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Basagni B, Malloggi S, Polito C, Pellicciari L, Campagnini S, Pancani S, Mannini A, Gemignani P, Salvadori E, Marignani S, Giovannelli F, Viggiano MP, Hakiki B, Grippo A, Macchi C, Cecchi F. MoCA Domain-Specific Pattern of Cognitive Impairment in Stroke Patients Attending Intensive Inpatient Rehabilitation: A Prospective Study. Behav Sci (Basel) 2024; 14:42. [PMID: 38247694 PMCID: PMC10813017 DOI: 10.3390/bs14010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/18/2023] [Accepted: 12/24/2023] [Indexed: 01/23/2024] Open
Abstract
A domain-specific perspective to cognitive functioning in stroke patients may predict their cognitive recovery over time and target stroke rehabilitation intervention. However, data about domain-specific cognitive impairment after stroke are still scarce. This study prospectively investigated the domain-specific pattern of cognitive impairments, using the classification proposed by the Montreal Cognitive Assessment (MoCA), in a cohort of 49 stroke patients at admission (T0), discharge (T1), and six-month follow-up (T2) from subacute intensive rehabilitation. The predictive value of T0 cognitive domains cognitive impairment at T1 and T2 was also investigated. Patients' cognitive functioning at T0, T1, and T2 was assessed through the MoCA domains for executive functioning, attention, language, visuospatial, orientation, and memory. Different evolutionary trends of cognitive domain impairments emerged across time-points. Patients' impairments in all domains decreased from T0 to T1. Attention and executive impairments decreased from T0 to T2 (42.9% and 26.5% to 10.2% and 18.4%, respectively). Conversely, altered visuospatial, language, and orientation increased between T1 and T2 (16.3%, 36.7%, and 40.8%, respectively). Additionally, patients' global cognitive functioning at T1 was predicted by the language and executive domains in a subacute phase (p = 0.031 and p = 0.001, respectively), while in the long term, only attention (p = 0.043) and executive (p = 0.019) domains intervened. Overall, these results confirm the importance of a domain-specific approach to target cognitive recovery across time in stroke patients.
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Affiliation(s)
- Benedetta Basagni
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Serena Malloggi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Cristina Polito
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Paola Gemignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Sara Marignani
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Fabio Giovannelli
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Maria Pia Viggiano
- Department of NEUROFARBA, University of Florence, 50143 Firenze, Italy; (F.G.); (M.P.V.)
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Firenze, Italy; (B.B.); (S.M.); (C.P.); (L.P.); (S.P.); (A.M.); (P.G.); (E.S.); (S.M.); (B.H.); (A.G.); (C.M.); (F.C.)
- Department of Experimental and Clinical Medicine, University of Florence, 50143 Firenze, Italy
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Basagni B, Hakiki B, Campagnini S, Salvadori E, Grippo A, Paperini A, Castagnoli C, Hochleitner I, Politi AM, Gemignani P, Mosca IE, Franceschini A, Bonotti EB, Sodero A, Mannini A, Pellicciari L, Poggesi A, Macchi C, Carrozza MC, Cecchi F. Critical issue on the extinction and inattention subtest of NIHSS scale: an analysis on post-acute stroke patients attending inpatient rehabilitation. BMC Neurol 2021; 21:475. [PMID: 34879861 PMCID: PMC8653531 DOI: 10.1186/s12883-021-02499-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives This study aims to evaluate the diagnostic performance of NIHSS extinction and inattention item, compared to the results of the Oxford Cognitive Screen (OCS) heart subtest. Additionally, the possible role of the NIHSS visual field subtest on the NIHSS extinction and inattention subtest performance is explored and discussed. Methods We analysed scores on NIHSS extinction and inattention subtest, NIHSS visual field subtest, and OCS heart subtest on a sample of 118 post-stroke patients. Results Compared to OCS heart subtest, the results on NIHSS extinction and inattention subtest showed an accuracy of 72.9% and a moderate agreement level (Cohen’s kappa = 0.404). Furthermore, a decrease in NIHSS accuracy detecting neglect (61.1%) was observed in patients with pathological scores in NIHSS visual field item. Conclusions Extreme caution is recommended for the diagnostic performance of extinction and inattention item of NIHSS. Signs of neglect may not be detected by NIHSS, and may be confused with visual field impairment. Trial registration This study refers to an observational study protocol submitted to ClinicalTrials.gov with identifier: NCT03968627. The name of the registry is “Development of a National Protocol for Stroke Rehabilitation in a Multicenter Italian Institution” and the date of the registration is the 30th May 2019.
