Evaluation of Arm Swing Features and Asymmetry during Gait in Parkinson’s Disease Using the Azure Kinect Sensor

Arm swinging is a typical feature of human walking: Continuous and rhythmic movement of the upper limbs is important to ensure postural stability and walking efficiency. However, several factors can interfere with arm swings, making walking more risky and unstable: These include aging, neurological diseases, hemiplegia, and other comorbidities that affect motor control and coordination. Objective assessment of arm swings during walking could play a role in preventing adverse consequences, allowing appropriate treatments and rehabilitation protocols to be activated for recovery and improvement. This paper presents a system for gait analysis based on Microsoft Azure Kinect DK sensor and its body-tracking algorithm: It allows noninvasive full-body tracking, thus enabling simultaneous analysis of different aspects of walking, including arm swing characteristics. Sixteen subjects with Parkinson’s disease and 13 healthy controls were recruited with the aim of evaluating differences in arm swing features and correlating them with traditional gait parameters. Preliminary results show significant differences between the two groups and a strong correlation between the parameters. The study thus highlights the ability of the proposed system to quantify arm swing features, thus offering a simple tool to provide a more comprehensive gait assessment

CIRCADIAN RHYTHM DYSFUNCTION IN ALZHEIMER’S DISEASE: HOW TO DETERMINE CIRCADIAN PHASE AND THE ROLE OF TAYLORED LIGHT THERAPY ON SLEEP AND COGNITION

In this thesis circadian rhythm alterations in Alzheimer’s disease (AD) are taken into account, in particular concerning the early stage of disease. In the first part of this 3-year work the research was focused on determining the circadian phase in early AD patients using subjective and objective measures: clinical scales, sleep-wake diaries, salivary melatonin determination (DLMO), phase angles between sleep and melatonin onset. To achieved this goal we performed a case-control observational study comparing the circadian phase of early AD patients elderly healthy controls (Hc). The main results of this first step were that Initial evening secretion of melatonin proves to be delayed and mildly impaired in patients with mild/moderate form of Alzheimer disease while patient’s subjective sleep parameters and chronotype are reported similar to those of HC. This data indicate that, subclinical altered patterns of melatonin secretion occur in subjects with AD at an early stage of the disease. The second part of the study aimed at comparing circadian phase of early AD patients to the one of another neurodegenerative dementia (OD), determining melatonin secretion in different biological fluids at different daytime. This case-control observational study was performed enrolling patients affected by probable Frontotemporal lobar degeneration (FTLD) and cortico-basal syndrome (CBS) at the early stage of the disease. The main results of this second step were that evening melatonin secretion was confirmed to be delayed and impaired in both AD and OD groups than Hc, but with some important differences between groups: in AD patients melatonin secretion was more delayed and less decreased than OD patients, at this fact was not affected by other factors than disease diagnosis. Furthermore, OD and AD patients showed an higher rate of phase angle alterations and circadian phase misperceptions than Hc. Melatonin secretion proved to correlate in the different biological fluids at a certain time among patients, an this finding support the use of DLMO determination in saliva as a sensitive marker of circadian phase. The third part of the work was focused on the use of a circadian phase modulator in order to interact with the circadian phase of AD patients and evaluate the effect on sleep and cognition. After a systematic review of the literature on this topic, light therapy showed some, albeit limited evidence supporting its use as circadian rhythm modulator in sleep disturbances and agitation in persons with cognitive impairment, with most studies examining light exposure reporting positive effects on at least one sleep measure. However, light therapy, including BLT, did not show any significant effect in 4 recent systematic reviews and meta-analysis including a Cochrane review specifically examining the results of RCTs. This suggests that the evidence supporting light therapy is at best equivocal due to the heterogeneity in sample size, degree and subtype of dementia, study design, type of light therapy and devices used. The future studies might include randomized controlled trials on specific subtypes of dementia, using preferentially blue-enriched light therapy carefully controlled, which effect must be verified with objective measures. Taking into account this evidences, we performed a single blind randomised control trial to investigate the effects of a tailored light therapy protocol on sleep and cognition parameters in patients with Alzheimer Disease (AD) of mild /moderate severity. The preliminary findings of this study showed that light therapy protocol tailored on the circadian phase proved to be feasible and associated to an objective phase shift in accordance to the melatonin phase response curve, a trend to an increased subjective sleep quality, 24-hour TST and cognitive performance

Cefalee nell’anziano: inquadramento clinico delle forme primitive e secondarie.

