Neuroanatomical correlates of gross manual dexterity in children with unilateral spastic cerebral palsy

Unilateral spastic Cerebral Palsy (UCP) results from congenital brain injury, and Magnetic Resonance Imaging (MRI) has a role in understanding the etiology and severity of brain insult. In UCP, functional impairment predominantly occurs in the upper limb (UL) of the more affected side, where manual ability and dexterity are typically reduced. Also, mirror movements (MMs), are often present in UCP, with a further possible negative functional impact. This study aims to investigate the relationships among neuroanatomical characteristics of brain injury at MRI, manual functional impairment and MMs, in children with UCP. Thirty-five children with UCP participated in the study (20, M = 15, F, mean age 9.2 ± 3.5 years). Brain lesions at MRI were categorized according to the Magnetic Resonance Classification System (MRICS) and by using a semi-quantitative MRI (sqMRI) scale. Gross manual performance was assessed through Manual Ability Classification System (MACS) and the Box and Block Test (BBT), and MMs by Woods and Teuber scale, for both hands. Non-parametric correlation analyses were run to determine the relationship between neuroanatomical and functional features. Regression models were run to explore the contribution of neuroanatomical features and MMs to UL function. Correlation analyses revealed moderate to strong associations between sqMRI scores contralateral to the more affected side and UL functional impairment on MACS and BBT, with more severe brain injuries significantly correlating with poorer function in the more affected hand. No association emerged between brain lesion severity scores and MMs. MRICS showed no association with MACS or BBT, while a significant correlation emerged between MRICS category and MMs in the more affected hand, with brain lesion category that are suggestive of presumed earlier injury being associated with more severe MMs. Finally, exploratory regression analyses showed that neuroanatomical characteristics of brain injury and MMs contributed to the variability of UL functional impairment. This study contributes to the understanding of the neuroanatomical and neurological correlates of some aspects of manual functional impairment in UCP by using a simple clinical brain MRI assessment

Concurrent and predictive validity of the infant motor profile in infants at risk of neurodevelopmental disorders

BACKGROUND: Preterm infants and infants with perinatal brain injury show a higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Scale (AIMS) and Prechtl's General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of the IMP with the AIMS, to assess its association with the GMA, to evaluate how the IMP reflects the severity of the brain injury and to compare the ability of the IMP and the AIMS to predict an abnormal outcome in 5-month-old infants at risk of NDD.METHODS: 86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3months corrected age (CA) using the GMA and at 5months CA using the IMP and the AIMS. The neurodevelopmental outcome was established at 18months.RESULTS: Results confirm a solid concurrent validity between the IMP Total Score and the AIMS (Spearman's rho 0.76; p<.001) and a significant association between IMP Total Score and the GMA. Unlike the AIMS, the IMP Total score accurately reflects the severity of neonatal brain injury (p<.001) and proves to be the strongest predictor of NDD (p<.001). The comparison of areas under receiver operating characteristic curves (AUC) confirms that the IMP Total score has the highest diagnostic accuracy at 5months (AUC 0.92). For an optimal IMP Total Score cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%).CONCLUSIONS: Early motor behaviour assessed with the IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of the IMP with the AIMS, its association with the GMA and its ability to reflect brain lesion load, hence contributing to the construct validity of the assessment.TRIAL REGISTRATION: NCT01990183 and NCT03234959 (clinicaltrials.gov)

Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study

Parental practices and environmental factors can impact a child's development and, consequently, functionality. The objective is to assess the parental practices and environmental differences in healthy and at-risk infants at 3-6 months of age living in upper-middle (Brazil) and high-income (Italy) countries. A total group of 115 infants was identified and classified into four groups: healthy Italian infants (H_IT); Italian infants exposed to biological risk factors (R_IT); healthy Brazilian infants (H_BR); and Brazilian infants exposed to environmental risk factors (L_BR). The dependent variables were parental practices and environmental factors, which were assessed through a semi-structured interview and the "variety of stimulation dimension" from the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire. Descriptive analyses, a multivariate analysis of variance (MANOVA), and correlation tests were applied. Regarding the environment and parental practices, the mother's age, maternal and paternal education, civil status, and variety of stimulation showed significant differences among the infants living in Brazil or in Italy. There were strong dissimilarities in parental practices and environmental factors among infants living in low/upper-middle and high-income countries. Since the home environment is the main stimulus for infant growth and development, our results are meaningful for providing knowledge about these two different cultures

