Faculty Bibliography

BACKGROUND:Progressive cerebellar ataxia is a neurodegenerative disorder without effective treatment options that seriously hinders quality of life. Previously, transcranial direct current stimulation (tDCS) has been demonstrated to benefit cerebellar functions (including improved motor control, learning and emotional processing) in healthy individuals and patients with neurological disorders. While tDCS is an emerging therapy, multiple daily sessions are needed for optimal clinical benefit. This case study tests the symptomatic benefit of remotely supervised tDCS (RS-tDCS) for a patient with cerebellar ataxia. METHODS:We report a case of a 71-year-old female patient with progressive cerebellar ataxia, who presented with unsteady gait and balance impairment, treated with tDCS. tDCS was administered using our RS-tDCS protocol and was completed daily in the patient's home (Monday - Friday) with the help of a trained study technician. tDCS was paired with 20 min of simultaneous cognitive training, followed by 20 min of physical exercises directed by a physical therapist. Stimulation consisted of 20 min of 2.5 mA direct current targeting the cerebellum via an anodal electrode and a cathodal electrode placed over the right shoulder. The patient completed baseline and treatment end visits with neurological, cognitive, and motor (Lafayette Grooved Pegboard Test, 25 ft walk test and Timed Up and Go Test) assessments. RESULTS:The patient successfully completed sixty tDCS sessions, 59 of which were administered remotely at the patient's home with the use of real time supervision as enabled by video conferencing. Mild improvement was observed in the patient's gait with a 7% improvement in walking speed, which she completed without a walking-aid at treatment end, which was in stark contrast to her baseline assessment. Improvements were also achieved in manual dexterity, with an increase in pegboard scores bilaterally compared to baseline. CONCLUSIONS:Results from this case report suggest that consecutively administered tDCS treatments paired with cognitive and physical exercise hold promise for improving balance, gait, and manual dexterity in patients with progressive ataxia. Remotely supervised tDCS provides home access to enable the administration over an extended period. Further controlled study in a large group of those with cerebellar ataxia is needed to replicate these findings. TRIAL REGISTRATION/BACKGROUND:ClinicalTrials.gov Identifier: NCT03049969 . Registered 10 February 2017- Retrospectively registered.

BACKGROUND:The dual task paradigm (the simultaneous performance of motor and cognitive task) is used in a laboratory setting to evaluate walking impairments that affect patients' daily lives. Although promising, it is poorly standardized and neither the cognitive task nor the motor task have been validated in a matched healthy control group (HC) for multiple sclerosis (MS). OBJECTIVE:Our aim was to set up a standardized instrument to evaluate cognitive motor interference in MS using the interference test par excellence: the stroop colour word test (SCWT). METHODS:Patients with MS and HC underwent 3D gait analysis with a dual task protocol, using the SCWT as a cognitive task. Gait performance impairment during the dual task was evaluated by dual task cost (DTC). A MANOVA was used to verify the effect of status (MS, HC) on DTC, calculated for the spatiotemporal parameter of the gait. RESULTS:In MS, the DTC was higher for the following gait parameters: speed (p = .013), cadence (p = .004), stride time (p = .005) stance phase (p < .001), and swing phase duration (p = .032). CONCLUSION/CONCLUSIONS:DTC is present in MS and HC, but the motor cost in MS is higher. The present work provides a useful and validated basis for future studies about cognitive motor interference in MS.

PURPOSE/OBJECTIVE:This study aimed to characterize age-related changes in Timed Up and Go (TUG) sub-phases (i.e., sit to stand, walking and turning) quantitatively assessed using an inertial sensor in healthy older adults and to verify the degree of correlation between TUG parameters and muscular strength (assessed by handgrip strength, HGS) in the different age ranges. METHODS:This is a cross-sectional study performed on 125 healthy older adults aged over 65 years stratified in four groups (< 70 years, 71-75, 76-80, > 80) who underwent an instrumental TUG carried out using a wearable inertial sensor. In addition, participants were asked to carry out the HGS test to establish possible relationships between muscular strength and TUG features. RESULTS:The results show a general decline in all phases of TUG performance (albeit with some gender-related differences) which becomes significant after 75 years of age. Also, HGS was found to be systematically higher in men at any age group. Significant negative correlations between HGS and TUG phases times were found for both genders (men r = - 0.28 to - 0.50, women r = - 0.34 to - 0.60). However, when age groups were analyzed separately, such correlations are confirmed only in case of women aged < 70 years, while they vanish for most parameters in all other age groups. CONCLUSION/CONCLUSIONS:The findings obtained in the present study suggest that muscular strength might have a different relationship with functional mobility according to age and gender, and this should be considered when physical activity program or rehabilitation plans are planned.

