Rita Bertoni
@dongnocchi.it
Larice Lab
Fondazione Don Carlo Gnocchi
RESEARCH, TEACHING, or OTHER INTERESTS
Rehabilitation, Neuroscience
Scopus Publications
Scopus Publications
Rebecca Cardini, Chiara Corrini, Rita Bertoni, Denise Anastasi, Davide Cattaneo, and Elisa Gervasoni
Elsevier BV
Ilaria Carpinella, Rita Bertoni, Denise Anastasi, Rebecca Cardini, Tiziana Lencioni, Maurizio Ferrarin, Davide Cattaneo, and Elisa Gervasoni
MDPI AG
Reduced walking endurance is common in people with multiple sclerosis (PwMS), leading to reduced social participation and increased fall risk. This highlights the importance of identifying which gait aspects should be mostly targeted by rehabilitation to maintain/increase walking endurance in this population. A total of 56 PwMS and 24 healthy subjects (HSs) executed the 6 min walk test (6 MWT), a clinical measure of walking endurance, wearing three inertial sensors (IMUs) on their shanks and lower back. Five IMU-based digital metrics descriptive of different gait domains, i.e., double support duration, trunk sway, gait regularity, symmetry, and local dynamic instability, were computed. All metrics demonstrated moderate–high ability to discriminate between HSs and PwMS (AUC: 0.79–0.91) and were able to detect differences between PwMS at minimal (PwMSmFR) and moderate–high fall risk (PwMSFR). Compared to PwMSmFR, PwMSFR walked with a prolonged double support phase (+100%), larger trunk sway (+23%), lower stride regularity (−32%) and gait symmetry (−18%), and higher local dynamic instability (+24%). Normative cut-off values were provided for all metrics to help clinicians in detecting abnormal scores at an individual level. The five metrics, entered into a multiple linear regression model with 6 MWT distance as the dependent variable, showed that gait regularity and the three metrics most related to dynamic balance (i.e., double support duration, trunk sway, and local dynamic instability) were significant independent contributors to 6 MWT distance, while gait symmetry was not. While double support duration and local dynamic instability were independently associated with walking endurance in both PwMSmFR and PwMSFR, gait regularity and trunk sway significantly contributed to 6 MWT distance only in PwMSmFR and PwMSFR, respectively. Taken together, the present results allowed us to provide hints for tailored rehabilitation exercises aimed at specifically improving walking endurance in PwMS.
Claudio Solaro, Rachele Di Giovanni, Erica Grange, Giampaolo Brichetto, Margit Mueller, Andrea Tacchino, Rita Bertoni, Francesco Patti, Angelo Pappalardo, Luca Prosperini,et al.
Springer Science and Business Media LLC
Piergiuseppe Liuzzi, Ilaria Carpinella, Denise Anastasi, Elisa Gervasoni, Tiziana Lencioni, Rita Bertoni, Maria Chiara Carrozza, Davide Cattaneo, Maurizio Ferrarin, and Andrea Mannini
Springer Science and Business Media LLC
AbstractPoor dynamic balance and impaired gait adaptation to different contexts are hallmarks of people with neurological disorders (PwND), leading to difficulties in daily life and increased fall risk. Frequent assessment of dynamic balance and gait adaptability is therefore essential for monitoring the evolution of these impairments and/or the long-term effects of rehabilitation. The modified dynamic gait index (mDGI) is a validated clinical test specifically devoted to evaluating gait facets in clinical settings under a physiotherapist’s supervision. The need of a clinical environment, consequently, limits the number of assessments. Wearable sensors are increasingly used to measure balance and locomotion in real-world contexts and may permit an increase in monitoring frequency. This study aims to provide a preliminary test of this opportunity by using nested cross-validated machine learning regressors to predict the mDGI scores of 95 PwND via inertial signals collected from short steady-state walking bouts derived from the 6-minute walk test. Four different models were compared, one for each pathology (multiple sclerosis, Parkinson’s disease, and stroke) and one for the pooled multipathological cohort. Model explanations were computed on the best-performing solution; the model trained on the multipathological cohort yielded a median (interquartile range) absolute test error of 3.58 (5.38) points. In total, 76% of the predictions were within the mDGI’s minimal detectable change of 5 points. These results confirm that steady-state walking measurements provide information about dynamic balance and gait adaptability and can help clinicians identify important features to improve upon during rehabilitation. Future developments will include training of the method using short steady-state walking bouts in real-world settings, analysing the feasibility of this solution to intensify performance monitoring, providing prompt detection of worsening/improvements, and complementing clinical assessments.