TABLET TOSCANA to Develop Innovative Organizational Models for Tele-Rehabilitation in Subjects with Congenital and Acquired Developmental Disabilities: A Wait-List Control Group Trial Protocol

Background/Objectives: In recent years, the advent of new technologies has fostered their application in neuro-psychomotor and language rehabilitation, particularly since the COVID-19 pandemic. Tele-rehabilitation has emerged as an innovative and timely solution, enabling personalized interventions monitored by clinicians. TABLET TOSCANA project aims to develop innovative tele-rehabilitation organizational models in children, adolescents and young adults with congenital and acquired developmental disabilities, using the Virtual Reality Rehabilitation System (VRRS) Home Kit and the MedicoAmico APP. Methods: The trial is designed according to the CONSORT statement guidelines. The project encompasses three phases: adapting the technologies for pediatric use, validating them through a wait-list study, and analyzing feasibility and effectiveness data to define new organizational models. A randomized wait-list-control study with 100 subjects aged 6 to 30 years will compare tele-rehabilitation versus prosecution of standard care. Discussion: Although literature highlights tele-rehabilitation benefits such as improved access, cost savings, and enhanced treatment adherence, practical implementation remains limited (i.e., the definition of standardized procedures). TABLET TOSCANA project seeks to address these gaps by focusing on multi-domain treatments for neurodevelopmental disabilities and emphasizing the integration of tele-rehabilitation into local health services. Conclusion: The project aims to improve the continuity and intensity of care through innovative models that integrate tele-rehabilitation into local health services. The results could inform healthcare policies and promote the development of innovative and collaborative models of care, paving the way for more effective and widespread tele-rehabilitation solutions and fostering collaborative networks among professionals

The wide world of technological telerehabilitation for pediatric neurologic and neurodevelopmental disorders – a systematic review

IntroductionThe use of Information and Communication Technology (ICT) for assessing and treating cognitive and motor disorders is promoting home-based telerehabilitation. This approach involves ongoing monitoring within a motivating context to help patients generalize their skills. It can also reduce healthcare costs and geographic barriers by minimizing hospitalization. This systematic review focuses on investigating key aspects of telerehabilitation protocols for children with neurodevelopmental or neurological disorders, including technology used, outcomes, caregiver involvement, and dosage, to guide clinical practice and future research.MethodThis systematic review adhered to PRISMA guidelines and was registered in PROSPERO. The PICO framework was followed to define the search strategy for technology-based telerehabilitation interventions targeting the pediatric population (aged 0–18) with neurological or neurodevelopmental disorders. The search encompassed Medline/PubMed, EMBASE, and Web of Science databases. Independent reviewers were responsible for selecting relevant papers and extracting data, while data harmonization and analysis were conducted centrally.ResultsA heterogeneous and evolving situation emerged from our data. Our findings reported that most of the technologies adopted for telerehabilitation are commercial devices; however, research prototypes and clinical software were also employed with a high potential for personalization and treatment efficacy. The efficacy of these protocols on health or health-related domains was also explored by categorizing the outcome measures according to the International Classification of Functioning, Disability, and Health (ICF). Most studies targeted motor and neuropsychological functions, while only a minority of papers explored language or multi-domain protocols. Finally, although caregivers were rarely the direct target of intervention, their role was diffusely highlighted as a critical element of the home-based rehabilitation setting.DiscussionThis systematic review offers insights into the integration of technological devices into telerehabilitation programs for pediatric neurologic and neurodevelopmental disorders. It highlights factors contributing to the effectiveness of these interventions and suggests the need for further development, particularly in creating dynamic and multi-domain rehabilitation protocols. Additionally, it emphasizes the importance of promoting home-based and family-centered care, which could involve caregivers more actively in the treatment, potentially leading to improved clinical outcomes for children with neurological or neurodevelopmental conditions.Systematic review registrationPROSPERO (CRD42020210663)

Implementazione della tele-riabilitazione nei servizi territoriali: nuovo modello organizzativo per la riabilitazione dei disturbi dell'equilibrio tramite il Virtual Reality Rehabilitation System (VRRS)