INTRODUCTION:Aging leads to poorer neuromuscular control that may impact mobility. However, the specific decades when these changes occur, and whether these time-based changes are sex-specific, are unclear. METHODS:Adults aged 20-82 years (N = 93, 51 females) walked six gait trials at their preferred speed over a 10-m platform. Electromyography (EMG) of the rectus femoris (RF), tibialis anterior (TA), and gastrocnemius lateralis (GL) were measured using wireless surface sensors. Root mean square (RMS) and within-cycle coefficient of variation (CV) values were calculated for several phases of gait. Mixed effect models were conducted to test for Age, Sex, Muscle, and interaction effects, covarying for gait speed and stride length. RESULTS:A significant Age × Sex × Muscle interaction on RMS at the mid-swing phase was found (p = .036), showing 4.2% higher RF RMS for males (β = 0.42, p = .008) and 3.3% higher GL RMS for females (β = 0.33, p = .038) with each of the three decades investigated. Significant Age × Muscle interactions on GL RMS were found at loading, mid-stance, and over the full gait cycle (ps < .05), with 2.0-4.3% higher values per decade (β = 0.20-0.43, ps < .05). There was generally higher CV with higher age at mid-swing and over the full gait cycle (significant Age effects, ps < .05). Females showed higher CV at loading, mid-stance, and terminal stance (significant Age × Sex effects, ps < .05). DISCUSSION/CONCLUSION:Results suggest sex-dependent influences of age on muscle recruitment during a few specific phases of gait, and sex-independent influences of age on the recruitment of the ankle musculature, and on the overall gait cycle. These influences may help explain overall increased instability and fall risk in older adults.

OBJECTIVE:The purpose of this study was to assess the influence of trunk rotation (TR) on postural sway and spatial-temporal parameters of gait in children and early adolescents screened at school for the presence of scoliosis. METHODS:Two hundred and fifty-five individuals aged 9-14 (141 boys, 114 girls) underwent trunk rotation (TR) assessment by means of angle of trunk rotation (ATR) measurements performed with Bunnell's scoliometer. Participants with ATR ≥ 5° formed the TR group whose data were compared with those of a control group (CON) composed of individuals with ATR < 5° matched for age and anthropometric features. Postural sway was calculated on the basis of center of pressure (COP) time series acquired using a pressure plate. Spatial-temporal parameters of gait were derived from trunk accelerations collected by a single inertial sensor located in the low-back region. RESULTS:Sway area, sway path, COP velocities in medio-lateral (ML) and antero-posterior (AP) directions and COP displacements in ML direction were found significantly higher in girls with TR, while no differences between the TR and CON groups were detected in boys. Both boys and girls with TR exhibited gait patterns similar to those of their CON schoolmates. CONCLUSIONS:These findings suggest that even mild levels of TR may influence balance of female children and early adolescents screened for scoliosis, and thus early interventions including selective and task-oriented exercises appear advisable. In contrast, TR does not appear to influence gait, but further investigations are required to clarify whether different ATR cut-offs may reveal alterations of spatial-temporal parameters.

BACKGROUND:In recent times, increasing safety concerns have been associated with the use of mobile phones by pedestrians. In particular, texting has been shown to significantly alter gait patterns. However, no specific investigations have been performed on people with Multiple Sclerosis (pwMS), who are already characterized by gait dysfunctions caused by the disease. OBJECTIVE:To assess the existence of possible alterations in spatio-temporal parameters of gait in pwMS when simultaneously texting on a smartphone and walking. METHODS:Fifty-four pwMS (mean age 40.5 ± 10.5) and 40 age-matched unaffected individuals were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. RESULTS:Texting induces reduction of gait speed, stride length and cadence in both groups, but such changes were smaller in magnitude in pwMS. An increase of stance and double support and reduction of swing phase were observed in pwMS only. CONCLUSIONS:Texting alters gait patterns of pwMS differently from unaffected individuals, probably due to a different prioritization of the task, which appears to take into account the motor and sensory impairments associated with the disease by favoring the motor task.