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Affiliation(s)
- Benedetta Basagni
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy. .,The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy.
| | - Emilia Salvadori
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Antonello Grippo
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Anita Paperini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Chiara Castagnoli
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Ines Hochleitner
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Angela Maria Politi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Paola Gemignani
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Irene Eleonora Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Azzurra Franceschini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Enrico Bacci Bonotti
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,The Biorobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Italy
| | - Leonardo Pellicciari
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Via di Scandicci 269 -, 50143, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Cecchi F, Diverio M, Arienti C, Corbella E, Marrazzo F, Speranza G, Del Zotto E, Poggianti G, Gigliotti F, Polcaro P, Zingoni M, Antonioli D, Avila L, Barilli M, Romano E, Landucci Pellegrini L, Gambini M, Verdesca S, Bertolucci F, Mosca I, Gemignani P, Paperini A, Castagnoli C, Hochleitner I, Luisi ML, Lucidi G, Hakiki B, Gabrielli MA, Fruzzetti M, Bruzzi A, Bacci Bonotti E, Pancani S, Galeri S, Macchi C, Aprile I. Development and implementation of a stroke rehabilitation integrated care pathway in an Italian no profit institution: an observational study. Eur J Phys Rehabil Med 2021; 56:713-724. [PMID: 33494558 DOI: 10.23736/s1973-9087.20.06195-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND To standardize assessment and coordinate processes in stroke rehabilitation, an integrated care pathway (ICP) was developed in an Italian Rehabilitation and Research Institution by a knowledge-translation interdisciplinary process, from evidence-based guidelines to rehabilitation practice. The ICP was implemented in two pilot Tuscan rehabilitation Centers. AIM The purpose of this study was to describe ICP development and assess the ICP effects on postacute stroke inpatient rehabilitation outcomes. DESIGN Prospective observational study, before and after comparison. SETTING Two Tuscan inpatient rehabilitation centers. POPULATION Patients accessing either centers for intensive rehabilitation after acute stroke. METHODS Two cohorts were prospectively recruited before (2015-2017) and after (2018) implementation of the pathway. The primary outcome was change in activities of daily living disability, assessed by the modified Barthel Index (mBI) from admission to discharge. Secondary outcomes included length of stay (LOS), adverse outcomes, and changes in communication ability, trunk control, pain, ambulation, bladder catheter (Y/N), bedsores (Y/N). RESULTS In 2015-2017, 443 postacute stroke patients (mean age 77±11 years, 47% women), while in 2018, 84 patients (mean age 76±13 years, 61% women) were admitted to the two facilities. Comparing the 2018 vs. the 2015-17 cohort, the mean mBI increase was not substantially different (26 vs. 24 points), nor were LOS (37±18 vs. 36±16 days), adverse outcomes, discharge destination, and improvement of ambulation, pain, and communication (P>0.05). Instead, a significantly higher improvement of trunk control (trunk control test: 69.6±33.2 vs. 79.0±31.3, P=0.019), and a higher percentage of bedsore resolution (13% vs. 5%, P=0.033), and bladder catheter removal (37% vs. 17% P<0.001) were observed in 2018 vs. 2015-2017. CONCLUSIONS Compared to prior practice, ICP was associated to improvement of trunk control recovery, bladder catheter removal, and bedsores resolution. Further ICP implementation on a larger scale is needed to verify improvements of stroke inpatient rehabilitation outcomes. CLINICAL REHABILITATION IMPACT An evidence-based stroke rehabilitation ICP was interdisciplinary developed and implemented in two rehabilitation centers of a multicenter Italian health group. ICP implementation as to inpatient intensive postacute stroke rehabilitation was associated to improved trunk control recovery, bladder catheter removal, and bedsore resolution. Further ICP implementation will allow multicenter studies and quality benchmarking.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Lucia Avila
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | - Irene Mosca
