Papers by mariella pazzaglia
Nature and Science of Sleep, 2020
Purpose In adolescence, physiological (circadian and homeostatic regulation of sleep) and social ... more Purpose In adolescence, physiological (circadian and homeostatic regulation of sleep) and social habits contribute to delayed sleep onset, while social obligations impose early sleep offset. The effects of delayed school start time on the subjective/objective measures of sleep–wake patterns and academic achievement have not been established. Methods This pre-, post-, and longitudinal non-randomized study included an early (8:00 am; ESC=30 students) and the late (9:00 am; LSC=21 students) start class. Multiple sleep data included a weekly sleep diary, Karolinska Sleepiness Scale, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. Sustained attention was measured using the Psychomotor Vigilance Task. Academic performance was evaluated by two different mathematical and scientific standard tests (entrance and final) and by school attendance indicators. Data were collected at monthly intervals from October 2018 to May 2019 and the beginning and end of the academic year (pre/po...
Journal of Pain Research
Background: Pain is a marker of bodily status, that despite being aversive under most conditions,... more Background: Pain is a marker of bodily status, that despite being aversive under most conditions, may also be perceived as a positive experience. However, how bodily states represent, define, and interpret pain signals, and how these processes might be reflected in common language, remains unclear. Methods: Qualitative and quantitative methods were used to explore the relationship between bodily awareness, pain reactions, and descriptions. A list of pain-related terms was generated from open-ended interviews with persons with spinal cord injury (SCI), and 138 participants (persons with SCI, health professionals, and a healthy control group) rated each descriptor as representative of pain on a gradated scale. A lexical decision task was used to test the strength of the automatic association of the word "pain" with positive and negative concepts. The behavioral results were related to body awareness, experience of pain, and exposure to pain, by comparing the three groups. Results: Higher positive and lower negative pain descriptors, as well as slower response times when categorizing pain as an unpleasant experience were found in the SCI group. The effect was not modulated by either the time since the injury or the present pain intensity, but it was linked to the level of subjective bodily awareness. Compared with the SCI group, health experts and non-experts both associated more quickly the word "pain" and unpleasant in the lexical decision task. However, while health professionals attributed positive linguistic qualities to pain, pain was exclusively associated with negative descriptors in healthy controls group. Conclusions: These findings are discussed in terms of their theoretical and clinical implications. An awareness of bodily signals prominently affects both the sensory and linguistic responses in persons with SCI. Pain should be evaluated more broadly to understand and, by extension, to manage, experiences beyond its adverse side.
JAMA Network Open
IMPORTANCE The association of fast backward-rotating shift work (ie, anticlockwise sequence of af... more IMPORTANCE The association of fast backward-rotating shift work (ie, anticlockwise sequence of afternoon, morning, and night shifts) with subjective and objective measures of sleep-wake quality, daytime attention, and tiredness of health care workers has not yet been established. OBJECTIVE To investigate the association of shift rotation direction with tiredness, sleepiness, and sustained attention among nurses working forward-and backward-rotating shifts. DESIGN, SETTING, AND PARTICIPANTS Data of this cohort study were collected from nurses working at 5 midsized Italian hospitals. The nurses had either a forward-rotating schedule (ie, morning to afternoon to night) and or a backward-rotating schedule (ie, afternoon to morning to night). The data were collected from July 2017 to February 2020. Data analysis was performed from May to October 2020. EXPOSURES Participants were working either forward-or backward-rotating schedules, in which the sequence of 3 shifts (morning, afternoon, and night) changed in a clockwise or anticlockwise direction. MAIN OUTCOMES AND MEASURES Sleep data were collected using the Karolinska Sleepiness Scale and Pittsburgh Sleep Quality Index. Sustained attention was measured using the Psychomotor Vigilance Task. Tiredness was evaluated using the Tiredness Symptom Scale. RESULTS A total of 144 nurses (mean [SE] age, 41.3 [0.8] years; 92 women [63.9%]) participated in the study; 80 nurses had forward-rotating schedules, and 64 had backward-rotating schedules. Nurses with irregular sleep-wake patterns due to night shift work had poor sleep quality (46 [57.5%] in forward-rotating schedule group; 37 [57.8%] in backward-rotating schedule group). Nurses working backward-rotating shifts exhibited significantly greater sleepiness (F 1,139 = 41.23; P < .001) and cognitive slowing (ie, longer median reaction times; F 1,139 = 42.12; P < .001) than those working forward rotations. Importantly, these differences were not affected by age, years of employment, and quality of sleep. Of nurses working on a backward-rotating schedule, 60 (93.8%) reported elevated sleepiness (Karolinska Sleepiness Scale score Ն7) after the night shift. The median reaction time (F 1,139 = 42.12; P < .001), 10% fastest reaction time (F 1,139 = 97.07; P < .001), minor lapses (F 1,139 = 46.29; P < .001), and reaction time distribution (F 1,139 = 60.13; P < .001) of nurses on backward-rotating schedules indicated a lower level of vigilance, which is negatively associated with neurobehavioral performance. CONCLUSIONS AND RELEVANCE In this study, both shift rotation models were negatively associated with health and cognitive performance. These findings suggest that forward shift rotation may be more beneficial than backward rotation for several measured performance attentional (continued) Key Points Question Among hospital staff who work day and night shifts, do sleep and attention metrics vary between those who work forward-vs backwardrotating shifts? Findings This cohort study of 144 nurses found that fast forward-rotating shifts for nurses were associated with lower levels of tiredness and sleepiness and higher levels of sustained attention compared with backwardrotating shifts. Meaning These findings suggest that optimization of shift rotations for nurses should be implemented to decrease the negative outcomes associated with shift work.
