Eleonora Guanziroli

Ospedale Valduce-Como · Rehabilitation Center

In the context of neurorehabilitation, there have been rapid and continuous improvements in sensors-based clinical tools to quantify limb performance. As a result of the increasing integration of technologies in the assessment procedure, the need to integrate evidence-based medicine with benchmarking has emerged in the scientific community. In this...

Background Following a stroke, patients may suffer from alterations in the perception of their own body due to an acquired deficit in body representations. While such changes may impact their quality of life as well as recovery, they are not systematically assessed in clinical practice. This study aims at providing a better understanding of the rat...

Objective: Electrical spinal cord stimulation (SCS) has emerged as a promising therapy for recovery of sensorimotor and autonomic dysfunctions following spinal cord injury (SCI). Despite the rise in studies using SCS for SCI complications, there are no standard guidelines for reporting SCS parameters in research publications, making it challenging...

Ischemic stroke (IS) can be caused by perturbations of the gut–brain axis. An imbalance in the gut microbiota (GM), or dysbiosis, may be linked to several IS risk factors and can influence the brain through the production of different metabolites, such as short-chain fatty acids (SCFAs), indole and derivatives. This study examines ecological change...

Stroke is one of the major causes of disability worldwide, and most stroke survivors require rehabilitation to recover motor and cognitive functions. Virtual Reality (VR) has emerged as a promising means to administer rehabilitative interventions due to its potential to provide high engagement and motivation, with positive effects on treatment comp...

In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients’ state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques ava...

Objective: Human figure drawings are widely used in clinical practice as a qualitative indication of Body Representations (BRs) alterations in stroke patients. The objective of this study is to present and validate the use of a new app called QDraw for the quantitative analysis of drawings and to investigate whether this analysis can reveal distort...

Stroke recovery trajectories vary substantially. The need for tracking and prognostic biomarkers in stroke is utmost for prognostic and rehabilitative goals: electroencephalography (EEG) advanced signal analysis may provide useful tools toward this aim. EEG microstates quantify changes in configuration of neuronal generators of short-lasting period...

italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">Objective : The aim of the present study is to explore whether a single session of transcutaneous Vagus Nerve Stimulation (tVNS) can enhance the ipsilesional, and contralesional upper limb motor functions as well as cognitive functions in stroke patien...

Background Following a stroke, patients may suffer from alterations in the perception of their own body due to an acquired deficit in body representations. While such changes may impact their quality of life as well as recovery, they are not systematically assessed in clinical practice. This study aims at providing a better understanding of the pre...

The aim of rehabilitation after neurological damage is functional recovery, which includes motor, sensory, and cognitive aspects, which are closely interrelated [22].

This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-mod...

Objective : To develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke. Design : Observational, cross-sectional, psychometric study. Setting : Inpatient and outpatient rehabilitation...

The continuous stream of multisensory information between the brain and the body during body-environment interactions is crucial to maintain the updated representation of the perceived dimensions of body parts (metric body representation) and the space around the body (the peripersonal space). Such flow of multisensory signals is often limited by u...

In hemiplegic patients with stroke, investigating the ipsilesional limb may shed light on the upper limb motor control, impairments and mechanisms of functional recovery. Usually investigation of motor impairment and rehabilitative interventions in patients are performed only based on the contralesional limb. Previous studies found that also the ip...

Isolated effective coherence (iCoh) is a measure of neural causal functional connectivity from EEG signals that was proven to overperform the Generalized Partial Directed Coherence (gPDC). However, iCoh sensitivity in the identification of reliable functional neural connections with respect to random links was not investigated. This study aims to c...

A detailed comprehension of the central and peripheral processes underlying walking is essential to develop effective therapeutic interventions to slow down gait decline with age, and rehabilitation strategies to maximize motor recovery for patients with damages at the central nervous system. The combined use of electromyography (EMG) and electroen...

Brain plasticity and functional reorganization are mechanisms behind functional motor recovery of patients after an ischemic stroke. The study of resting-state motor network functional connectivity by means of EEG proved to be useful in investigating changes occurring in the information flow and find correlation with motor function recovery. In the...

Background A conventional treatment outcome is suboptimal for sensory impairments in stroke patients. Novel approaches based on electrical stimulation or robotics are proposed as an adjuvant for rehabilitation, though their efficacy for motor, sensory, and body representation recovery have not been tested. Methods Sixty chronic stroke patients wit...

The recovery of symmetric and efficient walking is one of the key goals of a rehabilitation program in patients with stroke. The use of overground exoskeletons alongside conventional gait training might help foster rhythmic muscle activation in the gait cycle toward a more efficient gait. About twenty-nine patients with subacute stroke have been re...

For decades, powered exoskeletons have been considered for possible employment in rehabilitation and personal use. Yet, these devices are still far from addressing the needs of users. Here, we introduce TWIN, a novel modular lower limb exoskeleton for personal use of spinal-cord injury (SCI) subjects. This system was designed according to a set of...

Background: A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely-used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is cu...