Massimiliano Pau, Micaela Porta, Rita Bertoni, Fabiola Giovanna Mestanza Mattos, Eleonora Cocco, and Davide Cattaneo
Elsevier BV
Claudio Solaro, Rachele Di Giovanni, Erica Grange, Giampaolo Brichetto, Margit Mueller, Andrea Tacchino, Rita Bertoni, Francesco Patti, Angelo Pappalardo, Luca Prosperini,et al.
Wiley
AbstractBackground and purposeUpper limb (UL) function is often affected in people with multiple sclerosis (PwMS) and is typically assessed through objective measures, including the Nine Hole Peg Test (9‐HPT), Box and Block Test (BBT), and Hand Grip Strength (HGS). It is important to include the subjective perspective of PwMS in the assessment. This study aims to evaluate associations between Manual Ability Measure‐36 (MAM‐36) and 9‐HPT, BBT, and HGS in MS.MethodsThe cross‐sectional study included five Italian centers. Inclusion criteria were age ≥ 18 years, MS diagnosis, and stable disease course. Exclusion criteria were bilateral UL paralysis, and concomitant orthopedic or neurological diseases.ResultsA total of 199 PwMS were included: 128 female, mean age = 50.7 ± 13.0 years, 119 relapsing–remitting MS (RRMS), 31 primary and 49 secondary progressive MS, mean disease duration = 14.0 ± 10.4, years, mean Expanded Disability Status Scale (EDSS) = 4.6 ± 2.0.The MAM‐36 showed small correlations with 9‐HPT, BBT, and HGS. Correlations between MAM‐36 and 9‐HPT and BBT were highest among subjects with EDSS ≥ 6 and progressive MS. MAM‐36 and HGS showed the highest correlations in subjects with EDSS ≤ 5 and RRMS. Combining 9‐HPT and HGS provided the strongest predictive power over the MAM‐36.ConclusionsCorrelations between objective measures and MAM‐36 were small to moderate, meaning that objective measures do not match subjects' perception of UL function. The combination of 9‐HPT and HGS measures can help improve the assessment of UL function in activities of daily living.
Rita Bertoni, Fabiola Giovanna Mestanza Mattos, Micaela Porta, Federico Arippa, Eleonora Cocco, Massimiliano Pau, and Davide Cattaneo
Elsevier BV
Elisa Gervasoni, Rita Bertoni, Denise Anastasi, Claudio Solaro, Rachele Di Giovanni, Erica Grange, Hanns-Christian Gunga, Marco Rovaris, Davide Cattaneo, Martina Anna Maggioni,et al.
Frontiers Media SA
BackgroundHeat sensitivity occurs in a high percentage of people with multiple sclerosis (PwMS), in response to environmental or exercise-induced increase in body temperature. However, the kinetic and magnitude of adaptation of the internal load and of the core body temperature (CBT) to a submaximal continuous exercise has been poorly addressed in PwMS; this may be relevant for the brief exercise bouts usually occurring in normal daily life. The aim of this work was to evaluate whether multiple sclerosis influences the acute adaptation of the internal load, the CBT and the perceptual load in response to a constant submaximal work step.MethodsCBT has been continuously monitored (0.5 Hz) by a validated wearable heat-flux sensor and electrocardiography was recorded (250 Hz) by a wearable device during a standard 6-minute walk test (6MWT) in 14 PwMS (EDSS, 4.7 ± 1.2; disease duration: 13.0 ± 10.2 years; m ± SD) and 14 age, sex and BMI-matched healthy subjects (HS). The rate of perceived exertion (RPE) of the lower limbs was assessed during the 6MWT by the Borg scale (6-20).ResultsAs expected, PwMS walked a significantly shorter distance (361 ± 98 m) than the HS group (613 ± 62 m, p<0.001 vs PwMS). However, the kinetics of adaptation of CBT and the magnitude of CBT change from baseline did not differ between groups. Similarly, heart rate (HR) kinetics and HR change from baseline were comparable between groups during the 6MWT. Finally, lower limbs RPE gradually increased during the exercise test, but without significant differences between groups.ConclusionThe internal load, the metabolic heat production, and the perceptive load due to a standard submaximal walking exercise seems to be preserved in PwMS, suggesting a comparable acute heat production and dissipation during exercise. Therefore, it is unlikely that the different distance achieved during the 6MWT may be caused by altered thermoregulatory responses to exercise. Rather, this appears to be a consequence of the known increased energy cost of locomotion in PwMS.