Journal of Clinical Medicine
The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be asso... more The onset of Takotsubo syndrome (TTS), also known as stress cardiomyopathy, is thought to be associated with some life events. This study focuses on clarifying life event characteristics and the role of triggers in the onset of TTS. Participants with TTS (n = 54) were compared to those with acute myocardial infarction (AMI; n = 52) and healthy individuals (n = 54). Using a modified version of the Interview for Recent Life Events, information about general life events perceived as stressful and triggers preceding the onset of a cardiac syndrome was collected. The assessment included the impact of these events as indicated by the participants and estimated by the interviewer; finally, the objective impact was considered. Although the number of events and the objective impact did not differ among the groups, patients with TTS reported a more negative perceived impact. Moreover, 61% of these patients objectively and subjectively reported a more stressful trigger before the onset of the ...
Brain Sciences
Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of N... more Neuropathic pain (NP) is a chronic, debilitating, and resistant form of pain. The onset rate of NP following spinal cord injuries (SCI) is high and may reduce the quality of life more than the sensorimotor loss itself. The long-term ineffectiveness of current treatments in managing symptoms and counteracting maladaptive plasticity highlights the need to find alternative therapeutic approaches. Virtual reality (VR) is possibly the best way to administer the specific illusory or reality-like experience and promote behavioral responses that may be effective in mitigating the effects of long-established NP. This approach aims to promote a more systematic adoption of VR-related techniques in pain research and management procedures, highlighting the encouraging preliminary results in SCI. We suggest that the multisensory modulation of the sense of agency and ownership by residual body signals may produce positive responses in cases of brain-body disconnection. First, we focus on the trans...
International Journal of Environmental Research and Public Health
Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent sti... more Increasingly, refined virtual reality (VR) techniques allow for the simultaneous and coherent stimulation of multiple sensory and motor domains. In some clinical interventions, such as those related to spinal cord injuries (SCIs), the impact of VR on people′s multisensory perception, movements, attitudes, and even modulations of socio-cognitive aspects of their behavior may influence every phase of their rehabilitation treatment, from the acute to chronic stages. This work describes the potential advantages of using first-person-perspective VR to treat SCIs and its implications for manipulating sensory-motor feedback to alter body signals. By situating a patient with SCI in a virtual environment, sensorial perceptions and motor intention can be enriched into a more coherent bodily experience that also promotes processes of neural regeneration and plasticity. In addition to the great potential of research, the most significant areas of interest concern is managing neuropathic pain, m...
Symmetry, 2021
The AB refers to the performance impairment that occurs when visual selective attention is overlo... more The AB refers to the performance impairment that occurs when visual selective attention is overloaded through the very rapid succession of two targets (T1 and T2) among distractors by using the rapid serial visual presentation task (RSVP). Under these conditions, performance is typically impaired when T2 is presented within 200–500 ms from T1 (AB). Based on neuroimaging studies suggesting a role of top-down attention and working memory brain hubs in the AB, here we potentiated via anodal or sham tDCS the activity of the right DLPFC (F4) and of the right PPC (P4) during an AB task. The findings showed that anodal tDCS over the F4 and over P4 had similar effects on the AB. Importantly, potentiating the activity of the right frontoparietal network via anodal tDCS only benefitted poor performers, reducing the AB, whereas in good performers it accentuated the AB. The contribution of the present findings is twofold: it shows both top-down and bottom-up contributions of the right frontopar...
