Parkinson’s disease: new system to improve quality of life

Parkinson’s disease (PD) is the most common neurodegenerative movement disorder, affecting 0.3% of the general population(1). Postural instability is a loss of balance and it is a common feature of PD(2). Individuals with PD commonly experience gait and postural stability impairments, which may lead to falls, mobility loss, and reduced independence. Human Body Posturizer (HBP) is a fully articulated orthosis, light and able to adapt to the physical characteristics of each individual. Our aim has been to evaluate the role of HBP as an innovative tool for the conservative treatment of gait and postural stability impairments in patients affected by PD. This study analyzed 20 subjects (10 male and 10 female) affected by PD and a control group of age-matched healthy subjects (10 male and 10 female). A bipodal platform (Prokin, Tecnobody) was used to evaluate static balance. To describe the functional characteristics of the PD sample, a clinical assessment was carried out at the beginning of the study. The Berg Balance Scale and the Parkinson’s Disease Rating Scale (UPDRS) were administrated before the experimental session. All patients were firstly evaluated without HBP and wearing normal clothes; then, patients were asked to wear HBP and, after 40 mins, a second acquisition with HBP was performed. For the static evaluation, the patients performed a stabilometric test, 30 sec with eyes open and then 30 sec with eyes closed; perimeter sway, area of the center of pressure (CoP), anterior- posterior velocity (VA-P), and medial-lateral velocity (VM-L) have been evaluated. Our results showed a marked improvement of all analyzed parameters; in particular, a significant reduction in VA-P (p<0.05) was present when patients wear HBP in both open and closed eyes. Moreover, a significant reduction (p<0.05) of the CoP area was observed in closed eyes. This variable reflects the ability of balance system to achieve body stability. In conclusion, our data suggest a stabilizing effect of HBP in patients with PD with a role in improving quality of life

Effects of an innovative esoskeleton (Human Body Posturizer) on static balance in patients with Parkinson’s Disease

Parkinson disease (PD) is a progressive neurodegenerative disease, affecting 0.3% of the general population; cardinal symptoms include tremor, rigidity, bradykinesia, and postural instability. Individuals with PD commonly experience gait and postural stability impairments, which may lead to falls, mobility loss, and reduced independence (de Lau et al, 2006). Human Body Posturizer (HBP) is a fully articulated orthosis, light and able to adapt to the physical characteristics of each individual (Di Russo et al, 2013). Our aim has been to preliminary evaluate the role of HBP as an innovative tool for the conservative treatment of gait and postural stability impairments in patients affected by PD. This study analyzed 10 subjects (5 male and 5 female) affected by PD. A bipodal platform (Prokin, Tecnobody) was used to evaluate static balance. All patients were firstly evaluated without HBP and wearing normal clothes; then, patients were asked to wear HBP and, after 40 mins, a second acquisition with HBP was performed. For the static evaluation, the patients performed a stabilometric test, 30 sec with eyes open and then 30 sec with eyes closed; perimeter sway, area of the center of pressure (CoP), anterior-posterior velocity (VA-P), and medial-lateral velocity (VM-L) have been evaluated. Our results showed a significant reduction in VA-P (p<0.05) when patients wear HBP in both open and closen eyes condition. Moreover, a significant reduction (p<0.05) of the CoP area was observed in closen eyes evaluation. Area of the ellipse contained 95% of CoP data points, computed by considering the main axes of the ellipse, estimated using principal component analysis. This variable reflects the ability of balance system to achieve body stability. Our data suggest a stabilizing effect of HBP on anterior-posterior balance, in patients with PD

Stroke Gait Rehabilitation: A Comparison of End-Effector, Overground Exoskeleton, and Conventional Gait Training

Gait recovery is one of the main goals of post-stroke rehabilitation and Robot-Assisted Gait Training (RAGT) has shown positive outcomes. However, there is a lack of studies in the literature comparing the effects of different devices. This paper aims to study the effects, in terms of clinical and gait outcomes, of treadmill-based and overground RAGT, compared to conventional gait training in stroke subjects. The results showed a significant improvement of clinical outcomes in both robotic treatments and in conventional therapy. The performance of locomotor tasks was clinically significant in the robotic groups only. The spatio-temporal gait parameters did not reveal any significant difference. Results suggest future multicentre studies on a larger number of subjects