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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Hakiki B, Paperini A, Castagnoli C, Hochleitner I, Verdesca S, Grippo A, Scarpino M, Maiorelli A, Mosca IE, Gemignani P, Borsotti M, Gabrielli MA, Salvadori E, Poggesi A, Lucidi G, Falsini C, Gentilini M, Martini M, Luisi MLE, Biffi B, Mainardi P, Barretta T, Pancani S, Mannini A, Campagnini S, Bagnoli S, Ingannato A, Nacmias B, Macchi C, Carrozza MC, Cecchi F. Predictors of Function, Activity, and Participation of Stroke Patients Undergoing Intensive Rehabilitation: A Multicenter Prospective Observational Study Protocol. Front Neurol 2021; 12:632672. [PMID: 33897593 PMCID: PMC8060493 DOI: 10.3389/fneur.2021.632672] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation. Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers. Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes. Clinical Trial Registration:ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Bagnoli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Assunta Ingannato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Sozzi M, Algeri L, Corsano M, Crivelli D, Daga MA, Fumagalli F, Gemignani P, Granieri MC, Inzaghi MG, Pala F, Turati S, Balconi M. Neuropsychology in the Times of COVID-19. The Role of the Psychologist in Taking Charge of Patients With Alterations of Cognitive Functions. Front Neurol 2020; 11:573207. [PMID: 33178114 PMCID: PMC7593383 DOI: 10.3389/fneur.2020.573207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/26/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Matteo Sozzi
- Department of Neuroscience, Neurology Unit, ASST "A. Manzoni," Lecco, Italy.,Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy
| | - Lorella Algeri
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Psychology Unit, ASST "Papa Giovanni XXIII," Bergamo, Italy
| | - Matteo Corsano
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Center for Rehabilitation, Consorzio San Stef. Ar. Abruzzo, Pescara, Italy
| | - Davide Crivelli
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Research Unit in Affective and Social Neuroscience, Catholic University of the Sacred Heart, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Maria Angela Daga
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy
| | - Francesca Fumagalli
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura Privata del Policlinico, Milan, Italy
| | - Paola Gemignani
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Levante Ligure Rehabilitation Center, Fondazione Don C. Gnocchi Onlus, La Spezia, Italy
| | - Maria Concetta Granieri
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Associazione "J.F. Kennedy" - Centro di Riabilitazione Neuropsicomotoria ONLUS, Acireale, Italy
| | - Maria Grazia Inzaghi
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Laboratory for Neuropsychology, Istituto Clinico Quarenghi, San Pellegrino Terme, Italy
| | - Francesca Pala
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy
| | - Simone Turati
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy
| | - Michela Balconi
- Board of Società degli Psicologi dell'Area Neuropsicologica (SPAN), Civate, Italy.,Research Unit in Affective and Social Neuroscience, Catholic University of the Sacred Heart, Milan, Italy.,Department of Psychology, Catholic University of the Sacred Heart, Milan, Italy
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Redolfi A, Gugliotta M, Borsotti M, D'Amato A, Gemignani P, Maietti A, Mezzanato T, Sapienza S, Trimarchi PD, Negrini S, Mazzucchi A. Long-term services for the care and rehabilitation of people with severe acquired brain injury: a multicentre, cross-sectional study of 536 Italian families. Ann Ist Super Sanita 2017; 53:253-265. [PMID: 28956806 DOI: 10.4415/ann_17_03_12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND People with severe acquired brain injuries (ABIs) require complex, long-term multidisciplinary healthcare, and social welfare programmes, and their families experience social and emotional consequences that profoundly condition their quality of life. OBJECTIVE To investigate whether the possibility of gaining access to local rehabilitation and other services positively influences not only the quality of life of the patients but also the quality of life of their families. METHODS The sample consisted of 536 families of patients with severe ABIs. They were administered a specific 50-item questionnaire with a mix of multiple choice answers, dichotomous (yes/no) answers, or answers based on a Likert-type scale. RESULTS The results suggest that the long-term services provided to patients are substantially satisfactory but the data concerning the patients' social and working reintegration are discomforting. Furthermore, the families experience profound social discomfort related to their economic, emotional and caregiving burden regardless of the number and quality of the rehabilitation services activated, or the amount of welfare support received. CONCLUSIONS Post-severe ABI services provided at a local level should include not only long-term rehabilitative and social support for the patients, but also long-term social and psychological support for their families.