Stroke is the commonest cause of disability. Novel treatments require an improved understanding of the underlying mechanisms of recovery. Fractal approaches have demonstrated that a single metric can describe the complexity of seemingly random fluctuations of physiological signals. We hypothesize that fractal algorithms applied to electroencephalog...

Functional Electrical Stimulation (FES) has demonstrated to improve walking ability and to induce the carryover effect, long-lasting persisting improvement. Functional magnetic resonance imaging has been used to investigate effective connectivity differences and longitudinal changes in a group of chronic stroke patients that attended a FES-based re...

Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG)...

Background: Stroke is a disease with a high associated disability burden. Robotic-assisted gait training offers an opportunity for the practice intensity levels associated with good functional walking outcomes in this population. Neural interfacing technology, electroencephalography (EEG), or electromyography (EMG) can offer new strategies for robo...

Monitoring the real-life mobility of stroke patients could be extremely useful for clinicians. Step counters are a widely accessible, portable, and cheap technology that can be used to monitor patients in different environments. The aim of this study was to validate a low-cost commercial tri-axial accelerometer-based step counter for stroke patient...

Objectives Gait impairment dramatically affects stroke patients’ functional independence. The Ekso™ is a wearable powered exoskeleton able to improve over-ground gait abilities, but the relationship between the cortical gait control mechanisms and lower limbs kinematics is still unclear. Our aims are: to assess whether the Ekso™ induces an attentio...

Since the uprising of new biomedical orthotic devices, exoskeletons have been put in the spotlight for their possible use in rehabilitation. Even if these products might share some commonalities among them in terms of overall structure, degrees of freedom and possible actions, they quite often differ in their approach on how to generate a feasible,...

Objective: to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength (NS) and betweenness centrality (BC), induced by a single trial of exoskeleton assisted gait in chronic stroke survivors. Design: Study design was randomized cross-over. Sixtyfour channels EEG were recorded before gait (baseline,...

Wearable passive upper-limb exoskeletons have been proposed and commercialized as tools to improve the ergonomics of workers in repetitive or physically demanding tasks. In the study presented here, an innovative upper-limb exoskeleton is presented, along with experimental tests with human subjects. The device, called proto-MATE, is characterized b...

Background: Wearable powered exoskeletons provide intensive overground gait training with patient's active participation: these features promote a successful active motor relearning of ambulation in stroke survivors. Aim: The aim of this study was to investigate the feasibility and the clinical effects of an overground exoskeleton-assisted gait...

One of the major fields of application of upper limb exoskeletons in rehabilitation medicine is to reduce disability enhancing recovery of functions in patients with Upper Motor Neuron Syndrome. Robotic treatment has received significant attention because it can provide high-intensity and repetitive movement therapy. There is much evidence that the...

The ARTE project has the objective of developing and testing an integrated rehabilitative system composed of a robotic end-effector, a wristband and a wireless EEG system. The main purpose of this integrated system is to monitor patients during the execution of a rehabilitation session to evaluate their performance and the effectiveness of their re...

Background Restoration of independent gait after stroke is a principal goal of survivors. Exoskeleton overground gait training provides trunk support and inter-limb coordination based on fine-tuning of the robot control parameters. The aim of our study was to identify short-term plasticity based on electroencephalography (EEG) data induced by a sin...

Recovery of upper and lower limbs function is essential to reach independence in daily activities in patients with upper motor neuron syndrome (UMNS). Rehabilitation can provide a guide for motor recovery influencing the neurobiology of neuronal plasticity providing controlled, repetitive, and variable patterns. Increasing therapy dosage, intensity...

Background: Wearable powered robotic exoskeletons allow patients with complete spinal cord injury (SCI) to practice over-ground real-world gait scenarios. The global functional interaction subject-exoskeleton is a key factor to produce interlimb coordinated movements. Efficacy and efficiency of over-ground walking abilities using powered exoskelet...

Introduction/Background Gait recovery in post-stroke patients is one of the main goals of post-stroke rehabilitation. Wearable over-ground powered exoskeletons allow individuals with gait dysfunctions to perform an over-ground gait training. Literature lacks of clinical studies on exoskeleton-supported gait rehabilitation in stroke patients and on...

Stroke-related locomotor impairments are often associated with abnormal timing and intensity of recruitment of the affected and non-affected lower limb muscles. Restoring the proper lower limbs muscles activation is a key factor to facilitate recovery of gait capacity and performance, and to reduce maladaptive plasticity. Ekso is a wearable powered...

Mobile Brain/Body Imaging (MoBI) is rapidly gaining traction as a new imaging modality to study how cognitive processes support locomotion. Electroencephalogram (EEG) and electromyogram (EMG), due to their time resolution, non-invasiveness and portability are the techniques of choice for MoBI, but synchronization requirements among others restrict...

Stroke disease involves an increasing number of subjects due to the aging population. In clinical practice‚ the presence of widely accessible rehabilitative interventions to facilitate the patients’ motor recovery‚ especially in the early stages after injury when wider improvement can be gained‚ is crucial to reduce social and economical costs. The...

