Papers by giorgio maggioni
The Journal of Headache and Pain, 2004
The objective was to assess the effect of botulinum toxin type-A (BTX-A) in treating chronic tens... more The objective was to assess the effect of botulinum toxin type-A (BTX-A) in treating chronic tension-type headache (CTTH). A single centre, open label, pilot study was carried out at the
Disorders of Consciousness are a big challenge for the entire process of rehabilitation: assessme... more Disorders of Consciousness are a big challenge for the entire process of rehabilitation: assessment, diagnosis, pharmacological, and rehabilitation programs, including conventional treatments and the use of new technologies.
Frontiers in Neurology, 2021
Objective: Statins exert pleiotropic effects by influencing several mechanisms, including synapto... more Objective: Statins exert pleiotropic effects by influencing several mechanisms, including synaptogenesis, neurogenesis, cerebral flow regulation, and angiogenesis. Results from in vitro and animal models suggest that statins could have beneficial effect on functional recovery and outcome after stroke events. However, results in human studies are still controversial. The aim of our study was to evaluate the role of statin in influencing functional outcome and subsequent clinical follow-up in a large cohort of post-stroke rehabilitation patients.Methods: This retrospective study consecutively enrolled 413 adult patients with stroke event, admitted to the division of Neurorehabilitation of the IRCCS ICS Maugeri, Veruno (Italy), for an individual rehabilitation program between 2015 and 2017. Follow-up lasted 3–5 years after discharge. Demographic data, etiology, classification, and anatomical site of stroke lesion, functional assessment, use and duration of statin therapy, and death dur...
Frontiers in Neurology, 2021
Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a pro... more Introduction: Parkinson's disease (PD) is a chronic neurodegenerative disease involving a progressive alteration of the motor and non-motor function. PD influences the patient's daily living and reduces participation and quality of life in all phases of the disease. Early physical exercise can mitigate the effects of symptoms but access to specialist care is difficult. With current technological progress, telemedicine, and telerehabilitation is now a viable option for managing patients, although few studies have investigated the use of telerehabilitation in PD. In this systematic review, was investigated whether telerehabilitation leads to improvements in global or specific motor tasks (gait and balance, hand function) and non-motor dysfunction (motor speech disorder, dysphagia). The impact of TR on quality of life and patient satisfaction, were also assessed. The usage of telerehabilitation technologies in the management of cognitive impairment was not addressed.Method: An ...
Physiotherapists, 2019
Literature describes a wide range of treatments for secretion clearance. There is, however, a lac... more Literature describes a wide range of treatments for secretion clearance. There is, however, a lack of evidence to support any of these techniques. Several authors have shown more progress with the use of multiple techniques. The efficacy of a protocol is characterized by the combined use of 3 techniques (CPAP-Free Aspire-Cough Assist) in subjects with ineffective cough. The study was conducted in ICS MAUGERI-Veruno (NO, Italy). 10 patients with ineffective cough, bronchial encumbrance, lung parenchyma integrity and good collaboration were recruited. The protocol had a duration of 10 sessions: during each session, the patient performed 5’of CPAP, 15’ of Free Aspire and 5 cycles x 4 sequences of Cough Assist. Result measurements were: subjective perception of mucus encumbrance (VNS) and SpO2 detected at the start of each session and end of each technique, PO2/FiO2 and perceived health status (EQ-5D) detected at the start and end of the protocol. The variation of subjective perception of secretions (VNS) was tested both within the session and among the 10 treatment sessions. Statistically significant differences were found both comparing the VNS median values found at the start and end of each session (p: 0.004) and the median values found at the start and end of the protocol (p: 0.016). SpO2 values increased from the start to the end of a single session (p: 0.016). ABGT showed a not statically significant increase in the PO2/FiO2 (p: 0.094). All patients reported a remarkable improvement in perceived health status assessed with EQ-5D (p: 0.002). The protocol was effective in reducing the perception of obstruction and in improving SpO2 and quality of life
Neuropsychological Rehabilitation, 2018
In order to ensure the best possible rehabilitation plan and best outcome for patients with Disor... more In order to ensure the best possible rehabilitation plan and best outcome for patients with Disorders of Consciousness (DOC), optimal management of the early phase of rehabilitation is fundamental. This includes a correct diagnosis, accurate assessment of the patient's state of alertness and the main comorbidities, appropriate neurophysiological and neuroradiology examinations, and education of the caregiver and family so that they can provide the best assistance. Thirty years ago, specialists first began applying a systematic approach to the rehabilitation of patients with DOC, but still today many problems remain unsolved: the rate of misdiagnosis is still high, and recommendations about the most appropriate mode of rehabilitation are lacking, both as regards the timing of interventions and what the best techniques to use are. In a medical sector where nosography has changed over the last decade and where the documented evidence, though increasing, still remains insufficient, we discuss in this brief review the main assessment tools and disability scales to use and the key issues that need to be considered when a patient with DOC is admitted to the rehabilitation unit and decisions about the early rehabilitation plan are made.