Review sulla diagnosi e terapia delle cefalee dell'anziano, primarie e secondari

Monitoring of Gait Parameters in Post-Stroke Individuals: A Feasibility Study Using RGB-D Sensors

Stroke is one of the most significant causes of permanent functional impairment and severe motor disability. Hemiplegia or hemiparesis are common consequences of the acute event, which negatively impacts daily life and requires continuous rehabilitation treatments to favor partial or complete recovery and, consequently, to regain autonomy, independence, and safety in daily activities. Gait impairments are frequent in stroke survivors. The accurate assessment of gait anomalies is therefore crucial and a major focus of neurorehabilitation programs to prevent falls or injuries. This study aims to estimate, using a single RGB-D sensor, gait patterns and parameters on a short walkway. This solution may be suitable for monitoring the improvement or worsening of gait disorders, including in domestic and unsupervised scenarios. For this purpose, some of the most relevant spatiotemporal parameters, estimated by the proposed solution on a cohort of post-stroke individuals, were compared with those estimated by a gold standard system for a simultaneous instrumented 3D gait analysis. Preliminary results indicate good agreement, accuracy, and correlation between the gait parameters estimated by the two systems. This suggests that the proposed solution may be employed as an intermediate tool for gait analysis in environments where gold standard systems are impractical, such as home and ecological settings in real-life contexts

Short-Term Benefits of Continuous Positive Airway Pressure Treatment on Cognition in the Obstructive Sleep Apnea Syndrome: A Retrospective Study

The Obstructive Sleep Apnea Syndrome (OSAS) significantly impacts cognitive functioning. The prolonged use (more than 3 months) of ventilotherapy with continuous positive airway pressure (CPAP) seems to have positive effects in restoring cognitive difficulties. However, there is poor evidence about its possible short-term effect. We investigated whether the short use (less than 15 days at testing) of CPAP improved the cognitive functioning in fifty individuals with OSAS by collecting retrospective neuropsychological measures about verbal memory and learning, information processing speed, attention (i.e., alerting, orienting, and executive system), and executive functions (i.e., strategic reasoning, problem-solving, and mental planning). The predictive role of days of CPAP use on the neuropsychological scores was assessed by hierarchical multiple linear regression analyses, over and above the possible role of demographics, body mass index, level of OSAS severity, and the level of anxiety and depression. The average number of days since CPAP adaptation was 4.70 (SD = 3.90; range = 0–15). As the days of CPAP adaptation increased, verbal learning and long-term memory significantly improved, contrary to the other assessed domains. Our results show a significant improvement in some cognitive functions even after a short treatment with CPAP, pointing to the importance of the early use of ventilotherapy to rapidly improve cognitive functioning. Identifying which cognitive functions can or cannot be restored with CPAP use may enable the design of complementary neuropsychological interventions focused on those residual difficulties, possibly enhancing patients’ compliance to the treatment

Mind and body connection in expert meditators: a computational study based on central and peripheral nervous system

Abstract A meditative ‘technique’ is conceived as a continuum of different affective states involving mind and body jointly. Meditative practices can involve cognitive effort (e.g., focused attention and open-minded techniques), as well as automatic and implicit practices (e.g., transcendental techniques). The NGALSO tantric self-healing meditation technique is a brief, comprehensive meditation technique relying on mind and body connection. In this study, we aimed to investigate the state and the trait neurophysiological correlates of NGALSO meditation practice. First, 19 EEG channels and a 3-lead ECG signal were recorded from 10 expert meditators (more than 7 years of daily meditation) and 10 healthy inexpert participants (controls) who underwent the same meditative procedure. The neuropsychological profiles of experts and controls were compared. Results showed that expert meditators had significantly higher power spectra on alpha, theta and beta, and a higher sympathetic tone with lower parasympathetic tone after meditation. Conversely, the control group had significantly less power spectra on alpha, theta and beta, and a higher parasympathetic tone with lower sympathetic tone after meditation. A machine learning approach also allowed us to classify experts vs. controls correctly by using only EEG Theta bands before or after meditation. ECG results allowed us to show a significantly higher effort by expert meditators vs. controls, thus suggesting that a higher effort is required for this meditation, in line with the principle ‘no pain, no gain’ in body and mind

The prognostic value of sleep patterns in disorders of consciousness in the sub-acute phase

OBJECTIVE: This study aimed to evaluate, through polysomnographic analysis, the prognostic value of sleep patterns, compared to other prognostic factors, in patients with disorders of consciousness (DOCs) in the sub-acute phase. METHODS: Twenty-seven patients underwent 24-h polysomnography and clinical evaluation 3.5±2months after brain injury. Their clinical outcome was assessed 18.5±9.9months later. Polysomnographic recordings were evaluated using visual and quantitative indexes. A general linear model was applied to identify features able to predict clinical outcome. Clinical status at follow-up was analysed as a function of the baseline clinical status, the interval between brain injury and follow-up evaluation, patient age and gender, the aetiology of the injury, the lesion site, and visual and quantitative sleep indexes. RESULTS: A better clinical outcome was predicted by a visual index indicating the presence of sleep integrity (p=0.0006), a better baseline clinical status (p=0.014), and younger age (p=0.031). Addition of the quantitative sleep index strengthened the prediction. CONCLUSIONS: More structured sleep emerged as a valuable predictor of a positive clinical outcome in sub-acute DOC patients, even stronger than established predictors (e.g. age and baseline clinical condition). SIGNIFICANCE: Both visual and quantitative sleep evaluation could be helpful in predicting clinical outcome in sub-acute DOCs

