a dedicated rehabilitation unit and to compare functional outcomes between patients previously hospitalized in the intensive care unit (ICU group) and patients assisted in the medical care unit (MCU group). Materials and methods: Clinical and functional evaluations were performed at admission and discharge. The functional status was assessed using Barthel index (BI), functional ambulation categories (FAC), trunk control test (TCT), and dysphagia outcome and severity score (DOSS). All patients received multidisciplinary tailored rehabilitation. Results: We evaluated 171 patients (with a mean age of 67.7 ± 11.9 years, 117 were males), 110 coming from the ICU (with a mean age of 63.24 ± 10.9 years), and 61 coming from the MCU (with a mean age of 75.75 ± 9.09 years). The ICU group showed a worse functional status at admission compared with the MCU group [BI 2.5 (0-20) vs. 20 (10-60), FAC 0 (0-0) vs. 0 (0-2), TCT 61 (42-100) vs. 100 (61-100), DOSS 5 (1-7) vs. 7 (7-7)] and had significantly longer hospital stay. At discharge, all functional scales were improved with no statistically significant differences between the two groups. Conclusion: Early rehabilitation of COVID-19 survivors improves functional recovery closing the initial gap between the ICU and MCU groups. In addition, it is effective to improve the functional outcome reducing the costs for longer-term assistance of COVID-19 patients.
Language	English
Publishing date	2023-11-10
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-6861
ISSN (online)	2673-6861
DOI	10.3389/fresc.2023.1256999
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Article ; Online: Tele-rehabilitation for cognitive home-based treatment in young traumatic brain injury: a pilot study.

Bertolucci, Federica / Fossati, Loredana / Agostini, Barbara / Malasoma, Chiara / Sgandurra, Giuseppina / Del Lucchese, Benedetta / Miccoli, Mario / Posteraro, Federico

European journal of physical and rehabilitation medicine

2024

Language	English
Publishing date	2024-03-21
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2426908-6
ISSN	1973-9095 ; 1973-9087
ISSN (online)	1973-9095
ISSN	1973-9087
DOI	10.23736/S1973-9087.24.08379-5
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Article ; Online: Comprehensive rehabilitation treatment for sub-acute COVID-19 patients: an observational study.

Bertolucci, Federica / Sagliocco, Laura / Tolaini, Martina / Posteraro, Federico

European journal of physical and rehabilitation medicine

2021 Volume 57, Issue 2, Page(s) 208–215

Abstract: Background: COVID-19 is a respiratory infection, but it should be considered as a systemic illness with increasing interest on the survivors' sequelae and their management. Considering multi-organ disabilities, a comprehensive rehabilitation provided in ...

