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Article ; Online: Rehabilitation assisted by robotic and electromechanical devices for people with neurological disabilities: contributions for the preparation of a national conference in Italy.

Boldrini, Paolo / Bonaiuti, Donatella / Mazzoleni, Stefano / Posteraro, Federico

European journal of physical and rehabilitation medicine

2020 Volume 57, Issue 3, Page(s) 458–459

MeSH term(s)	Consensus ; Electric Power Supplies ; Humans ; Italy ; Nervous System Diseases/rehabilitation ; Robotics/methods
Language	English
Publishing date	2020-11-02
Publishing country	Italy
Document type	Editorial
ZDB-ID	2426908-6
ISSN	1973-9095 ; 1973-9087
ISSN (online)	1973-9095
ISSN	1973-9087
DOI	10.23736/S1973-9087.21.07084-2
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Article ; Online: Shaping the future: an Italian survey unveils the unmet need to empower physical medicine and rehabilitation professionals with technological skills.

Capecci, Marianna / Gandolfi, Marialuisa / Straudi, Sofia / Calabrò, Rocco S / Baldini, Nicolò / Pepa, Lucia / Andrenelli, Elisa / Smania, Nicola / Ceravolo, Maria G / Morone, Giovanni / Bonaiuti, Donatella

European journal of physical and rehabilitation medicine

2024

Language	English
Publishing date	2024-04-15
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/S1973-9087.24.08376-X
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Article: Robotic versus Conventional Overground Gait Training in Subacute Stroke Survivors: A Multicenter Controlled Clinical Trial.

Pournajaf, Sanaz / Calabrò, Rocco Salvatore / Naro, Antonino / Goffredo, Michela / Aprile, Irene / Tamburella, Federica / Filoni, Serena / Waldner, Andreas / Mazzoleni, Stefano / Focacci, Antonella / Ferraro, Francesco / Bonaiuti, Donatella / Franceschini, Marco / TreadStroke Group

Journal of clinical medicine

2023 Volume 12, Issue 2

Abstract: Background: Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector ...

Abstract	Background: Although stroke survivors can benefit from robotic gait rehabilitation, stationary robot-assisted gait training needs further investigation. In this paper, we investigated the efficacy of this approach (with an exoskeleton or an end-effector robot) in comparison to the conventional overground gait training in subacute stroke survivors. Methods: In a multicenter controlled clinical trial, 89 subacute stroke survivors conducted twenty sessions of robot-assisted gait training (Robotic Group) or overground gait training (Control Group) in addition to the standard daily therapy. The robotic training was performed with an exoskeleton (RobotEXO-group) or an end-effector (RobotEND-group). Clinical outcomes were assessed before (T0) and after (T1) the treatment. The walking speed during the 10-Meter Walk Test (10 MWT) was the primary outcome of this study, and secondary outcomes were the 6-Minute Walk Test (6 MWT), Timed Up and Go test (TUG), and the modified Barthel Index (mBI). Results: The main characteristics assessed in the Robotic and Control groups did not differ at baseline. A significant benefit was detected from the 10 MWT in the Robotic Group at the end of the study period (primary endpoint). A benefit was also observed from the following parameters: 6 MWT, TUG, and mBI. Moreover, patients belonging to the Robot Group outperformed the Control Group in gait speed, endurance, balance, and ADL. The RobotEND-group improved their walking speed more than the RobotEXO-group. Conclusion: The stationary robot-assisted training improved walking ability better than the conventional training in subacute stroke survivors. These results suggest that people with subacute stroke may benefit from Robot-Assisted training in potentiating gait speed and endurance. Our results also support that end-effector robots would be superior to exoskeleton robots for improving gait speed enhancement.
Language	English
Publishing date	2023-01-05
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12020439
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Article ; Online: Robot-assisted end-effector-based gait training in chronic stroke patients: A multicentric uncontrolled observational retrospective clinical study.

Mazzoleni, Stefano / Focacci, Antonella / Franceschini, Marco / Waldner, Andreas / Spagnuolo, Chiara / Battini, Elena / Bonaiuti, Donatella

NeuroRehabilitation

2017 Volume 40, Issue 4, Page(s) 483–492

Abstract: Background: Until now studies report inconclusive results as regards the effectiveness of exclusive use of robot-assisted training and clinical indications in stroke patients.: Objective: To evaluate if the only robot-assisted end-effector-based gait ...