Computation of Gait Parameters in Post Stroke and Parkinson’s Disease: A Comparative Study Using RGB‐D Sensors and Optoelectronic Systems

The accurate and reliable assessment of gait parameters is assuming an important role, especially in the perspective of designing new therapeutic and rehabilitation strategies for the remote follow‐up of people affected by disabling neurological diseases, including Parkinson’s disease and post‐stroke injuries, in particular considering how gait represents a fundamental motor activity for the autonomy, domestic or otherwise, and the health of neurological patients. To this end, the study presents an easy‐to‐use and non‐invasive solution, based on a single RGB‐D sensor, to estimate specific features of gait patterns on a reduced walking path compatible with the available spaces in domestic settings. Traditional spatio‐temporal parameters and features linked to dynamic instability during walking are estimated on a cohort of ten parkinsonian and eleven post‐stroke subjects using a custom‐written software that works on the result of a body‐tracking algorithm. Then, they are compared with the “gold standard” 3D instrumented gait analysis system. The statistical analysis confirms no statistical difference between the two systems. Data also indicate that the RGB‐D system is able to estimate features of gait patterns in pathological individuals and differences between them in line with other studies. Although they are preliminary, the results suggest that this solution could be clinically helpful in evolutionary disease monitoring, especially in domestic and unsupervised environments where traditional gait analysis is not usable

Whole-Body Cryostimulation as an Adjunctive Treatment for Neurophysiologic Tinnitus and Associated Disorders: Preliminary Evidence from a Case Study

Background: Tinnitus, which is often associated with reduced quality of life, depression, and sleep disturbances, lacks a definitive treatment targeting its pathophysiological mechanism. Inflammatory markers like TNF-α have been linked to tinnitus, thereby underlining the necessity for innovative therapies. This case study investigates the potential benefits of a multi-approach rehabilitation intervention involving whole-body cryostimulation (WBC) for a 47-year-old male suffering from chronic neurophysiologic tinnitus, who had underwent various unsuccessful treatments from 2005. Methods: the patient underwent a personalized, multidisciplinary rehabilitation intervention covering diet, pharmacotherapy, physiotherapy and physical activity classes tailored to the patient’s needs and capacities, repetitive transcranial magnetic stimulation (rTMS), and whole-body cryostimulation (WBC). Results: The adjunctive WBC intervention resulted in a significant progressive improvement in tinnitus severity (tinnitus handicap inventory Δ% = −46.3%, VAS tinnitus score Δ% = −40%). Additional positive outcomes were noted in sleep quality (PSQI Δ% = −41.67%), emotional wellbeing (BDI Δ% = −41.2%), and quality of life (SF-36, WHO-5 Δ% = +16.5). Conclusions: This study supports the existing literature suggesting the potential of WBC as an adjunct in a multi-approach intervention in ameliorating tinnitus severity and tinnitus-associated disorders. However, randomized controlled trials in larger populations, which specifically consider WBC’s effects on tinnitus, are necessary to confirm these findings and to explore the mechanisms that underlie the observed improvements

Obstructive sleep apnea syndrome and Alzheimer's disease pathology: may continuous positive airway pressure treatment delay cognitive deterioration?

Purpose The main aim of the present study was to identify the long-term effects of continuous positive airway pressure (CPAP) treatment in patients co-affected by obstructive sleep apnea syndrome (OSAS) and mild cognitive impairment (MCI) or dementia due to Alzheimer's disease (ADD). Methods This retrospective multicentre study included patients affected by MCI or ADD, diagnosed according to the core clinical and biomarkers criteria, and presenting comorbid OSAS. Only patients performing at least a 1-year visit during their follow-up to monitor cognitive deterioration and adherence with CPAP treatment were included. Both Mini-Mental State Examination (MMSE) and clinical dementia rating scale (CDR) were conducted during the baseline and the follow-up visits. Results Twenty-four patients were included in the study and were distributed according to the diagnosis in MCI (n = 8) or ADD (n = 16). There were no significant differences in the variables analysed at baseline between the CPAP non-adherent and CPAP adherent patients. In the whole group, a significant decrease was found in MMSE scores, and a significant increase was found in CDR scores between baseline and follow-up. No longitudinal changes in ESS scores were statistically significant from baseline to follow-up. A significant difference was found for the mean score change of the CDR since CPAP non-adherent patients showed a higher mean change of CDR compared to CPAP adherent patients. No significant differences were found for the mean change of MMSE. Conclusion These findings highlight the clinical potential of treating OSAS with CPAP to delay cognitive deterioration in patients with MCI or ADD