Ruolo del cervelletto nell'integrazione sensori-motoria per il movimento finalizzato dell'arto superiore.

L'obiettivo di questa tesi è stato studiare l’effetto delle lesioni cerebellari sui meccanismi di integrazione sensoriale coinvolti nell’esecuzione di movimenti volontari dell’arto superiore. In particolare, ci siamo proposti di verificare se, durante un compito di puntamento manuale (“pointing”) di bersagli visivi, il cervelletto contribuisce ad integrare l’informazione visiva relativa alla posizione del bersaglio con le informazioni propriocettive relative alla posizione dell’occhio nell’orbita e della testa rispetto al corpo, allo scopo di localizzare il bersaglio in un sistema di riferimento appropriato per il movimento. A tale scopo abbiamo allestito un set-up sperimentale che ci ha consentito di manipolare separatamente l’orientamento degli occhi rispetto alla testa, e della testa rispetto al tronco, durante un compito di puntamento di bersagli in visione foveale. I parametri cinematici dei movimenti eseguiti da un gruppo di pazienti con lesione cerebellare sono stati confrontati con quelli di un gruppo di controllo costituito da soggetti neurologicamente sani. L’assunto su cui si è basato l’esperimento è che ogni differenza nell’errore direzionale tra la condizione di allineamento di testa e sguardo col bersaglio ed una delle altre condizioni di rotazione della testa e/o degli occhi, rifletta una difficoltà ad integrare le informazioni sensoriali, visive e propriocettive ai fini della trasformazione di coordinate necessaria per l’accuratezza del pointing. I risultati dello studio mostrano pattern diversi di compromissione dei meccanismi di integrazione sensoriale e di trasformazione visuomotoria in base alla sede della lesione. Tali risultati sono rilevanti sia ai fini di una migliore comprensione del ruolo funzionale svolto dal cervelletto nella pianificazione ed esecuzione di movimenti finalizzati dell’arto superiore, sia per una riflessione sulle possibili strategie riabilitative in pazienti con lesione cerebellare

What Therapy for My Child? Features, Strengths, and Gaps to Fill for the Implementation of Early Autism Interventions

Scientific literature suggests the neurobiological value of early intervention for children at risk of ASD and of other neurodevelopmental disorders, because it is based on the promotion of brain plasticity mechanisms in an ecological, noninvasive, and evidence-based way. Moreover, several authors suggest the greatest efficacy of early rehabilitation programs, involving both the parents and the children, is to improve not only sensory-motor and cognitive outcomes but also child-parent interactions and the wellness of the familiar system. In this chapter, the neurobiological fundaments and features for the early intervention and the most recent early approaches for children at risk of ASD (behavioral, developmental, naturalistic developmental behavioral, and parent-mediated interventions) will be explained

The social effect of "being imitated" in children with autism spectrum disorder

There is evidence that "being imitated" has social effects, and that the imitation of the child's actions may be used as a strategy to promote social engagement in children with autism spectrum disorder (ASD). The observation of someone that imitates us recruits, indeed, neural areas involved in social cognition. We reviewed studies exploring the behavioral consequences of "being imitated" in children with ASD. We aimed at assessing what are the social skills targeted by this strategy, and the factors that may improve the response. The "being imitated" strategy improves social gazes, proximal social behaviors, and play skills, particularly in children with low developmental level, and also when the strategy is implemented by children's mothers. The "being imitated" may be used as a tool in early intervention to improve social skills, helping to assess the effects of intervention at both behavioral and neural level

Object use affects motor planning in infant prehension

The purpose of this study was to investigate the factors underlying the ability to plan object-oriented grasping movements in the first two years of life. In particular, we were interested in evaluating the relationship between manual motor planning, object use and infant-parent interaction. In order to achieve this aim, grasping behaviors of nineteen healthy infants, aged nine to 25 months, were examined during naturalistic play sessions with a standard set of toys. Our main finding was that, regardless of age, infants perform a better manual planning when they use an object in a functional rather than non-functional way, suggesting that the planning of an action also depends on knowing the functional properties of an object. In addition, we found that the ability to use objects in a functional way was strongly affected by infant-parent interaction. Thus, level of object use and environmental role must be taken into account in order to understand the development of manual motor planning

Prediction of body composition in anorexia nervosa: Results from a retrospective study

Summary Background & aims The assessment of body composition is crucial in evaluating nutritional status in female subjects with anorexia nervosa (AN) and improving their clinical management. The aim of this retrospective study was to assess the accuracy of selected BIA (bioimpedance analysis) equations for fat-free mass (FFM) in female AN subjects and to formulate a specific equation for these subjects. Methods Eighty-two restrictive female AN subjects (age 20.5 ± 3.7 yrs, BMI 15.7 ± 1.7 kg/m 2 ) were studied. Body composition was determined with dual-energy X-ray absorptiometry (DXA) and estimated by BIA using five different equations. Linear correlation analysis was carried out to evaluate the association of FFM with selected variables. Multiple regression analysis was used to formulate specific equations to predict FFM in AN. Results All predictive equations underestimated FFM at the population level with a bias from −5.6 to −11.7%, while the percentage of accurate predictions varied from 12.2% to 35.4%. More interestingly, multiple regression analysis clearly indicates that, in addition to weight, ZI 100 or RI also emerged as independent predictors of DXA-derived FFM, increasing the prediction power of the equation well above that observed with anthropometric characteristics only. Conclusions This study shows that the selected predictive BIA equations considered exhibit an insufficient accuracy at the population and the individual level. Predictive formulas based on body weight plus BIA parameters such as RI and ZI 100 offer a rather accurate prediction of FFM (with high R squared)