Abstract	Background: Until now studies report inconclusive results as regards the effectiveness of exclusive use of robot-assisted training and clinical indications in stroke patients. Objective: To evaluate if the only robot-assisted end-effector-based gait training can be feasible in chronic stroke subjects in terms of gait recovery. Methods: Five rehabilitation centers participated and one hundred chronic post-stroke patients were recruited. Patients underwent a robot-assisted end-effector-based gait training as only rehabilitation treatment.6 Minute Walk Test, 10 Meter Walk Test, Timed Up and Go test, Modified Ashworth Scale, Motricity Index, Functional Ambulation Classification (FAC) and Walking Handicap Scale were used as outcome clinical measure. Patients were divided into two groups: those assessed as FAC <3 (Group 1) and as FAC ≥ 3 (Group 2). Results: Statistically significant changes were observed in each clinical outcome measure. Significant changes were observed in Group 1 and in Group 2. Significant percentages of patients achieved Minimally Clinically Important Difference in 6 Minute Walk Test in Group 2 and Timed Up and Go test in Group 1. Conclusions: Chronic stroke patients exposed to only robot-assisted end-effector-based gait training showed significant improvements in global motor performances, gait endurance, balance and coordination, lower limbs strength and even spasticity.
Language	English
Publishing date	2017
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1087912-2
ISSN	1878-6448 ; 1053-8135
ISSN (online)	1878-6448
ISSN	1053-8135
DOI	10.3233/NRE-161435
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Article: Lower urinary tract symptoms associated with neurological conditions: Observations on a clinical sample of outpatients neurorehabilitation service.

Torelli, Fabrizio / Terragni, Erica / Blanco, Salvatore / Di Bella, Natale / Grasso, Marco / Bonaiuti, Donatella

Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica

2015 Volume 87, Issue 2, Page(s) 154–157

Abstract: Objectives: The overall aims of this study were to investigate the lower urinary tract symptoms (LUTS) associated with neurological conditions and their prevalence and impact on a clinical sample of outpatients of a neurorehabilitation service.: ... ...

Abstract	Objectives: The overall aims of this study were to investigate the lower urinary tract symptoms (LUTS) associated with neurological conditions and their prevalence and impact on a clinical sample of outpatients of a neurorehabilitation service. Materials and methods: We reviewed the files of 132 patients treated in our neurorehabilitation service from December 2012 to December 2013. Patients were divided into several subgroups based on the neurological diagnosis: Multiple Sclerosis (MS), other demyelinating diseases, Peripheral Neuropathy, neurovascular disorders (ND), neoplastic disease, traumatic brain injury (TBI), Parkinson and Parkinsonism, spinal cord injuries (SCI). Urinary status was based on medical evaluations of history of LUTS, type, degree, onset and duration of symptoms. We tried to analyze prevalence, kind of disorder, timing of presentation (if before or after the neurological onset) and eventual persistence of urological disorders (in the main group and in all subgroups). Results: At the time of admission to our rehabilitation service, LUTS were observed in 14 out of 132 cases (11%). A high proportion of these outpatients (64.2%) presented bothersome urinary symptoms such as incontinence, frequency and urgency (storage LUTS). The most frequent symptom was urinary urge incontinence (42.8%). This symptom was found to be prevalent in the multiple sclerosis and neurovascular disorders. In 93% the urinary symptoms arose as a result of neurologic conditions and 78.5% did not present a complete recovery of urological symptoms in spite of improved self-reported functional activity limitations. None of these patients performed urological rehabilitation. Conclusions: Neurological disorders are a significant issue in rehabilitation services and it can lead to lower tract dysfunction, which causes LUTS. Storage symptoms are more common, especially urge incontinence. Current literature reports that a further optimization of the rehabilitation potential of neurologically ill patients is possible through an implementation of urological basic measures into the neurological treatment routine.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Italy/epidemiology ; Lower Urinary Tract Symptoms/complications ; Lower Urinary Tract Symptoms/diagnosis ; Lower Urinary Tract Symptoms/epidemiology ; Lower Urinary Tract Symptoms/rehabilitation ; Male ; Medical Records ; Middle Aged ; Nervous System Diseases/complications ; Nervous System Diseases/rehabilitation ; Outpatients ; Prevalence ; Quality of Life ; Rehabilitation Centers ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2015-07-07
Publishing country	Italy
Document type	Journal Article
ZDB-ID	1153526-x
ISSN	2282-4197 ; 1124-3562 ; 1120-8538
ISSN (online)	2282-4197
ISSN	1124-3562 ; 1120-8538
DOI	10.4081/aiua.2015.2.154
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Article ; Online: Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay: cross-sectional survey.

