E-ACTION TRAINING

Programmi di tele-riabilitazione domiciliare per migliorare la mobilità, l’equilibrio, le funzioni cognitive e ridurre il rischio di cadute in soggetti anziani fragili

Regione Liguria

UOC Clinica di Neuroriabilitazione. Ospedale Policlinico San Martino-IRCCS. Largo Rosanna Benzi, 10 - 16132 Genova

Il progetto è dedicato alle persone a rischio di caduta. Si propone di migliorare il loro equilibrio e la loro stabilità durante il cammino attraverso l’utilizzo di exergames associato a “Action Observation Treatment” (AOT). Gli exergames sono videogiochi nei quali gli spostamenti dell’avatar dipendono dai movimenti della persona che gioca. Possono essere utilizzati in riabilitazione per migliorare l’equilibrio e la coordinazione. L’AOT favorisce il recupero della funzione motoria attraverso l’osservazione di un’altra persona che compie determinate azioni. Si basa sulla teoria dei neuroni a specchio. Le sedute riabilitative, comprendenti exergames e AOT, saranno svolte presso il domicilio del partecipante, sotto la supervisione da remoto di un fisioterapista (tele-riabilitazione).

Saranno inclusi nello studio solo persone che abbiano presentato almeno 2 cadute nei 6 mesi precedenti l’arruolamento. Potrà trattarsi di persone anziane senza patologie neurologiche (Gruppo 1), di persone con malattia di Parkinson (Gruppo 2) oppure di persone con esiti di ictus (Gruppo 3). Il trattamento avrà una durata di 2 mesi. Le sedute saranno effettuate dal lunedì al venerdì, con una durata variabile da 20 a 50 minuti ciascuna. La difficoltà degli esercizi dipenderà dalle capacità della persona e sarà incrementata tenendo conto dei suoi progressi. L’AOT si baserà sull’osservazione di video, nei quali un nostro fisioterapista eseguirà delle azioni. Le persone partecipanti allo studio dovranno osservare e contemporaneamente eseguire tali azioni. I parametri cinematici dei movimenti eseguiti saranno registrati ed analizzati off line ogni settimana. Inoltre, i partecipanti saranno seguiti on line dal fisioterapista, soprattutto nelle fasi iniziali del trattamento. Recluteremo 40 persone per ogni gruppo. Venti persone saranno sottoposte al trattamento, mentre le restanti 20 entreranno nel braccio placebo. I videogiochi saranno gli stessi, ma i partecipanti dovranno osservare solo immagini di paesaggi.

I partecipanti saranno valutati all’inizio e alla fine del trattamento. Il follow up avrà la durata di 12 mesi. La misura principale di outcome sarà il numero di cadute nei 12 mesi successivi al trattamento. Le misure secondarie di outcome faranno riferimento alla deambulazione, all’equilibrio e allo stato cognitivo dei partecipanti.

Riferimento Scientifico

• Prof. Carlo Trompetto - Direttore UOC Clinica di Neuroriabilitazione. Professore Associato Dipartimento Neuroscienze (DINOGMI), Università di Genova (This email address is being protected from spambots. You need JavaScript enabled to view it.) 010-5555647.
• Prof.ssa Laura Mori - Associato Dipartimento Neuroscienze (DINOGMI), Università di Genova (This email address is being protected from spambots. You need JavaScript enabled to view it.)
• Prof.ssa Elisa Pelosin - Associato Dipartimento Neuroscienze (DINOGMI), Università di Genova (This email address is being protected from spambots. You need JavaScript enabled to view it.)

Riferimento Amministrativo

• Dott.ssa Flavia Mammoliti - Grant and Technology transfer office-Direzione Scientifica, Ospedale Policlinico San Martino-IRCCS (This email address is being protected from spambots. You need JavaScript enabled to view it.).

STIMO. TE-REHAB

Clinical efficacy and neurophysiological correlates of cognitive stimulation in aged subjects with mild and moderate cognitive impairment.

Calabrian Region

Azienda Ospedaliera Universitaria Mater Domini, Unità di Neurologia, Catanzaro & Università degli Studi di Catanzaro

Rehabilitative treatments, based on cognitive stimulation, have been recently proposed as useful approaches to improve or stabilize cognitive functions in patients with mild or moderate cognitive impairment. Unfortunately the generalization of clinical results to activities of daily living isn't proven yet and frequently most of patients living at home don't receive adequate rehabilitation thus leading to functional deterioration. To face these difficulties telerehabilitation could supply

homebound subjects with treatments, without displacement of therapist or patient. Therefore the aim of this study is to verify if, in PD and chronic post-stroke patients with mild to moderate cognitive impairment, CS delivered from a distance by a telerehabilitation system, may improve cognitive performances and/or activities of daily living.