Rita Bertoni, Davide Cattaneo, Cristina Grosso, Francesca Baglio, and Johanna Jonsdottir
Elsevier BV
Erica Grange, Davide Marengo, Rachele Di Giovanni, Margit Mueller, Giampaolo Brichetto, Andrea Tacchino, Rita Bertoni, Francesco Patti, Angelo Pappalardo, Luca Prosperini,et al.
Elsevier BV
Gloria Perini, Rita Bertoni, Rune Thorsen, Ilaria Carpinella, Tiziana Lencioni, Maurizio Ferrarin, and Johanna Jonsdottir
IOS Press
BACKGROUND: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement, and robotic therapy which allows many repetitions of movements. OBJECTIVE: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients. METHODS: Eighteen stroke subjects (onset ⩾ 3 months, age 60.1 ± 15.5) were recruited and randomized to receive an experimental combination of MeCFES during task-oriented reaching followed by robot therapy (MRG) or same intensity conventional rehabilitation care (CG) aimed at the recovery of the upper limb (20 sessions/45 minutes). Change was evaluated through Fugl-Meyer upper extremity (FMA-UE), Reaching Performance Scale and Box and Block Test. RESULTS: The experimental treatment resulted in higher improvement on the FMA-UE compared with CG (P= 0.04), with a 10-point increase following intervention. Effect sizes were moderate in favor of the MRG group on FMA-UE, FMA-UE proximal and RPS (0.37–0.56). CONCLUSIONS: Preliminary findings indicate that a combination of MeCFES and robotic treatment may be more effective than standard care for recovery of the plegic arm in persons > 3 months after stroke. The mix of motor learning techniques may be important for successful rehabilitation of arm function.
Johanna Jonsdottir and Rita Bertoni
SAGE Publications
compared to following shorter and longer timeframes. In addition, investigations are needed in order to understand the mechanisms of which the different components of the multidisciplinary rehabilitation affects relapses. An example to illustrate this can be shown in terms of physical rehabilitation by the means of exercise. Authors of a perspective review have proposed conceptual mechanisms of how exercise can affect relapses in PwMS.10 The conceptual proposal forms a foundation to generate further evidence. Moreover, evidence generation needs to take into account understanding the experience of PwMS, in terms of their needs and limitations following an acute relapse along different timeframes.
C. Solaro, R. Di Giovanni, E. Grange, M. Mueller, M. Messmer Uccelli, R. Bertoni, G. Brichetto, A. Tacchino, F. Patti, A. Pappalardo,et al.
Wiley
Background and purposeLimited data are available in the literature for upper limb impairment in multiple sclerosis (MS). This study aimed to report the distribution of values of hand grip strength (HGS), of the box and block test (BBT) and of the nine‐hole peg test (9HPT) correlated with demographic and clinical data in subjects with MS.MethodsThis study involved five Italian neurological centres. The inclusion criteria were age ≥ 18, MS diagnosis, stable disease phase, right‐hand dominance. All subjects underwent HGS, BBT and 9‐HPT evaluation.ResultsIn all, 202 subjects with MS were enrolled: 137 females; mean age 48.4 years; mean Expanded Disability Status Scale (EDSS) 4.17; mean disease duration 14.12 years; disease course 129 relapsing–remitting, 21 primary progressive and 52 secondary progressive MS subjects; mean right HGS 25.3 kg, left 23.2 kg; mean right BBT 45.7 blocks, left 44.9 blocks; mean right 9‐HPT 30.7 s, left 33.4 s. All results were statistically significantly different compared to healthy controls. HGS, BBT and 9‐HPT were associated with age, EDSS and disease duration, whilst disease course correlated with BBT and 9‐HPT. The BBT and 9‐HPT scores significantly differed according to level of disability (EDSS ≤3.0, 3.5–5.5, ≥6.0).ConclusionHand grip strength and BBT value distribution in a large MS population is reported. Correlations between HGS, BBT and 9‐HPT were generally low.