Bargellesi, Stefano / Cavasin, Luisa / Scarponi, Federico / De Tanti, Antonio / Bonaiuti, Donatella / Bartolo, Michelangelo / Boldrini, Paolo / Estraneo, Anna

Clinical rehabilitation

2017 Volume 32, Issue 2, Page(s) 255–262

Abstract: Objectives: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.: Design: Multicentre cross-sectional survey.: Setting!# ...

Abstract	Objectives: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres. Design: Multicentre cross-sectional survey. Setting: A total of 48 severe acquired brain injury rehabilitation institutes. Participants: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016. Main outcome measure: Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion. Results: Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications. Conclusion: Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Brain Injuries, Traumatic/diagnosis ; Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/rehabilitation ; Comorbidity ; Cross-Sectional Studies ; Female ; Glasgow Coma Scale ; Humans ; Incidence ; Injury Severity Score ; Italy ; Male ; Middle Aged ; Ossification, Heterotopic/diagnosis ; Ossification, Heterotopic/epidemiology ; Ossification, Heterotopic/rehabilitation ; Predictive Value of Tests ; Prognosis ; Rehabilitation Centers ; Risk Assessment ; Sex Distribution ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2017-08-14
Publishing country	England
Document type	Comparative Study ; Journal Article ; Multicenter Study
ZDB-ID	639276-3
ISSN	1477-0873 ; 0269-2155
ISSN (online)	1477-0873
ISSN	0269-2155
DOI	10.1177/0269215517723161
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Article ; Online: Mobilization in early rehabilitation in intensive care unit patients with severe acquired brain injury: An observational study.

Bartolo, Michelangelo / Bargellesi, Stefano / Castioni, Carlo Alberto / Intiso, Domenico / Fontana, Andrea / Copetti, Massimiliano / Scarponi, Federico / Bonaiuti, Donatella

Journal of rehabilitation medicine

2017 Volume 49, Issue 9, Page(s) 715–722

Abstract: Objective: To determine whether early mobilization of patients with severe acquired brain injury, performed in the intensive/neurointensive care unit, influences functional outcome.: Design: Prospective observational study.: Setting: Fourteen ... ...

Abstract	Objective: To determine whether early mobilization of patients with severe acquired brain injury, performed in the intensive/neurointensive care unit, influences functional outcome. Design: Prospective observational study. Setting: Fourteen centres in Italy. Subjects: A total of 103 consecutive patients with acquired brain injury. Methods: Clinical, neurological and functional data, including the Glasgow Coma Scale (GCS), Disability Rating Scale (DRS), the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Early Rehabilitation Barthel Index (ERBI), Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM) were collected at admission and every 3?5 days until discharge from the intensive/neurointensive care unit. Patients were divided into mobilization and no mobilization groups, depending on whether they received mobilization. Data were analysed by intragroup and intergroup analysis using a multilevel regression model. Results: Sixty-eight patients were included in the mobilization group. At discharge, both groups showed significant improvements in GCS, DRS, LCF and ERBI scores. The mobilization group showed significantly better improvements in FIM cognitive, GOS and ERBI. The patients in the mobilization group stayed longer in the intensive care unit (p=0.01) and were more likely to be discharged to intensive rehabilitation at a significantly higher rate (p=0.002) than patients in the no mobilization group. No adverse events were reported in either group. Conclusion: Early mobilization appears to favour the clinical and functional recovery of patients with severe acquired brain injury in the intensive care unit.
Language	English
Publishing date	2017-11-21
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	2039427-5
ISSN	1651-2081 ; 1651-2235 ; 0891-060X ; 1650-1977
ISSN (online)	1651-2081 ; 1651-2235
ISSN	0891-060X ; 1650-1977
DOI	10.2340/16501977-2269
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Article ; Online: Acute medical complications in patients admitted to a stroke unit and safe transfer to rehabilitation.

Bonaiuti, Donatella / Sioli, Paolo / Fumagalli, Lorenzo / Beghi, Ettore / Agostoni, Elio

Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology

2011 Volume 32, Issue 4, Page(s) 619–623

Abstract: Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, ... ...