L’equilibrio è definito, da un punto di vista fisico, come lo stato di un oggetto quando le azioni di carico risultanti, forze e momenti che agiscono su di esso, sono uguali a zero. In un individuo quando si parla di controllo dell’equilibrio o controllo posturale, si intendono quei meccanismi e quelle strategie che il sistema nervoso centrale (SNC) mette in atto per garantire una risposta nei confronti della forza di gravità, stabilizzando i vari distretti anatomici in uno stato di equilibrio, a seconda delle diverse situazioni in cui l’individuo si trova. Lo sviluppo dell’equilibrio inizia dalla nascita, perfezionandosi durante lo sviluppo, in età adolescenziale, con un miglioramento progressivo fino all’età adulta. Il controllo posturale richiede l'organizzazione e l'integrazione degli input propriocettivi, visivi e vestibolari da parte del SNC, così da generare adeguate risposte motorie. Per questo, qualsiasi deficit cognitivo, sensoriale o motorio può provocare un disturbo del controllo posturale, che è un problema comune nei bambini con disturbi neurologici (sia centrali che periferici), ortopedici e/o vestibolari. Infatti, il controllo posturale è influenzato da tutte quelle patologie che alterano gli organi coinvolti in tale funzione, quindi patologie che disturbano l'output sensoriale, il controllo della forza e del movimento e l'orientamento spaziale. È di fondamentale importanza identificare precocemente i deficit dell’equilibrio, in quanto possono avere un grande impatto su tutto lo sviluppo motorio. Tra i disturbi che possono manifestare un’alterazione dell’equilibrio durante l’età evolutiva ricordiamo la Paralisi Cerebrale Infantile (PCI) e il Disturbo della Coordinazione Motoria (DCD) per cui è necessario utilizzare strumenti di valutazione, test clinici standardizzati e test strumentali che forniscano variabili qualitative e quantitative sia per lo screening e la diagnosi, sia per definire un percorso riabilitativo. Infatti, la presa in carico del soggetto in età evolutiva con un disturbo dell’equilibrio prevede la stesura di un progetto riabilitativo individuale, utilizzando un approccio valutativo e riabilitativo che non può prescindere dall’applicare i principi fondamentali della Classificazione Internazionale del Funzionamento, della Disabilità e della Salute, ICF (OMS, 2001). All’interno di questa cornice, i dispositivi tecnologici possono essere di notevole aiuto in quanto supportano il lavoro del clinico, offrendo la possibilità di misurare e registrare parametri e variabili della performance motoria. Negli ultimi anni, si sono verificati rapidi sviluppi tecnologici, tra cui l’utilizzo della telemedicina e tele-riabilitazione, anche in età evolutiva. La tele-riabilitazione offre una buona opportunità di accesso ai servizi di riabilitazione, in modo da garantire una continuità delle cure, un sostanziale risparmio di costi, un miglioramento del comfort e dello stile di vita del paziente e una maggiore frequenza e aderenza al trattamento. Studi dimostrano che tale metodo di riabilitazione può essere promettente per diversi gruppi di pazienti, tra cui i bambini con disturbi neurologici e per il trattamento di disturbi motori e del controllo posturale. Oggigiorno, diversi strumenti tecnologici possono essere sfruttati per la tele-riabilitazione, tra cui i sistemi di realtà virtuale che, grazie al loro approccio immersivo, permettono all’utente di interagire con l’ambiente virtuale e di ricevere feedback sensoriali (visivi, uditivi, tattili, etc.) Questo progetto di tesi si è posto l’obiettivo di descrivere l’uso di un nuovo sistema di realtà virtuale, il Virtual Reality Rehabilitation System (VRRS) (Khymeia, Italia), come strumento di riabilitazione e tele-riabilitazione, per promuovere le capacità di equilibrio nei bambini con un disturbo del neurosviluppo. In particolare, lo studio si propone di implementare la tele-riabilitazione anche nei servizi territoriali, portando in esame tre casi esemplificativi di un diverso utilizzo del sistema, così da rappresentare tre possibili modelli operativi differenti su cui poter discutere le prospettive future. I risultati ottenuti sono promettenti e anche se sono presenti dei limiti, sarà interessante continuare e migliorare l’esperienza della tele-riabilitazione e riabilitazione con il VRRS. Lo studio è stato svolto presso il laboratorio INNOVATE (Laboratorio di Tecnologie INNOVATivE in Neuroriabilitazione) dell’IRCCS Fondazione Stella Maris di Calambrone (Pisa)