C. Solaro, E. Grange, R. Di Giovanni, D. Cattaneo, R. Bertoni, L. Prosperini, M. Messmer Uccelli, and D. Marengo
Elsevier BV
Claudio Solaro, Rachele Di Giovanni, Erica Grange, Giampaolo Brichetto, Margit Mueller, Andrea Tacchino, Rita Bertoni, Francesco Patti, Angelo Pappalardo, Luca Prosperini,et al.
Springer Science and Business Media LLC
Claudio Solaro, Davide Cattaneo, Angelo Basteris, Ilaria Carpinella, Alice De Luca, Margit Mueller, Rita Bertoni, Maurizio Ferrarin, and Vittorio Sanguineti
Elsevier BV
Ilaria Carpinella, Tiziana Lencioni, Thomas Bowman, Rita Bertoni, Andrea Turolla, Maurizio Ferrarin, and Johanna Jonsdottir
Springer Science and Business Media LLC
AbstractBackgroundRobot-based rehabilitation for persons post-stroke may improve arm function and daily-life activities as measured by clinical scales, but its effects on motor strategies during functional tasks are still poorly investigated. This study aimed at assessing the effects of robot-therapy versus arm-specific physiotherapy in persons post-stroke on motor strategies derived from upper body instrumented kinematic analysis, and on arm function measured by clinical scales.MethodsForty persons in the sub-acute and chronic stage post-stroke were recruited. This sample included all those subjects, enrolled in a larger bi-center study, who underwent instrumented kinematic analysis and who were randomized in Center 2 into Robot (R_Group) and Control Group (C_Group). R_Group received robot-assisted training. C_Group received arm-specific treatment delivered by a physiotherapist. Pre- and post-training assessment included clinical scales and instrumented kinematic analysis of arm and trunk during a virtual untrained task simulating the transport of an object onto a shelf. Instrumented outcomes included shoulder/elbow coordination, elbow extension and trunk sagittal compensation. Clinical outcomes included Fugl-Meyer Motor Assessment of Upper Extremity (FM-UE), modified Ashworth Scale (MAS) and Functional Independence Measure (FIM).ResultsR_Group showed larger post-training improvements of shoulder/elbow coordination (Cohen’s d = − 0.81,p = 0.019), elbow extension (Cohen’s d = − 0.71,p = 0.038), and trunk movement (Cohen’s d = − 1.12,p = 0.002). Both groups showed comparable improvements in clinical scales, except proximal muscles MAS that decreased more in R_Group (Cohen’s d = − 0.83,p = 0.018). Ancillary analyses on chronic subjects confirmed these results and revealed larger improvements after robot-therapy in the proximal portion of FM-UE (Cohen’s d = 1.16,p = 0.019).ConclusionsRobot-assisted rehabilitation was as effective as arm-specific physiotherapy in reducing arm impairment (FM-UE) in persons post-stroke, but it was more effective in improving motor control strategies adopted during an untrained task involving vertical movements not practiced during training. Specifically, robot therapy induced larger improvements of shoulder/elbow coordination and greater reduction of abnormal trunk sagittal movements. The beneficial effects of robot therapy seemed more pronounced in chronic subjects. Future studies on a larger sample should be performed to corroborate present findings.Trial registrationwww.ClinicalTrials.govNCT03530358. Registered 21 May 2018. Retrospectively registered.
J. Jonsdottir, G. Perini, A. Ascolese, T. Bowman, A. Montesano, M. Lawo, and R. Bertoni
Elsevier BV
Elisa Gervasoni, Davide Cattaneo, Rita Bertoni, Cristina Grosso, Ambra Bisio, Marco Rovaris, and Marco Bove
Ovid Technologies (Wolters Kluwer Health)
Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann–Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: −0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS.