Abstract	Background: COVID-19 is a respiratory infection, but it should be considered as a systemic illness with increasing interest on the survivors' sequelae and their management. Considering multi-organ disabilities, a comprehensive rehabilitation provided in sub-acute phase could be considered a suitable setting for these patients. Aim: The aim of this article was to report the features and rehabilitative outcomes of patients requiring rehabilitation due to disabilities related to severe COVID-19 infection. Design: Longitudinal Observational Study. Setting: Department of Rehabilitation in General Hospital. Population: Patients showing multiple disabilities due to severe COVID-19 infection. Methods: Thirty-nine consecutive patients were admitted to a rehabilitation ward transferred from ICU or Medical wards. Barthel Index (BI) and Functional Ambulation Categories (FAC) were scored as disabilities measures. Data regarding comorbidity, rehabilitation course, swabs, procedures in acute phase, non-respiratory manifestations, dysphagia, mental confusion, PaO2/FiO2, oxygen supplementation have been collected to admission and discharge. For all patients a comprehensive rehabilitation treatment have been provided. Results: Functional outcome is good with a statistically significant improvement in BI and FAC scores. Thirty-eight patients were discharged at their home. Mean lenght of stay (LOS) in acute wards was 46 days. Mean LOS in rehabilitation was 20 day. Eleven patients still had tracheostomy at admission, none at discharge and all dysphagic patients recovered a normal oral feeding. The change in PaO2/FiO2 and the reduction of the oxygen supplementation testify a good recovery of pulmonary function. Conclusions: Our results showed a consistent recovery with little caregiver burden at discharge. Fast relocation from ICU makes beds available which are very valuable during pandemic. Comprehensive rehabilitation treatment provided in sub-acute phase for patients still positive for SARS-CoV-2, would be desirable as it seems to be an effective setting. In this setting a strong medical assistance must be ensured. Clinical rehabilitation impact: The activation of comprehensive rehabilitation settings able to assist sub-acute patients still positive would be desirable as it could be a very efficient Healthcare Systems answer to the catastrophic pandemic, decompressing acute hospital as well. Furthermore, contagious patients with swabs positivity affected by other kind of disabilities (i.e. Stroke, Femur Fracture) can be treated avoiding to lose the early rehabilitation.
MeSH term(s)	Aged ; COVID-19/epidemiology ; COVID-19/rehabilitation ; Female ; Humans ; Intensive Care Units ; Male ; Pandemics ; Retrospective Studies ; SARS-CoV-2
Language	English
Publishing date	2021-02-04
Publishing country	Italy
Document type	Journal Article ; Observational Study
ZDB-ID	2426908-6
ISSN	1973-9095 ; 1973-9087
ISSN (online)	1973-9095
ISSN	1973-9087
DOI	10.23736/S1973-9087.21.06674-0
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Article ; Online: The potential dual role of transcallosal inhibition in post-stroke motor recovery.

Bertolucci, Federica / Chisari, Carmelo / Fregni, Felipe

Restorative neurology and neuroscience

2018 Volume 36, Issue 1, Page(s) 83–97

Abstract: Up to now, the mechanism of motor impairment and recovery after stroke has been thought to be based on the interhemispheric competition model. According to this model, which assumes that suppressing the excitability of contralesional hemisphere will ... ...

Abstract	Up to now, the mechanism of motor impairment and recovery after stroke has been thought to be based on the interhemispheric competition model. According to this model, which assumes that suppressing the excitability of contralesional hemisphere will enhance recovery by reducing transcallosal inhibition (TCI) of the stroke hemisphere, many clinical trials used non-invasive brain stimulation to improve motor function. Despite some positive findings, meta-analysis shows an important source of variability in the results, questioning whether the interhemispheric competition model would be exhaustive enough to explain the positive results or whether other mechanisms could explain the motor effects of inhibitory stimulation in the contralesional hemisphere. The goal of this study was to review the relationship between increased TCI and motor impairment after stroke.A systematic review of clinical studies investigating TCI through transcranial magnetic stimulation (TMS) in stroke patients and the relationship of this metric with motor recovery was then performed. After a literary search in PubMed eleven articles were included. The potential role of several covariates was examined and discussed.Overall, the importance of TCI as a putative mechanism for stimulation of the contralesional hemisphere seems to depend on the baseline motor function. In other words, from evidence coming mostly from chronic patients, modulation of abnormal TCI seems to be useful for patients with good motor function and less important in patients with poor motor function. TCI seems to be negatively correlated with mirror movements of the paretic hand. It can be inferred that suppressing the activity of the contralesional hemisphere could be beneficial for patients with good residual motor function and strong TCI, but not for those with poor motor function and weak TCI. Baseline motor function and measure of TCI should be taken into account for stratification of patients in clinical trials and for the design of customized treatment.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Corpus Callosum/physiology ; Databases, Bibliographic/supply & distribution ; Female ; Functional Laterality ; Humans ; Male ; Middle Aged ; Motor Activity/physiology ; Motor Cortex/physiopathology ; Stroke/physiopathology ; Stroke Rehabilitation/methods ; Transcranial Magnetic Stimulation/methods
Language	English
Publishing date	2018-02-13
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1017098-4
ISSN	1878-3627 ; 0922-6028
ISSN (online)	1878-3627
ISSN	0922-6028
DOI	10.3233/RNN-170778
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Zs.A 2792: Show issues

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Article ; Online: Chronic muscle stimulation improves muscle function and reverts the abnormal surface EMG pattern in myotonic dystrophy: a pilot study.