Microchimerism in multiple sclerosis: The association between sex of offspring and MRI features in women with multiple sclerosis

Aims: During pregnancy, fetal cells can migrate to the mother via blood circulation. A percentage of these cells survive in maternal tissues for decades generating a population of fetal microchimeric cells (fMCs), whose biological role is unclear. The aim of this study was to investigate the association between the sex of offspring, an indirect marker of fMCs, and magnetic resonance imaging (MRI) features in women with multiple sclerosis (MS). Methods: We recruited 26 nulliparous MS patients (NPp), 20 patients with at least one male son (XYp), and 8 patients with only daughters (XXp). Each patient underwent brain MR scan to acquire 3D-T2w FLAIR FatSat and 3D-T1w FSPGR/TFE. Lesion Segmentation Tool (LST) and FreeSurfer were used to obtain quantitative data from MRI. Additional data were collected using medical records. Multiple regression models were applied to evaluate the association between sex of offspring and MS data. Results: Comparing NPp and XXp, we found that NPp had larger 4th ventricle volume (2.02 ± 0.59 vs. 1.70 ± 0.41; p = 0.022), smaller left entorhinal volume (0.55 ± 0.17 vs. 0.68 ± 0.25; p = 0.028), and lower thickness in the following cortical areas: left paracentral (2.34 ± 0.16 vs. 2.39 ± 0.17; p = 0.043), left precuneus (2.27 ± 0.11 vs. 2.34 ± 0.16; p = 0.046), right lateral occipital (2.14 ± 0.11 vs. 2.25 ± 0.08; p = 0.006). NPp also had lower thickness in left paracentral cortex (2.34 ± 0.16 vs. 2.46 ± 0.17; p = 0.004), left precalcarine cortex (1.64 ± 0.14 vs. 1.72 ± 0.12; p = 0.041), and right paracentral cortex (2.34 ± 0.17 vs. 2.42 ± 0.14; p = 0.015) when compared to XYp. Comparing XYp and XXp, we found that XYp had higher thickness in left cuneus (1.80 ± 0.14 vs. 1.93 ± 0.10; p = 0.042) and left pericalcarine areas (1.59 ± 0.19 vs. 1.72 ± 0.12; p = 0.032) and lower thickness in right lateral occipital cortex (2.25 ± 0.08 vs. 2.18 ± 0.13; p = 0.027). Discussion: Our findings suggested an association between the sex of offspring and brain atrophy. Considering the sex of offspring as an indirect marker of fMCs, we speculated that fMCs could accumulate in different brain areas modulating MS neuropathological processes

Higgs and non-universal gaugino masses: no SUSY signal expected yet?

So far, no supersymmetric particles have been detected at the Large Hadron Collider (LHC). However, the recent Higgs results have interesting implications for the SUSY parameter space. In this paper, we study the consequences of an LHC Higgs signal for a model with non-universal gaugino masses in the context of SU(5) unification. The gaugino mass ratios associated with the higher representations produce viable spectra that are largely inaccessible to the current LHC and direct dark matter detection experiments. Thus, in light of the Higgs results, the non-observation of SUSY is no surprise.Comment: supplementary file containing plots with log priors in ancillary files. v2: added some comments on more general settings and references, accepted for publication in JHE

Psychological treatments and psychotherapies in the neurorehabilitation of pain. Evidences and recommendations from the italian consensus conference on pain in neurorehabilitation