Johanna Jonsdottir, Gloria Perini, Antonio Ascolese, Thomas Bowman, Angelo Montesano, Michael Lawo, and Rita Bertoni
Elsevier BV
Rita Bertoni, Johanna Jonsdottir, Peter Feys, Ilse Lamers, and Davide Cattaneo
Elsevier BV
Johanna Jonsdottir, Elisa Gervasoni, Thomas Bowman, Rita Bertoni, Eleonora Tavazzi, Marco Rovaris, and Davide Cattaneo
Frontiers Media SA
Introduction: Persons with multiple sclerosis (MS) have deficits in many aspects of physical and cognitive functioning that can impact on mobility and participation in daily life. The effect of a 4 week intensive multimodal treadmill training on functional mobility, balance, executive functions and participation in persons with MS with moderate to severe disability was investigated. Methods: Thirty eight persons with MS admitted to a rehabilitation center participated in a two arm randomized 2:1 controlled trial. Participants in the experimental group received supervised intensive treadmill training including cognitive and motor dual tasks (DT-group, N = 26), 5 sessions per week and a control group received the same amount of supervised strength training (S-group, N = 12). The participants were assessed before and after the rehabilitation period with the 2 Minutes Walking Test (2MWT), speed and, static and dynamic balance measures, the Frontal Assessment Battery and the Short Form-12 questionnaire. The main hypothesis was related to the superiority of the treadmill intervention based on a greater proportion of people making a clinically relevant gain (15% increase on 2MWT) in gait resistance following treatment. ANCOVA (Analysis of covariance) models adjusting for baseline measurement of the respective outcome variable, as well as sex and age, were used to evaluate differences in efficacy for all variables. P was set at 0.05. Results: Nineteen out of 26 persons in the DT-group made a clinically relevant gain and two out of 12 in the S-Group (P = 0.001). The DT-group improved more in gait resistance, speed and mobility (P < 0.01). Balance and executive functions instead improved moderately in both groups following training while perception of health remained similar in both groups. Conclusion: A four week multimodal training on treadmill was highly effective in augmenting gait resistance and mobility in moderately to severely affected persons with MS.
Johanna Jonsdottir, Rita Bertoni, Michael Lawo, Angelo Montesano, Thomas Bowman, and Silvia Gabrielli
Elsevier BV
Davide Cattaneo, Ilse Lamers, Rita Bertoni, Peter Feys, and Johanna Jonsdottir
Elsevier BV
Rita Bertoni, Ilse Lamers, Christine C Chen, Peter Feys, and Davide Cattaneo
SAGE Publications
Background: There has been limited research on upper limb dysfunction in people with multiple sclerosis (PwMS). Objective: The objective of this paper is to study unilateral and bilateral upper limb dysfunction at different International Classification of Functioning (ICF) levels according to overall disability in PwMS. Methods: A total of 105 PwMS (16 with EDSS<4 (mild); 17 with EDSS 4–5.5 (moderate); 37 with EDSS 6–6.5 (severe); 35 with EDSS>6.5 (severe non-ambulant)) were recruited from two rehabilitation centers and assessed in a cross-sectional study. Results: The whole sample showed a diminished sensory function (median (first/third interquartile)) score of 3 (2/3) on the Monofilament Test and a reduced strength 91 (76/100) points on the Motricity Index (Body-Function level). Sensory dysfunction did not increase with higher EDSS while strength decreased from 100 (86/100) in the mild subgroups to 91 (80/100) points in the severe subgroup. All showed diminished dexterity, scoring 0.28 peg/s (0.17/0.35) on the Nine-Hole Peg Test (NHPT) (activity level). Score was better for the mild (0.38 (0.35/0.46)) peg/s compared to the severe subgroup (0.28 (0.17/0.35)). Sixty-eight percent, 44% and 75% of PwMS showed bilateral disorders in sensation, strength and dexterity, respectively. The Community Integration Questionnaire (participation level) showed a 35% reduction in home activities, even among PwMS with EDSS<4. Conclusion: This study showed uni-/bilateral upper limb abnormalities at all ICF levels increasing with the overall disability.