Frontiers in Human Neuroscience
1 Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy... more 1 Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Santa Lucia, Rome, Italy, Department of Anatomy, University of Otago, Dunedin, New Zealand, Brain Health Research Centre, Dunedin, New Zealand, Medical Technologies Centre of Research Excellence, Auckland, New Zealand, Centre for Health Systems and Technology, Dunedin, New Zealand, 6 Laboratory for Neuromechanics and Biorobotics, Jožef Stefan Institute, Ljubljana, Slovenia, Department of
Behavioral and Brain Sciences
In view of current scientific knowledge, it seems premature to hypothesize a qualitative distinct... more In view of current scientific knowledge, it seems premature to hypothesize a qualitative distinction between processes, networks, and structures involved in abstract processes from those based on perception, episodic, or procedural memories. Predictive thought and mental travel strongly rely, at different levels of consciousness, on past and ongoing sensory input, bodily information (e.g., interoception), and the results of perceptual elaboration.
Psychological Research
Lacunae are the voids left by missing or damaged pieces of artwork, and their presence constitute... more Lacunae are the voids left by missing or damaged pieces of artwork, and their presence constitutes a central problem in the aesthetic experience of viewing artwork. However, we hypothesize that experience and knowledge of art might differentially modify viewer reactions to degraded artwork. Here, we investigated the implicit and explicit attitudes of art experts and non-experts towards the aesthetics of perfectly intact and lacunar artwork. Sections of Flemish oil paintings were displayed with or without a degradation mask, which mimics lacunae. Three groups differing in their interaction with art were assessed: art restorers, art historians, and art viewers lacking any art-related professional expertise. We found that (1) professional experience/expertise in art restoration affected implicit, but not explicit, attitudes among restorers, (2) art historians had positive explicit, but not implicit, attitudes toward intact artwork, and (3) it was difficult for non-specialist viewers to understand or appreciate artwork that was not perfectly intact. We further discuss the implications of these results to other forms of aesthetic evaluation and expertise. Modified preferences in experts may improve knowledge of the plastic changes that occur in the cognition of aesthetics and may thus be of significant relevance to enhance the effectiveness of art conservation programs.
Brain Sciences
The multisensory regions in frontoparietal cortices play a crucial role in the sense of body and ... more The multisensory regions in frontoparietal cortices play a crucial role in the sense of body and self. Disrupting this sense may lead to a feeling of disembodiment, or more generally, a sense of disownership. Experimentally, this altered consciousness disappears during illusory own-body perceptions, increasing the intensity of perceived ownership for an external virtual limb. In many clinical conditions, particularly in individuals with a discontinuous or absent sense of bodily awareness, the brain may effortlessly create a convincing feeling of body ownership over a surrogate body or body part. The immediate visual input dominates the current bodily state and induces rapid plastic adaptation that reconfigures the dynamics of bodily representation, allowing the brain to acquire an alternative sense of body and self. Investigating strategies to deconstruct the lack of a normal sense of bodily ownership, especially after a neurological injury, may aid the selection of appropriate clin...
Frontiers in Neurology
Although several outcome measures are used to assess various areas of interest regarding spinal c... more Although several outcome measures are used to assess various areas of interest regarding spinal cord injuries (SCIs), little is known about the frequency of their use, and the ways in which they transform shared knowledge into implemented practices. Herein, 800 professionals from the International Spinal Cord Society, especially trained for caring in patients with SCI, were invited to respond to an Internet survey collecting information on the use of standardized measures in daily clinical practices. We asked both clinicians and researchers with different areas of interest about their use of functional outcome measures, and, in particular, which scales they habitually use to assess various aspects of clinical practice and rehabilitation. We selected a set of rating scales, which were validated for measuring SCIs (http://www.scireproject.com/outcome-measures). The results show that the areas of interest assessed by most of the participants were neurological status, upper limb, lower limb gait, pain, spasticity, self-care, and daily living. The most widely used rating scales were the spinal cord independence measure, the functional independence measure and the International Standards for Neurological Classification of Spinal Cord Injury. Instead, the majority of respondents did not evaluate the use of assistive technology. Despite the availability of several outcome scales, the practice of evaluating SCIs with standardized measures for assistive technologies and wheelchair mobility is still not widespread, even though it is a high priority in the rehabilitation of SCI patients. The results emphasize the need for a more thorough knowledge and use of outcome scales, thus improving the quality of assistive device evaluation.