Abstract	Acute medical complications often prevent patients with stroke from being transferred from stroke units to rehabilitation units, prolonging the occupation of hospital beds and delaying the start of intensive rehabilitation. This study defined incidence, timing, duration and risk factors of these complications during the acute phase of stroke. A retrospective case note review was made of hospital admissions of patients with stroke not associated with other disabling conditions, admitted to a stroke unit over 12 months and requiring rehabilitation for gait impairment. In this cohort, a search was made of hypertension, oxygen de-saturation, fever, and cardiac and pulmonary symptoms requiring medical intervention. Included were 135 patients. Hypertension was the most common complication (16.3%), followed by heart disease (14.8%), oxygen de-saturation (7.4%), fever (6.7%) and pulmonary disease (5.2%). Heart disease was the earliest and shortest complication. Most complications occurred during the first week. Except for hypertension, all complications resolved within 2 weeks.
MeSH term(s)	Acute Disease ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Female ; Fever/complications ; Fever/epidemiology ; Heart Diseases/complications ; Heart Diseases/epidemiology ; Hospital Units ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Hypoxia/complications ; Hypoxia/epidemiology ; Lung Diseases/complications ; Lung Diseases/epidemiology ; Male ; Middle Aged ; Patient Transfer ; Retrospective Studies ; Risk Factors ; Stroke/complications ; Stroke/epidemiology ; Stroke Rehabilitation ; Young Adult
Language	English
Publishing date	2011-04-30
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2016546-8
ISSN	1590-3478 ; 1590-1874
ISSN (online)	1590-3478
ISSN	1590-1874
DOI	10.1007/s10072-011-0588-2
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Article: Robot-Assisted Training for Upper Limb in Stroke (ROBOTAS): An Observational, Multicenter Study to Identify Determinants of Efficacy.

Journal of clinical medicine

2021 Volume 10, Issue 22

Abstract: Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and ... ...

Abstract	Background: The loss of arm function is a common and disabling outcome after stroke. Robot-assisted upper limb (UL) training may improve outcomes. The aim of this study was to explore the effect of robot-assisted training using end-effector and exoskeleton robots on UL function following a stroke in real-life clinical practice. Methods: A total of 105 patients affected by a first-ever supratentorial stroke were enrolled in 18 neurorehabilitation centers and treated with electromechanically assisted arm training as an add-on to conventional therapy. Both interventions provided either an exoskeleton or an end-effector device (as per clinical practice) and consisted of 20 sessions (3/5 times per week; 6-8 weeks). Patients were assessed by validated UL scales at baseline (T0), post-treatment (T1), and at three-month follow-up (T2). The primary outcome was the Fugl-Meyer Assessment for the upper extremity (FMA-UE). Results: FMA-UE improved at T1 by 6 points on average in the end-effector group and 11 points on average in the exoskeleton group ( Conclusions: robot-assisted training might help improve UL function in stroke patients as an add-on treatment in both subacute and chronic stages. Pragmatic and highmethodological studies are needed to confirm the showed effectiveness of the exoskeleton and end-effector devices.
Language	English
Publishing date	2021-11-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm10225245
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Article ; Online: What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials.

Bowman, Thomas / Gervasoni, Elisa / Amico, Angelo P / Antenucci, Roberto / Benanti, Paolo / Boldrini, Paolo / Bonaiuti, Donatella / Burini, Angelo / Castelli, Enrico / Draicchio, Francesco / Falabella, Vincenzo / Galeri, Silvia / Gimigliano, Francesca / Grigioni, Mauro / Mazzon, Stefano / Mazzoleni, Stefano / Mestanza Mattos, Fabiola G / Molteni, Franco / Morone, Giovanni /

Petrarca, Maurizio / Picelli, Alessandro / Posteraro, Federico / Senatore, Michele / Turchetti, Giuseppe / Crea, Simona / Cattaneo, Davide / Carrozza, Maria C

European journal of physical and rehabilitation medicine

2021 Volume 57, Issue 2, Page(s) 246–253

Abstract: Introduction: In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance ...

Abstract	Introduction: In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described. Evidence acquisition: As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies. Evidence synthesis: The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed. Conclusions: In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.
MeSH term(s)	Combined Modality Therapy ; Disability Evaluation ; Exoskeleton Device ; Gait Disorders, Neurologic/rehabilitation ; Humans ; Multiple Sclerosis/rehabilitation ; Randomized Controlled Trials as Topic ; Robotics/methods ; Walk Test
Language	English
Publishing date	2021-02-04
Publishing country	Italy
Document type	Journal Article ; Systematic Review
ZDB-ID	2426908-6
ISSN	1973-9095 ; 1973-9087
ISSN (online)	1973-9095
ISSN	1973-9087
DOI	10.23736/S1973-9087.21.06692-2
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