European journal of physical and rehabilitation medicine, Jan 27, 2016
Several robotic devices have been proposed for upper limb rehabilitation, but they differ in term... more Several robotic devices have been proposed for upper limb rehabilitation, but they differ in terms of application fields and the technical solutions implemented. To compare the effectiveness of three different robotic devices for shoulder-elbow rehabilitation in reducing motor impairment and improving motor performance in post-stroke patients. Retrospective multi-center study. Inpatient rehabilitation hospital. Eighty-seven chronic and subacute post-stroke patients, aged 48-85 years. Data were obtained through a retrospective analysis of patients who underwent a 3- week rehabilitation program including robot-assisted therapy of the upper limb and conventional physical therapy. Patients were divided into three groups according to the robot device used for exercise training: 'Braccio di Ferro" (BdF), InMotion2 (IMT), and MEchatronic system for MOtor recovery after Stroke (MEMOS). They were evaluated at the beginning and end of treatment using the Fugl-Meyer (FM) and Modified ...
Journal of Neurosurgery, 2016
OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the o... more OBJECTIVE Deep brain stimulation of the thalamus was introduced more than 40 years ago with the objective of improving the performance and attention of patients in a vegetative or minimally conscious state. Here, the authors report the results of the Cortical Activation by Thalamic Stimulation (CATS) study, a prospective multiinstitutional study on the effects of bilateral chronic stimulation of the anterior intralaminar thalamic nuclei and adjacent paralaminar regions in patients affected by a disorder of consciousness. METHODS The authors evaluated the clinical and radiological data of 29 patients in a vegetative state (unresponsive wakefulness syndrome) and 11 in a minimally conscious state that lasted for more than 6 months. Of these patients, 5 were selected for bilateral stereotactic implantation of deep brain stimulating electrodes into their thalamus. A definitive consensus for surgery was obtained for 3 of the selected patients. All 3 patients (2 in a vegetative state and 1...
Clinical Neurophysiology, 2016
This study aimed to evaluate, through polysomnographic analysis, the prognostic value of sleep pa... more 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. 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. 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. 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). Both visual and quantitative sleep evaluation could be helpful in predicting clinical outcome in sub-acute DOCs.
European journal of physical and rehabilitation medicine, 2009
The aim of this study was to provide a description of a newly-developed remote rehabilitation sys... more The aim of this study was to provide a description of a newly-developed remote rehabilitation system that can be employed both at home and in the hospital, supporting motor rehabilitation for post-stroke patients with upper-limb impairment. A garment, which embeds kinesthetic sensors made of a piezoresitive polymer, is provided with a wireless connection to a computer (the patient station). The station detects in real time whether the patient is performing the exercises correctly or not, and provides feedback through an easy visual representation on the screen. Movement recognition is performed using a template matching approach, which allows exercises to be defined during each session as required without additional configuration. In this study an healthy volunteer used the garment to record 840 exercises, mimicking both correct and incorrect compensatory movements under expert supervision. The sensitivity and specificity of the recognition system were measured through its ability t...
Journal of Neurology, 2014
ABSTRACT Dear Sirs,Disorders of Consciousness (DoC) represent a serious difficulty for caring int... more ABSTRACT Dear Sirs,Disorders of Consciousness (DoC) represent a serious difficulty for caring interventions and they are a diagnostic, clinical and rehabilitative problem [1]. In the last few years, great attention has been developed towards rehabilitative treatments and protocols of different interventions to better define improvements and variations of the consciousness state level [2]. The literature concerning music therapy (active and receptive techniques) is scant and based mainly on single cases or small samples [3–6]. The present study aimed at evaluating the effects of active music therapy (AMT) on some physiological parameters and on behavioural responses in DoC.This controlled observational case series study involved 10 patients with severe brain injuries (5 with a Cerebral Anoxia, 4 with a Brain Haemorrhage and 1 with Head Injury). Informed consent was obtained from proxies of all patients. The patients were divided into two sub-groups. Four of those were in a minimally conscious st ...