Chisari, Carmelo / Bertolucci, Federica / Dalise, Stefania / Rossi, Bruno

Journal of neuroengineering and rehabilitation

2013 Volume 10, Page(s) 94

Abstract: Background: To date, in Myotonic Dystrophy type 1 (DM1) the rehabilitative interventions have always been aimed at muscle strengthening, increasing of fatigue resistance and improving of aerobic metabolism efficiency whereas the electrical membrane ... ...

Abstract	Background: To date, in Myotonic Dystrophy type 1 (DM1) the rehabilitative interventions have always been aimed at muscle strengthening, increasing of fatigue resistance and improving of aerobic metabolism efficiency whereas the electrical membrane fault has always been addressed pharmacologically. Neuromuscular electrical stimulation (NMES) is a useful therapeutic tool in sport medicine and in the rehabilitation of many clinical conditions characterized by motor impairment such as stroke, cerebral palsy and spinal cord injury. Methods: Five DM1 patients and one patient with Congenital Myotonia (CM) performed a home electrical stimulation of the tibialis anterior muscle lasting 15 days with a frequency of two daily sessions of 60 minutes each. Muscle strength was assessed according to the MRC scale (Medical Research Council) and functional tests (10 Meter Walking Test, 6 Minutes Walking Test and Timed Up and Go Test) were performed. We analyzed the average rectified value of sEMG signal amplitude (ARV) to characterize the sarcolemmal excitability. Results: After the treatment an increase of muscle strength in those DM1 patients with a mild strength deficit was observed. In all subjects an improvement of 10MWT was recorded. Five patients improved their performance in the 6MWT. In TUG test 4 out of 6 patients showed a slight reduction in execution time. All patients reported a subjective improvement when walking. A complete recovery of the normal increasing ARV curve was observed in 4 out of 5 DM1 patients; the CM patient didn't show modification of the ARV pattern. Conclusions: NMES determined a clear-cut improvement of both the muscular weakness and the sarcolemmal excitability alteration in our small group of DM1 patients. Therefore this rehabilitative approach, if confirmed by further extensive studies, could be considered early in the management of muscular impairment in these patients. An attractive hypothesis to explain our encouraging result could be represented by a functional inhibition of SK3 channels expressed in muscle of DM1 subjects.
MeSH term(s)	Adult ; Aged ; Electric Stimulation Therapy/methods ; Electrodes, Implanted ; Electromyography ; Female ; Humans ; Male ; Middle Aged ; Muscle Strength ; Muscle, Skeletal/physiopathology ; Myotonic Dystrophy/physiopathology ; Myotonic Dystrophy/rehabilitation ; Pilot Projects
Language	English
Publishing date	2013-08-12
Publishing country	England
Document type	Journal Article
ISSN	1743-0003
ISSN (online)	1743-0003
DOI	10.1186/1743-0003-10-94
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Article ; Online: rTMS in the management of allodynia from brachial plexus injuries.

Bertolucci, Federica / Fanciullacci, Chiara / Rossi, Bruno / Chisari, Carmelo

Brain stimulation

2013 Volume 6, Issue 2, Page(s) 218–219

MeSH term(s)	Adult ; Brachial Plexus/injuries ; Brachial Plexus Neuropathies/physiopathology ; Brachial Plexus Neuropathies/therapy ; Female ; Humans ; Hyperalgesia/physiopathology ; Hyperalgesia/therapy ; Motor Cortex/physiopathology ; Pain Measurement ; Transcranial Magnetic Stimulation/methods ; Treatment Outcome
Language	English
Publishing date	2013-03
Publishing country	United States
Document type	Letter
ZDB-ID	2394410-9
ISSN	1876-4754 ; 1935-861X
ISSN (online)	1876-4754
ISSN	1935-861X
DOI	10.1016/j.brs.2012.03.016
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Article ; Online: Unidirectional brain to muscle connectivity reveals motor cortex control of leg muscles during stereotyped walking.