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Affiliation(s)
| | - Maria Gugliotta
- Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Parma, Parma, Italy
| | | | | | | | | | - Tiziana Mezzanato
- IRCCS Santa Maria Nascente, Fondazione Don Gnocchi Onlus, Milan, Italy
| | - Sabrina Sapienza
- IRCCS Santa Maria Nascente, Fondazione Don Gnocchi Onlus, Milan, Italy
| | | | - Stefano Negrini
- IRCCS Santa Maria Nascente, Fondazione Don Gnocchi Onlus, Milan, Italy - Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Brescia, Brescia, Italy
| | - Anna Mazzucchi
- IRCCS Santa Maria Nascente, Fondazione Don Gnocchi Onlus, Milan, Italy
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7
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Basagni B, Luzzatti C, Navarrete E, Caputo M, Scrocco G, Damora A, Giunchi L, Gemignani P, Caiazzo A, Gambini MG, Avesani R, Mancuso M, Trojano L, De Tanti A. VRT (verbal reasoning test): a new test for assessment of verbal reasoning. Test realization and Italian normative data from a multicentric study. Neurol Sci 2017; 38:643-650. [DOI: 10.1007/s10072-017-2817-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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Mancuso M, Pacini M, Gemignani P, Bartalini B, Agostini B, Ferroni L, Caputo M, Capitani D, Mondin E, Cantagallo A. Clinical application of prismatic lenses in the rehabilitation of neglect patients. A randomized controlled trial. Eur J Phys Rehabil Med 2012; 48:197-208. [PMID: 22318363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Many studies reveal that neglect is a major cause of disability in stroke patients, and two months from onset neglect is still present in approximately 50% of individuals with a right brain lesion. Among the various methods of neglect rehabilitation, we have turned our attention to the prism adaptation treatment, developed by Rossetti in 1998. This treatment uses prismatic lenses, which produce a deviation of the fixation point of the visual field of 10 degrees to the right, 5 degrees below the coordinates of reference resulting from neglect. AIM To set out the possible effectiveness of less powerful lenses, we studied the response of a group of neglect patients treated with prismatic lenses that produce a deviation of the fixation point of only 5 degrees to the right, comparing them with a group of patients receiving placebo lenses. DESIGN Randomized controlled trial. SETTING Outpatients. POPULATION The study involved 29 patients with left visual neglect. METHODS All patients were assessed with a battery of seven visual-spatial tests. All patients were randomized by the pilot center and assigned to two different groups: "A" treated with pointing exercises and prismatic lenses of 5° to the right; "B" treated with pointing exercises and neutral lenses. Each group was treated with 5 rehabilitation sessions, lasting about 30 minutes each, from Monday to Friday for one week in the morning, by the same investigator, in each center. CONCLUSION The results showed that the prismatic lenses of only five degrees, used for the study, did not contribute to the variation in performance. Thus, this deviation of the fixation point of the visual field to the right is not sufficient to create a therapeutic effect. The improvement observed within the two groups, seems likely to be correlated with the pointing exercises, which force the subject to perform a visuomotor task with the healthy arm also in the neglected side. CLINICAL REHABILITATION IMPACT We believe that in order to carry out an effective treatment with prismatic lenses they must have a grade of at least 20 prism diopters. Lower grades are unable to determine an effect. Finally, because of the severe impact of neglect on the work of the rehabilitation team, and since our data shows that only five sessions are sufficient to demonstrate a change in performance, we believe that it is appropriate to use this method, especially in the acute phase of the disease.
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Affiliation(s)
- M Mancuso
- Neurologic Rehabilitation Unit, Az. USL 9 Grosseto, Italy.
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Mastracci L, Auriati L, Gemignani P, Cabiddu F, Malatto M, Tunesi G. [Parosteal ossifying lipoma of the femur. Description of a case]. Pathologica 2003; 95:167-9. [PMID: 12968313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
A case of parosteal ossifyng lipoma of femour in 67 years-old female patient is described. Review of literature (1966-1999) about parosteal lipoma reveals less then 70 referred cases; much less common is the ossifyng type; in our knowledge five cases of this very rare subtype are referred in last thirty years.
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Affiliation(s)
- L Mastracci
- Servizio di Anatomia ed Istologia Patologica, Polo Ospedaliero di Sestri Levante.
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dos Santos SDS, Almeida GM, Monteiro ML, Gemignani P, Duarte MI, Toscano CM, Barone AA. Ocular myositis and diffuse meningoencephalitis from Trypanosoma cruzi in an AIDS patient. Trans R Soc Trop Med Hyg 1999; 93:535-6. [PMID: 10696415 DOI: 10.1016/s0035-9203(99)90370-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- S de S dos Santos
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, Brazil
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