Journal of Clinical Medicine
Neuroplastic changes in somatotopic organization within the motor and somatosensory systems have ... more Neuroplastic changes in somatotopic organization within the motor and somatosensory systems have long been observed. The interruption of afferent and efferent brain–body pathways promotes extensive cortical reorganization. Changes are majorly related to the typical homuncular organization of sensorimotor areas and specific “somatotopic interferences”. Recent findings revealed a relevant peripheral contribution to the plasticity of body representation in addition to the role of sensorimotor cortices. Here, we review the ways in which structures and brain mechanisms react to missing or critically altered sensory and motor peripheral signals. We suggest that these plastic events are: (i) variably affected across multiple timescales, (ii) age-dependent, (iii) strongly related to altered perceptual sensations during and after remapping of the deafferented peripheral area, and (iv) may contribute to the appearance of secondary pathological conditions, such as allodynia, hyperalgesia, and ...
Frontiers in Neurology
Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-obs... more Neurorehabilitation and brain stimulation studies of post-stroke patients suggest that action-observation effects can lead to rapid improvements in the recovery of motor functions and long-term motor cortical reorganization. Apraxia is a clinically important disorder characterized by marked impairment in representing and performing skillful movements [gestures], which limits many daily activities and impedes independent functioning. Recent clinical research has revealed errors of visuo-motor integration in patients with apraxia. This paper presents a rehabilitative perspective focusing on the possibility of action observation as a therapeutic treatment for patients with apraxia. This perspective also outlines impacts on neurorehabilitation and brain repair following the reinforcement of the perceptual-motor coupling. To date, interventions based primarily on action observation in apraxia have not been undertaken.
Psychological Research
Corporeal awareness of body unity, continuity, and integrity is hardwired in the brain, even foll... more Corporeal awareness of body unity, continuity, and integrity is hardwired in the brain, even following massive deafferentation. Following peripheral limb injury, referred phantom sensations are reported frequently on the cheek and, rarely, on the ear. Here, we explore how brain plasticity mechanisms induced by multisensory stimulation of different facial regions (cheek and ear) modulate the feeling that a complete missing limb is still attached to the body. We applied the modified rubber hand illusion (RHI) paradigm following synchronous and asynchronous stimulation of the face–hand and ear–hand in the unusual case of a patient with a brachial plexus lesion, who had lost upper-left limb sensation and developed a phantom sensation of the arm restricted to the ear. He experienced a strong illusion of ownership of the rubber hand during synchronous stroking of the ear but not the cheek and reported more defined tactile sensations in his previously numb body part during the illusion than when simply touching the ear. Phantom experiences are not exclusively based on sensory memories of the once-present body periphery, they are organized into a topographic cortical map with the ear–hand area adjoining but separate from the face. Multimodal experiences specifically modulate possible remapping of ear–hand representations and generate a more defined connection between the brain’s memory of the body and what one feels of the actual physical body. We suggest that RHI is a form of sensory intervention that makes the best use of residual signals from disconnected body parts after peripheral injury, evoking and controlling the limb sensations.
Cortex
MP conducted the first neuropsychological evaluation on patient, study concept and design, acquis... more MP conducted the first neuropsychological evaluation on patient, study concept and design, acquisition of data, analysis and interpretation, writing and drafting of the manuscript, critical revision of the manuscript for important intellectual content. GG performed acquisition, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. GG and MM performed acquisition of neurologic data. GL: performed the acquisition, analysis, interpretation and writing of EEG data. PH: analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript. Summary Referred phantom sensations are frequently reported following a peripheral injury. However, very few cases describe such sensations of the ear, and it remains unclear how the aural nerve territory can be remapped to one specific peripheral nerve region. We report on a patient with brachial plexus avulsion who underwent sensory testing and was asked to report the location of the
Scientific Reports
Growing evidence indicates that perceptual-motor codes may be associated with and influenced by a... more Growing evidence indicates that perceptual-motor codes may be associated with and influenced by actual bodily states. Following a spinal cord injury (SCI), for example, individuals exhibit reduced visual sensitivity to biological motion. However, a dearth of direct evidence exists about whether profound alterations in sensorimotor traffic between the body and brain influence audio-motor representations. We tested 20 wheelchair-bound individuals with lower skeletal-level SCI who were unable to feel and move their lower limbs, but have retained upper limb function. In a two-choice, matching-to-sample auditory discrimination task, the participants were asked to determine which of two action sounds matched a sample action sound presented previously. We tested aural discrimination ability using sounds that arose from wheelchair, upper limb, lower limb, and animal actions. Our results indicate that an inability to move the lower limbs did not lead to impairment in the discrimination of lower limb-related action sounds in SCI patients. Importantly, patients with SCI discriminated wheelchair sounds more quickly than individuals with comparable auditory experience (i.e. physical therapists) and inexperienced, able-bodied subjects. Audio-motor associations appear to be modified and enhanced to incorporate external salient tools that now represent extensions of their body schemas.
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Papers by mariella pazzaglia