Artoni, Fiorenzo / Fanciullacci, Chiara / Bertolucci, Federica / Panarese, Alessandro / Makeig, Scott / Micera, Silvestro / Chisari, Carmelo

NeuroImage

2017 Volume 159, Page(s) 403–416

Abstract: In lower mammals, locomotion seems to be mainly regulated by subcortical and spinal networks. On the contrary, recent evidence suggests that in humans the motor cortex is also significantly engaged during complex locomotion tasks. However, a detailed ... ...

Abstract	In lower mammals, locomotion seems to be mainly regulated by subcortical and spinal networks. On the contrary, recent evidence suggests that in humans the motor cortex is also significantly engaged during complex locomotion tasks. However, a detailed understanding of cortical contribution to locomotion is still lacking especially during stereotyped activities. Here, we show that cortical motor areas finely control leg muscle activation during treadmill stereotyped walking. Using a novel technique based on a combination of Reliable Independent Component Analysis, source localization and effective connectivity, and by combining electroencephalographic (EEG) and electromyographic (EMG) recordings in able-bodied adults we were able to examine for the first time cortical activation patterns and cortico-muscular connectivity including information flow direction. Results not only provided evidence of cortical activity associated with locomotion, but demonstrated significant causal unidirectional drive from contralateral motor cortex to muscles in the swing leg. These insights overturn the traditional view that human cortex has a limited role in the control of stereotyped locomotion, and suggest useful hypotheses concerning mechanisms underlying gait under other conditions. One sentence summary: Motor cortex proactively drives contralateral swing leg muscles during treadmill walking, counter to the traditional view of stereotyped human locomotion.
MeSH term(s)	Adult ; Electroencephalography ; Electromyography ; Female ; Humans ; Male ; Motor Cortex/physiology ; Muscle, Skeletal/innervation ; Neural Pathways/physiology ; Walking/physiology
Language	English
Publishing date	2017-08-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1147767-2
ISSN	1095-9572 ; 1053-8119
ISSN (online)	1095-9572
ISSN	1053-8119
DOI	10.1016/j.neuroimage.2017.07.013
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Zs.A 3664: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Abnormal Lactate Levels Affect Motor Performance in Myotonic Dystrophy Type 1.

Tramonti, Caterina / Dalise, Stefania / Bertolucci, Federica / Rossi, Bruno / Chisari, Carmelo

European journal of translational myology

2014 Volume 24, Issue 4, Page(s) 4726

Abstract: Myotonic Dystrophy type 1 (DM1) is a dominantly inherited disease comprehending multiple features. Fatigue and exhaustion during exercise often represent significant factors able to negatively influence their compliance to rehabilitation programs. ... ...

Abstract	Myotonic Dystrophy type 1 (DM1) is a dominantly inherited disease comprehending multiple features. Fatigue and exhaustion during exercise often represent significant factors able to negatively influence their compliance to rehabilitation programs. Mitochondrial abnormalities and a significant increase in oxidative markers, previously reported, suggest the hypothesis of a mitochondrial functional impairment. The study aims at evaluating oxidative metabolism efficiency in 18 DM1 patients and in 15 healthy subjects, through analysis of lactate levels at rest and after an incremental exercise test. The exercise protocol consisted of a submaximal incremental exercise performed on an electronically calibrated treadmill, maintained in predominantly aerobic condition. Lactate levels were assessed at rest and at 5, 10 and 30 minutes after the end of the exercise. The results showed early exercise-related fatigue in DM1 patients, as they performed a mean number of 9 steps, while controls completed the whole exercise. Moreover, while resting values of lactate were comparable between the patients and the control group (p=0.69), after the exercise protocol, dystrophic subjects reached higher values of lactate, at any recovery time (p<0,05). These observations suggest an early activation of anaerobic metabolism, thus evidencing an alteration in oxidative metabolism of such dystrophic patients. As far as intense aerobic training could be performed in DM1 patients, in order to improve maximal muscle oxidative capacity and blood lactate removal ability, then, this safe and validate method could be used to evaluate muscle oxidative metabolism and provide an efficient help on rehabilitation programs to be prescribed in such patients.
Language	English
Publishing date	2014-12-24
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2545577-1
ISSN	2037-7460 ; 2037-7452
ISSN (online)	2037-7460
ISSN	2037-7452
DOI	10.4081/ejtm.2014.4726
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Article: Using Brain Oscillations and Corticospinal Excitability to Understand and Predict Post-Stroke Motor Function.