Moreover, we plan to verify the presence of correlations between clinical effects of CS and functional and metabolic patterns of cerebral areas.

SpecificObjectives:

1. After a treatment with CS delivered from a distance by a telerehabilitation system to PD patients with mild to moderate cognitive impairment, we expect an improvement or stabilization of performances on cognitive tasks and on activities of daily living.
2. After a treatment with CS delivered from a distance by a telerehabilitation system we expect an improvement of performances on cognitive tasks and on activities of daily living.
3. In patients treated with CS, we expect to observe modifications of metabolic and/or functional parameters, investigated by neuroimaging techniques.

We plan to produce new information on:

• the effects of cognitive stimulation delivered by TR to patients with cognitive impairment, consequence of different pathological conditions. These data will overtake the results of a few previous studies, limited to small groups of patients affected by degenerative dementia.
• the impact of the same model of cognitive stimulation on the activities of daily living, adding new information to previous results, limited to the effects on the impairment.
• the correlation of metabolic and/or functional parameters, investigated by neuroimaging techniques with cognitive stimulation delivered by TR. These data will fill an absolutely lacking field. Indeed, no studies have been performed until today in degenerative dementia using an advanced diagnostic approach, such as the PET-MRI, i.e., an innovative technology combining the information coming from the metabolic study of the cerebral cortex and morphometric data detected by MRI. 

Reference facilities

Azienda Ospedaliera Universitaria “Mater Domini” di Catanzaro, U.O di Neurologia,

Campus “Salvatore Venuta”, Viale Europa, Loc. Germaneto, 88100, Catanzaro

Sede legale: Via Tommaso Campanella, 115, 88100, Catanzaro

Telefono centralino 0961712111

Azienda Sanitaria Provinciale di Crotone

C/O Il Granaio, Via M. Nicoletta, 88900 Crotone (KR). Telefono centralino  0962 924671

Istituto S.Anna, Crotone

Via Siris, 11. Crotone (KR). Telefono centralino: 096227579

Reference team

Scientific references

• Prof. Gennarina Arabia (Principal Investigator), This email address is being protected from spambots. You need JavaScript enabled to view it.
• Ing. Loris Pignolo (Co- Principal Investigator), This email address is being protected from spambots. You need JavaScript enabled to view it.
• Dott. Paolo Tonin (supervisor), This email address is being protected from spambots. You need JavaScript enabled to view it.

Administrative references

• D.ssa Marinella Rocca, This email address is being protected from spambots. You need JavaScript enabled to view it.
• Dr. Giuseppe Fico, This email address is being protected from spambots. You need JavaScript enabled to view it.

ORDER

Evaluation of appropriateness of drug prescriptions in the elderly and development of programs to improve it in Piedmont

Regione Piemonte

Azienda Ospedaliera Universitaria Maggiore della Carità, Novara & Università degli Studi del Piemonte Orientale, Dipartimento di Scienze del Farmaco, Novara

The exponential increase in the number of available pharmacological treatments for primary and specialty care in the elderly has increased the number of drugs that each individual is likely to be prescribed simultaneously. While on one hand this is likely to increase the quality (and length) of life of patients, it is now recognized that this might also lead to inappropriate prescriptions that might have the opposite effect.

The present proposal, by using multiple approaches, including pharmaco-epidemiological data coupled with outcome research, active pharmacovigilance, clinical governance represented by multidisciplinary working groups and pharmacogenetics wishes to analyze the phenomenon in depth in the Piedmont Region and provide appropriate tools to improve appropriate prescriptions.

The starting hypothesis is that part of the Italian elderly subject to poly-pharmacy treatments are at risk of inappropriate or deleterious prescriptions and that personalized measures across disciplines must be put in place to reduce risks.

The measures to be taken must, in our opinion, be determined in a data- and prescriber- and patient-driven process. Therefore, we plan to use administrative data (i.e. pharmaceutical reimbursement, hospital admissions and discharges), field investigations of drug use in long-term care facilities and field investigations on pharmacovigilance coupled to pharmacogenetics, to evaluate the current situation. This will then be followed by the use of the data by a multi-disciplinary working group to improve the quality of care of co-morbid out-patients and in assisted discharge.

The present proposal expects to:

• present a snapshot of drug use in the elderly in the Piedmont Region, implementing this with outcome research;
• compile an annotated list of inappropriate prescriptions that have been observed in real life;
• execute a pilot exploratory study to evaluate oral anticoagulant therapy and the impact of pharmacogenetics in predicting bleeding.

Reference facilities

A.O.U. Maggiore della Carità, Novara

Reference team

Scientific references

Prof. Armando Genazzani (Principal Investigator)