2007 Virtual Rehabilitation, 2007
... ACKNOWLEDGMENT The authors would like to thank F. Lorussi and D. De Rossi (University of Pisa... more ... ACKNOWLEDGMENT The authors would like to thank F. Lorussi and D. De Rossi (University of Pisa); R. Mauri (Fondazione Salvatore Maugeri, Pavia); M. Stefanelli (University of Pavia) for inspiring discussions. REFERENCES ...
Physiological Measurement, 2013
Spasticity is a common motor impairment in patients with neurological disorders that can prevent ... more Spasticity is a common motor impairment in patients with neurological disorders that can prevent functional recovery after rehabilitation. In the clinical setting, its assessment is carried out using standardized clinical scales. The aim of this study was to verify the applicability of inertial sensors for an objective measurement of quadriceps spasticity and evaluate its test-retest and inter-rater reliability during the implementation of the Wartenberg pendulum test. Ten healthy subjects and 11 patients in vegetative state with severe brain damage were enrolled in this study. Subjects were evaluated three times on three consecutive days. The test-retest reliability of measurement was assessed in the first two days. The third day was devoted to inter-rater reliability assessment. In addition, the lower limb muscle tone was bilaterally evaluated at the knee joint by the modified Ashworth scale. The factorial ANOVA analysis showed that the implemented method allowed us to discriminate between healthy and pathological conditions. The fairly low SEM and high ICC values obtained for the pendulum parameters indicated a good test-retest and inter-rater reliability of measurement. This study shows that an inertial sensor can be reliably used to characterize leg kinematics during the Wartenberg pendulum test and provide quantitative evaluation of quadriceps spasticity.
Neurology, 2013
Objective: To investigate functional connectivity between the default mode network (DMN) and othe... more Objective: To investigate functional connectivity between the default mode network (DMN) and other networks in disorders of consciousness. Methods: We analyzed MRI data from 11 patients in a vegetative state and 7 patients in a minimally conscious state along with age-and sex-matched healthy control subjects. MRI data analysis included nonlinear spatial normalization to compensate for disease-related anatomical distortions. We studied brain connectivity data from resting-state MRI temporal series, combining noninferential (independent component analysis) and inferential (seed-based general linear model) methods. Results: In DMN hypoconnectivity conditions, a patient's DMN functional connectivity shifts and paradoxically increases in limbic structures, including the orbitofrontal cortex, insula, hypothalamus, and the ventral tegmental area. Conclusions: Concurrently with DMN hypoconnectivity, we report limbic hyperconnectivity in patients in vegetative and minimally conscious states. This hyperconnectivity may reflect the persistent engagement of residual neural activity in self-reinforcing neural loops, which, in turn, could disrupt normal patterns of connectivity. Neurology â 2013;81:1417-1424 GLOSSARY ACC 5 anterior cingulate cortex; DMN 5 default mode network; GLM 5 general linear model; ICA 5 independent component analysis; MCS 5 minimally conscious state; PCC 5 posterior cingulate cortex; ROI 5 region of interest; VS 5 vegetative state; VTA 5 ventral tegmental area.
IEEE Transactions on Information Technology in Biomedicine, 2009
Recent studies suggest that the quality of recovery after a stroke can be increased by early and ... more Recent studies suggest that the quality of recovery after a stroke can be increased by early and more intensive rehabilitation. Portable unobtrusive devices are promising candidates for the realization of stroke-rehabilitation systems that complement care in the post-acute rehabilitation phase, both in the clinic and at home. The proposed system allows patients to increase the amount of motor exercise they can perform in autonomy, providing them with a real-time feedback based on wearable sensors embedded in the garment's tissue across the upper limb and trunk. A dynamic time warping algorithm allows for the recognition of correct and incorrect motor exercises. After the feedback phase, data are stored in a central location for review and statistics. Workstations can be installed either at home or at the hospital to support patients, independent of their location. The performance of the system on healthy subjects was quantified for seven types of motor exercises for upper limb's rehabilitation. Finally, we present the preliminary results of a pilot clinical study to test the system's acceptability and usability by post-stroke patients, and physicians in a clinical setting.
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Papers by giorgio maggioni