Thibaut, Aurore / Simis, Marcel / Battistella, Linamara Rizzo / Fanciullacci, Chiara / Bertolucci, Federica / Huerta-Gutierrez, Rodrigo / Chisari, Carmelo / Fregni, Felipe

Frontiers in neurology

2017 Volume 8, Page(s) 187

Abstract: What determines motor recovery in stroke is still unknown and finding markers that could predict and improve stroke recovery is a challenge. In this study, we aimed at understanding the neural mechanisms of motor function recovery after stroke using ... ...

Abstract	What determines motor recovery in stroke is still unknown and finding markers that could predict and improve stroke recovery is a challenge. In this study, we aimed at understanding the neural mechanisms of motor function recovery after stroke using neurophysiological markers by means of cortical excitability (transcranial magnetic stimulation-TMS) and brain oscillations (electroencephalography-EEG). In this cross-sectional study, 55 subjects with chronic stroke (62 ± 14 yo, 17 women, 32 ± 42 months post-stroke) were recruited in two sites. We analyzed TMS measures (i.e., motor threshold-MT-of the affected and unaffected sides) and EEG variables (i.e., power spectrum in different frequency bands and different brain regions of the affected and unaffected hemispheres) and their correlation with motor impairment as measured by Fugl-Meyer. Multiple univariate and multivariate linear regression analyses were performed to identify the predictors of good motor function. A significant interaction effect of MT in the affected hemisphere and power in beta bandwidth over the central region for both affected and unaffected hemispheres was found. We identified that motor function positively correlates with beta rhythm over the central region of the unaffected hemisphere, while it negatively correlates with beta rhythm in the affected hemisphere. Our results suggest that cortical activity in the affected and unaffected hemisphere measured by EEG provides new insights on the association between high-frequency rhythms and motor impairment, highlighting the role of an excess of beta in the affected central cortical region in poor motor function in stroke recovery.
Language	English
Publishing date	2017-05-10
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2017.00187
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Article: Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement.

Fanciullacci, Chiara / Bertolucci, Federica / Lamola, Giuseppe / Panarese, Alessandro / Artoni, Fiorenzo / Micera, Silvestro / Rossi, Bruno / Chisari, Carmelo

Frontiers in human neuroscience

2017 Volume 11, Page(s) 385

Abstract: A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings ... ...

Abstract	A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings pointed out the necessity of applying a stratification based on lesion location when investigating inter-hemispheric balance in stroke. Here, we tested whether cortical involvement could imply differences in band-specific activity and brain symmetry in post stroke patients with cortico-subcortical and subcortical strokes. We explored brain activity related to lesion location through EEG power analysis and quantitative Electroencephalography (qEEG) measures. Thirty stroke patients in the subacute phase and 10 neurologically intact age-matched right-handed subjects were enrolled. Stroke patients were equally subdivided in two groups based on lesion location: cortico-subcortical (CS, mean age ± SD: 72.21 ± 10.97 years; time since stroke ± SD: 31.14 ± 11.73 days) and subcortical (S, mean age ± SD: 68.92 ± 10.001 years; time since stroke ± SD: 26.93 ± 13.08 days) group. We assessed patients' neurological status by means of National Institutes of Health Stroke Scale (NIHSS). High density EEG at rest was recorded and power spectral analysis in Delta (1-4 Hz) and Alpha (8-14 Hz) bands was performed. qEEG metrics as pairwise derived Brain Symmetry Index (pdBSI) and Delta/Alpha Ratio (DAR) were computed and correlated with NIHSS score. S showed a lower Delta power in the Unaffected Hemisphere (UH) compared to Affected Hemisphere (AH;
Language	English
Publishing date	2017-07-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2425477-0
ISSN	1662-5161
ISSN	1662-5161
DOI	10.3389/fnhum.2017.00385
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