Il tirocinio professionalizzante del Terapista della Neuro e Psicomotricità dell'eta evolutiva

La formazione professionalizzante nei corsi di Laurea delle Professioni Sanitarie e nello specifico di questa tesi del Terapista della neuro e psicomotricità dell’età evolutiva prevede, oltre ad una accurata e specifica preparazione teorica, un’adeguata formazione pratica attraverso l’attività di tirocinio clinico. Questo tipo di formazione assume un ruolo centrale in quanto lo studente termina il percorso di studi con la discussione di un elaborato, ma anche e soprattutto con la prova pratica che ha come esito l’abilitazione alla professione. Il tirocinio, e più in generale l’apprendimento clinico, ha subito una notevole evoluzione nel corso degli anni in virtù del riconoscimento e della definizione delle competenze della figura del Terapista della neuro e psicomotricità dell’età evolutiva, al fine di ottimizzare la sua preparazione per permettergli di arrivare preparato e svolgere in modo migliore la sua professione. Il tirocinio del Terapista della neuro e psicomotricità dell’età evolutiva, momento concreto della formazione, viene analizzato in questa tesi sotto molteplici punti di vista, in modo da fornire un quadro generale rispetto alla sua regolamentazione, l’organizzazione, l’importanza, la valutazione ed infine vengono forniti alcuni spunti per lo sviluppo della programmazione del tirocinio applicabile al Corso di Laurea

New Technological Approach for the Evaluation of Postural Control Abilities in Children with Developmental Coordination Disorder

Background: Developmental Coordination Disorder (DCD) causes difficulties in postural control which are crucial to assess due to their impact on everyday life. There is a lack of suitable tools to acquire quantitative data and deeply analyze postural control, especially during the developmental age. The aim of this study is to investigate postural control skills in children with DCD and typically developing children (TD) using the Virtual Reality Rehabilitation System (VRRS). Methods: 18 children with DCD and 30 TD children (mean age 9.12 +/- 2.65 and 7.12 +/- 2.77 years, respectively) were tested by using the Movement Assessment Battery for Children Second Edition (MABC-2) and a VRRS stabilometric balance platform. A t-test was performed to identify differences in the VRRS parameters between the two groups. Furthermore, we investigated whether a correlation exists between the VRRS data and the MABC-2. Results: Significant differences (p < 0.05) in mean distance and frequency of the COP are found in the two groups. These parameters also correlate with the MABC-2 total score (p <= 0.05) and balance subscales (p <= 0.05). Conclusions: This study opens a new frontier for the assessment of postural skills in children with DCD and represents a potential basis for a tailored rehabilitation program, from which their postural stability and, consequently, their everyday life will benefit

A new system for quantitative evaluation of infant gaze capabilities in a wide visual field.

Background: The visual assessment of infants poses specific challenges: many techniques that are used on adults are based on the patient’s response, and are not suitable for infants. Significant advances in the eye-tracking have made this assessment of infant visual capabilities easier, however, eye-tracking still requires the subject’s collaboration, in most cases and thus limiting the application in infant research. Moreover, there is a lack of transferability to clinical practice, and thus it emerges the need for a new tool to measure the paradigms and explore the most common visual competences in a wide visual field. This work presents the design, development and preliminary testing of a new system for measuring infant’s gaze in the wide visual field called CareToy C: CareToy for Clinics. Methods: The system is based on a commercial eye tracker (SmartEye) with six cameras running at 60 Hz, suitable for measuring an infant’s gaze. In order to stimulate the infant visually and audibly, a mechanical structure has been designed to support five speakers and five screens at a specific distance (60 cm) and angle: one in the centre, two on the right-hand side and two on the left (at 30° and 60° respectively). Different tasks have been designed in order to evaluate the system capability to assess the infant’s gaze movements during different conditions (such as gap, overlap or audiovisual paradigms). Nine healthy infants aged 4–10 months were assessed as they performed the visual tasks at random. Results: We developed a system able to measure infant’s gaze in a wide visual field covering a total visual range of ±60° from the centre with an intermediate evaluation at ±30°. Moreover, the same system, thanks to different integrated software, was able to provide different visual paradigms (as gap, overlap and audio-visual) assessing and comparing different visual and multisensory sub-competencies. The proposed system endowed the integration of a commercial eye-tracker into a purposive setup in a smart and innovative way. Conclusions: The proposed system is suitable for measuring and evaluating infant’s gaze capabilities in a wide visual field, in order to provide quantitative data that can enrich the clinical 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

Toxin Levels and Profiles in Microalgae from the North-Western Adriatic Sea—15 Years of Studies on Cultured Species