Case report: Preemptive intervention for an infant with early signs of autism spectrum disorder during the first year of life

Autism spectrum disorder (ASD) includes neurodevelopmental conditions traditionally considered to bring life long disabilities, severely impacting individuals and their families. Very early identification and intervention during the very first phases of life have shown to significantly diminish symptom severity and disability, and improve developmental trajectories. Here we report the case of a young child showing early behavioral signs of ASD during the first months of life, including diminished eye contact, reduced social reciprocity, repetitive movements. The child received a pre-emptive parent mediated intervention based on the Infant Start, an adaptation of the Early Start Denver Model (ESDM), specifically developed for children with ASD signs during the first year of life. The child here described received intervention from 6 to 32 months of age, in combination with educational services. Diagnostic evaluations performed at several time points (8, 14, 19, and 32 months) showed progressive improvements in his developmental level and ASD symptoms. Our case study supports the possibility of identifying ASD symptoms and providing services as soon as concerns emerge even during the first year of life. Our report, in combination with recent infant identification and intervention studies, suggests the need for very early screening and preemptive intervention to promote optimal outcomes

Body composition changes in patients with anorexia nervosa after complete weight recovery.

ABSTRACT OBJECTIVE: To assess body composition changes occurring in female anorectic patients after complete weight recovery. DESIGN: Longitudinal study. SUBJECTS: : Ten female patients with anorexia nervosa (age at baseline: 19.7+/-5.8 y) were studied both when undernourished (body mass index, BMI 14.8+/-1.3 kg/ m(2)) and after the achievement of a BMI >18.5 kg/m(2). The control group comprised 18 well-nourished women (age 20.1+/-4.4 y; BMI 19.0-23.0 kg/ m(2)). INTERVENTIONS: Fat mass and fat-free mass were determined by dual-energy X-ray absorptiometry. Skinfold thicknesses and circumferences were also measured. Arm muscle area and arm fat area were calculated by standard formulas. RESULTS: The undernourished patients had lower fat-free mass, fat mass, skinfold thicknesses and circumferences. After refeeding, fat mass represented 25-71%(mean 56%) of the mass regained, this percentage being directly related to the extent of weight gain. The increases in skinfolds and circumferences depended upon the site considered and were correlated to a various extent with those in weight or BMI. Skinfolds at biceps and abdominal sites and the waist-to-hip ratio remained significantly higher, whereas arm muscle circumference was significantly lower, in the refed group than in the control one. CONCLUSION: The percentage of fat in the weight regained by refed female anorectic patients was directly related to the extent of body mass increase. Refed anorectic patients appear to preferentially regain fat in the abdominal and triceps regions. Abnormalities in skinfolds (at biceps and abdominal sites), arm muscle area and waist-to-hip ratio still persist in refed anorectic patients in comparison to control healthy controls

Interpersonal motor coordination during joint actions in children with and without autism spectrum disorder: The role of motor information

Background: Kinematics plays a key role in action prediction, imitation and joint action coordination. Despite people with autism spectrum disorder (ASD) show a failure to use kinematic cues during observation and imitation, there is a paucity of studies exploring the role of this dysfunction during joint actions in children with ASD. Aim: To evaluate the interpersonal motor coordination of children with ASD and typically developing (TD) children during a joint action task. Method: Twenty-two participants performed two cooperative tasks. In the first one (Clear End-Point), children were provided with a priori information on movement end-point. In the second one (Unclear End-Point), the end-point was unknown and children had to use kinematic cues to accomplish the shared goal. Results: We found no between-group differences in the first task, even if children with ASD displayed greater reaction time variability. In the second task, they showed less accurate and slower movements than TD children. Moreover, their movement features did not differ between the two tasks, whereas TD children showed reduced reaction time variability and number of errors in the second task. Conclusion: Children with ASD were impaired in joint action coordination when they had to rely only on kinematic information. They were not able to pay more attention to the kinematic cues in absence of a visual goal

Locomotion and grasping impairment in preschoolers with autism spectrum disorder

Objective: To investigate expressiveness of motor impairment in autism spectrum disorder (ASD) and its correlation with developmental and clinical features of ASD. Method: Thirty-five male preschoolers with ASD completed the Peabody Developmental Motor Scales-2 (PDMS- 2; Folio and Fewell, 2000) and underwent a multidisciplinary assessment including medical examination, standardized assessment of cognitive abilities, administration of Autism_Diagnostic_Observation_Schedule (ADOS) and a parent interview about adaptive skills. Results: Results revealed a substantial impairment in locomotion and grasping skills. Both fine and gross motor skills were significantly correlated with non verbal IQ and adaptive behaviours (p<0.01) but not with chronological age or ADOS scores. Children with weaker motor skills have greater cognitive and adaptive behaviours deficits. Conclusions: Motor development in ASD can be detected at preschool age and locomotion and grasping skills are substantially the most impaired area. These findings support the need to assess motor skills in preschoolers with ASD in addition to other developmental skill areas. Along with the increasingly acknowledged importance of motor skills for subsequent social, cognitive, and communicative development our findings support the need to consider motor intervention as a key area in therapeutic program to improve outcome in preschoolers with ASD