Objective: To design and implement an electromyography (EMG)-based controller for a hand robotic assistive device, which is able to classify the user's motion intention before the effective kinematic movement execution. Methods: Multiple degrees-of-freedom hand grasp movements (i.e. pinching, grasp an object, grasping) were predicted by means of...

Background: Recovery of therapeutic or functional ambulatory capacity in post-stroke patients is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients with gait dysfunctions to perform over-ground gait training, even immediately after the acute event. Aim: To investigate the feasibility and the clinical effects of an ove...

Powered exoskeletons can be used by the persons with complete spinal cord injury to achieve bipedal locomotion again. The training required before being able to efficiently operate these orthotics, however, is currently based on the subjective assessments of the patient performance by his therapist, without any quantitative information about the in...

Neurorehabilitation effective delivery for stroke is likely to be improved by establishing a mechanistic understanding of how to enhance adaptive plasticity. Functional electrical stimulation is effective at reducing poststroke foot drop; in some patients, the effect persists after therapy has finished with an unknown mechanism. We used fMRI to exa...

The objective of the present study was to design and experiment a hand rehabilitation device for domestic intensive and repetitive training for subjects affected by hemiparesis, assuring their active participation during the exercise. The designed system is composed by the Gloreha hand rehabilitation glove along with its controller PC, and a device...

The study of new systems for supporting upper limb rehabilitation is of primary importance, due to the high number of people in need of rehabilitation and the limited effectiveness of most of the current systems. The research work described in this paper proposes a VR system for upper-limb rehabilitation that is immersive, is based on hand gestures...

Upper-limb movement analysis is important to monitor objectively rehabilitation interventions, contributing to improving the overall treatments outcomes. Simple, fast, easy-to-use, and applicable methods are required to allow routinely functional evaluation of patients with different pathologies and clinical conditions. This paper describes the Rea...

Accuracy analysis.pdf: With the model used the pronation/supination angle and the displacement between the markers and the joint centres cannot be estimated. An analysis of the accuracies of the measure is provided in the file. HtMM.wmv: A healthy subject performing 5 Hand-to Mouth movements, one of the two investigated gestures. The movement is pe...

The foreseen outcome of a rehabilitation treatment is a stable improvement on the functional outcomes, which can be longitudinally assessed through multiple measures to help clinicians in functional evaluation. In this study, we propose an automatic comprehensive method of combining multiple measures in order to assess a functional improvement. As...

The standard account of motor control considers descending outputs from primary motor cortex (M1) as motor commands and efference copy. This account has been challenged recently by an alternative formulation in terms of active inference: M1 is considered as part of a sensorimotor hierarchy providing top-down proprioceptive predictions. The key diff...

Increasing somatosensory input and concurrent volitional intention can enhance functionally relevant brain reorganization after stroke and is a potential mechanism of action of functional electrical stimulation (FES). Here we used fMRI to investigate this interaction in the brain during FES. FES is used as a method to augment proprioception during...

/st>The interaction between operators and their working environment during laryngoscopy is poorly understood. Numerous studies have focused on the forces applied to the patient's airway during laryngoscopy, but only a few authors have addressed operator muscle activity and workload. We tested whether different devices (Glidescope(®) and Macintosh)...

MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user's direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be ad...

Lower limb rehabilitation is a fundamental part of post-acute care in neurological disease. Early commencement of active workout is often prevented by paresis, thus physical treatment may be delayed until patients regain some voluntary command of their muscles. Passive mobilization of the affected joints is mostly delivered in order to safeguard ti...

The ankle joint is a fundamental element in the biomechanical system of locomotion. When its functions are impaired, due to neurological insult such as brain trauma or a stroke, severe disability and loss of personal independence may ensue. For this reason, great care is given to the physical rehabilitation of the lower limb. On the other hand, it...

Functional Electrical Stimulation (FES) has been reported to be an effective treatment for neurological patients, e.g. post-stroke patients. Besides beneficial effects at muscles themselves, a re-learning process named carryover effect has been observed in some patients. This work aims at defining a quantitative method to assess the carryover effec...

MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions that exploits any residual control of the end-user. The MUNDUS controller integrates information collected by electromyography, head/eye tracking, and brain computer interface commands. MUNDUS actu...

Background: MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user’s direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user a...

Background / Purpose: Functional Electrical Stimulation (FES) is a known rehabilitation treatment in clinic, but little is know about its mechanism of action that allows some patients to gain a functional effect that outlasts the period of stimulation (carry-over effect). Main conclusion: The cortical correlates of FES in the context of active...

The restoration of walking ability is the main goal of post-stroke lower limb rehabilitation and different studies suggest that pedaling may have a positive effect on locomotion. The aim of this study was to explore the feasibility of a biofeedback pedaling treatment and its effects on cycling and walking ability in chronic stroke patients. A case...

The restoration of walking ability is crucial for maximizing independent mobility among patients with stroke. Leg cycling is becoming an established intervention to supplement ambulation training for stroke patients with problems of unbalance and weakness. The aim of the study was to explore the feasibility of a biofeedback pedaling treatment and i...