The Northern Adriatic Sea is the area of the Mediterranean Sea where eutrophication and episodes related to harmful algae have occurred most frequently since the 1970s. In this area, which is highly exploited for mollusk farming, the first occurrence of human intoxication due to shellfish consumption occurred in 1989, nearly 10 years later than other countries in Europe and worldwide that had faced similar problems. Until 1997, Adriatic mollusks had been found to be contaminated mostly by diarrhetic shellfish poisoning toxins (i.e., okadaic acid and dinophysistoxins) that, along with paralytic shellfish poisoning toxins (i.e., saxitoxins), constitute the most common marine biotoxins. Only once, in 1994, a toxic outbreak was related to the occurrence of paralytic shellfish poisoning toxins in the Adriatic coastal waters. Moreover, in the past 15 years, the Adriatic Sea has been characterized by the presence of toxic or potentially toxic algae, not highly widespread outside Europe, such as species producing yessotoxins (i.e., Protoceratium reticulatum, Gonyaulax spinifera and Lingulodinium polyedrum), recurrent blooms of the potentially ichthyotoxic species Fibrocapsa japonica and, recently, by blooms of palytoxin-like producing species of the Ostreopsis genus. This review is aimed at integrating monitoring data on toxin spectra and levels in mussels farmed along the coast of the Emilia-Romagna region with laboratory studies performed on the species involved in the production of those toxins; toxicity studies on toxic or potentially toxic species that have recently appeared in this area are also reviewed. Overall, reviewed data are related to: (i) the yessotoxins producing species P. reticulatum, G. spinifera and L. polyedrum, highlighting genetic and toxic characteristics; (ii) Adriatic strains of Alexandrium minutum, Alexandrium ostenfeldii and Prorocentrum lima whose toxic profiles are compared with those of strains of different geographic origins; (iii) F. japonica and Ostreopsis cf. ovata toxicity. Moreover, new data concerning domoic acid production by a Pseudo-nitzschia multistriata strain, toxicity investigations on a Prorocentrum cf. levis, and on presumably ichthyotoxic species, Heterosigma akashiwo and Chattonella cf. subsalsa, are also reported

Action observation training for rehabilitation in brain injuries: A systematic review and meta-analysis

Background : To systematically review and analyse the effects of Action Observation Training on adults and children with brain damage. Methods : Seven electronic databases (Cochrane, EBSCO, Embase, Eric, PubMed, Scopus and Web of Science) were searched up to 16 September 2018 to select Randomized Controlled Trials focused on adults and children with brain damage that included AOT training on upper and/or lower limb carried out for at least 1 week. Identification of studies and data extraction was conducted with two reviewers working independently. Oxford Centre for Evidence-based Medicine (March2009) – Levels of Evidence and Physiotherapy Evidence Database scale were used to grade studies. The data collected from the articles were analysed using software R, version 3.4.3. Hedge’s g values were calculated and effect size estimates were pooled across studies. Separate meta-analyses were carried out for each ICF domain (i.e. body function and activity) for upper and lower limb. Results : Out of the 210 records identified after removing duplicates, 22 were selected for systematic review and 19 were included in the meta-analysis. Thirteen studies included in the meta-analysis focused on upper limb rehabilitation (4 in children and 9 in adults) and 6 on lower limb rehabilitation (only studies in adults). A total of 626 patients were included in the meta-analysis. An overall statistically significant effect size was found for upper limb body function (0.44, 95% CI: [0.24, 0.64], p<0.001) and upper limb activity domain (0.47, 95% CI: [0.30, 0.64], p<0.001). For lower limb, only the activity domain was analysed, revealing a statistically significant overall effect size (0.56, 95% CI: [0.28, 0.84], p<0.001). Conclusions : Action Observation Training (AOT) is an innovative rehabilitation tool for individuals with brain damage, which shows promising results in improving the activity domain for upper and lower limbs, and also the body function domain for the upper limb. However, the examined studies lack uniformity and further well-designed, larger controlled trials are necessary to determine the most suitable type of AOT particularly in childre

Monitoraggio dell'emostasi mediante tromboelastometria ed ACT in cani sottoposti ad emodialisi

Obiettivo – Lo scopo dello studio è quello di valutare la concordanza tra ACT e tromboelastometria in pazienti sottoposti ad emodialisi intermittente. Materiali e Metodi – In questo studio prospettico sono stati inclusi 10 cani, recatisi presso l’Ospedale Didattico Veterinario “Mario Modenato” nel periodo compreso tra Ottobre 2017 e Agosto 2018, sottoposti ad emodialisi intermittente. I pazienti sono stati valutati a tre tempi: prima della dialisi (T0), a metà del trattamento emodialitico (T1) e dopo la dialisi (T2). Sono stati sottoposti ad esame clinico, esame emocromocitometrico, analisi tromboelastometrica e ACT. Nell’analisi tromboelastometrica sono stati valutati i canali EXTEM, INTEM e FIBTEM di cui rispettivamente abbiamo considerato i parametri che seguono: CT, CFT, MCF, α angle. Il paziente è stato considerato ipercoagulabile nel caso si fossero presentate almeno due di queste alterazioni: CT diminuito, CFT diminuito, MCF aumentato, α angle aumentato. Al contrario è stato considerato ipocoagulabile nel caso si fossero presentate almeno due di queste alterazioni: CT aumentato, CFT aumentato, MCF diminuito, α angle diminuito. L’ACT è stato considerato ipocoagulabile per valori < 180 secondi, ipercoagulabile per valori <180 secondi. Risultati – Il Kappa di Cohen ha dimostrato che esiste una lieve concordanza tra l’INTEM al tempo 1 e 2 con l’ACT, mentre non esiste concordanza tra l’ACT e tutti gli altri tempi dei canali EXTEM e INTEM. Si è inoltre calcolata la sensibilità e la specificità delle due metodiche nel rilevare la presenza di coaguli all’interno del catetere al tempo 0: il ROTEM è risultato avere una sensibilità del 100% e una specificità del 55%, mentre l’ACT una sensibilità dell’80% e una specificità del 22%. Conclusioni – Il ROTEM è uno strumento molto più accurato nella valutazione della coagulazione del paziente dializzato, poiché è in grado di valutare sia la via intrinseca che la via estrinseca della coagulazione. E’ maggiormente sensibile nella rilevazione della presenza di coaguli rispetto all’ACT. E’ necessario ampliare lo studio con l’utilizzo del canale HEPTEM, in grado di rilevare, unito al canale INTEM, i disturbi della coagulazione da eparina, poiché il solo canale INTEM risulta essere troppo sensibile al trattamento eparinico