BACKGROUND: It is increasingly recognized that treating pain is crucial for effective care within neurological rehabilitation in the setting of the neurological rehabilitation. The Italian Consensus Conference on Pain in Neurorehabilitation was constituted with the purpose identifying best practices for us in this context. Along with drug therapies and physical interventions, psychological treatments have been proven to be some of the most valuable tools that can be used within a multidisciplinary approach for fostering a reduction in pain intensity. However, there is a need to elucidate what forms of psychotherapy could be effectively matched with the specific pathologies that are typically addressed by neurorehabilitation teams. OBJECTIVES: To extensively assess the available evidence which supports the use of psychological therapies for pain reduction in neurological diseases. METHODS: A systematic review of the studies evaluating the effect of psychotherapies on pain intensity in neurological disorders was performed through an electronic search using PUBMED, EMBASE, and the Cochrane Database of Systematic Reviews. Based on the level of evidence of the included studies, recommendations were outlined separately for the different conditions. RESULTS: The literature search yielded 2352 results and the final database included 400 articles. The overall strength of the recommendations was medium/low. The different forms of psychological interventions, including Cognitive-Behavioral Therapy, cognitive or behavioral techniques, Mindfulness, hypnosis, Acceptance and Commitment Therapy (ACT), Brief Interpersonal Therapy, virtual reality interventions, various forms of biofeedback and mirror therapy were found to be effective for pain reduction in pathologies such as musculoskeletal pain, fibromyalgia, Complex Regional Pain Syndrome, Central Post-Stroke pain, Phantom Limb Pain, pain secondary to Spinal Cord Injury, multiple sclerosis and other debilitating syndromes, diabetic neuropathy, Medically Unexplained Symptoms, migraine and headache. CONCLUSIONS: Psychological interventions and psychotherapies are safe and effective treatments that can be used within an integrated approach for patients undergoing neurological rehabilitation for pain. The different interventions can be specifically selected depending on the disease being treated. A table of evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation is also provided in the final part of the pape

C. elegans expressing D76N β 2 -microglobulin: a model for in vivo screening of drug candidates targeting amyloidosis

Funder: Ministero dell'Istruzione, dell'Università e della Ricerca Dipartimenti di Eccellenza 2018-2022 grant to the Molecular Medicine Department (University of Pavia)Abstract: The availability of a genetic model organism with which to study key molecular events underlying amyloidogenesis is crucial for elucidating the mechanism of the disease and the exploration of new therapeutic avenues. The natural human variant of β2-microglobulin (D76N β2-m) is associated with a fatal familial form of systemic amyloidosis. Hitherto, no animal model has been available for studying in vivo the pathogenicity of this protein. We have established a transgenic C. elegans line, expressing the human D76N β2-m variant. Using the INVertebrate Automated Phenotyping Platform (INVAPP) and the algorithm Paragon, we were able to detect growth and motility impairment in D76N β2-m expressing worms. We also demonstrated the specificity of the β2-m variant in determining the pathological phenotype by rescuing the wild type phenotype when β2-m expression was inhibited by RNA interference (RNAi). Using this model, we have confirmed the efficacy of doxycycline, an inhibitor of the aggregation of amyloidogenic proteins, in rescuing the phenotype. In future, this C. elegans model, in conjunction with the INVAPP/Paragon system, offers the prospect of high-throughput chemical screening in the search for new drug candidates

Robot-assisted upper limb training for patients with multiple sclerosis: an evidence-based review of clinical applications and effectiveness

Upper extremities limitation is a common functional impairment in patients with Multiple Sclerosis (PwMS). Novel technological devices are increasingly used in neurorehabilitation to support motor function improvement and the quantitative assessment of motor performance during training in patients with neurological diseases. In this review, we systematically report the evidence on clinical applications and robotic-assisted arm training (RAT) in functional recovery in PwMS. PubMed/MEDLINE, the Cochrane Library, and the Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to March 2021. The 10-item PEDro scale assessed the study quality for the RCT, and the AMSTAR-2 was used to assess the quality of the systematic review. The 5-item Oxford CEBM scale was used to rate the level of evidence. A total of 10 studies (161 subjects) were included. The selected studies included one systematic review, four RCTs, one randomized crossover, and four case series. The RCTs were scored as high-quality studies, while the systematic review was determined to be of low quality. Shoulder range of motion, handgrip strength, and proximal arm impairment improved after RAT. Manual dexterity, arm function, and use in daily life also ameliorated arm function. The high clinical heterogeneity of treatment programs and the variety of robot devices affects the generalizability of the study results; therefore, we emphasize the need to standardize the intervention type in future studies that evaluate the role of robotic-assisted training in PwMS. Robot-assisted treatment seems safe and useful to increase manual dexterity and the quality of movement execution in PwMS with moderate to severe disability. Additional studies with an adequate sample size and methodological rigour are warranted to drive definite conclusion

Upper limb robotic rehabilitation for patients with cervical spinal cord injury: a comprehensive review

The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on "Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin" (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury