Autore: GRDNDR110

  • DIFFICOLTÀ NELLA SCRITTURA IN PAZIENTI CON MALATTIA DI PARKINSON: VALUTAZION TECNOLOGICA E CORRELATI DI RM FUNZIONALE A RIPOSO

    HANDWRITING DIFFICULTIES IN PARKINSON’S DISEASE: TECHNOLOGICAL ASSESSMENT AND RESTING-STATE FMRI CORRELATES

    Autori

    Gardoni Andrea (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Elisabetta Sarasso (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy)

    Lucia Zenere (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Roberta Balestrino (Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Marco Forghieri (Vita-Salute San Raffaele University, Milan, Italy). Elisa Sibilla (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Elisa Canu (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Andrea Grassi (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Silvia Basaia (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Veronica Castelnovo (Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy). Massimo Malcangi (Neurology Unit and Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy)

    Maria Antonietta Volontè (Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy). Davide Corbetta (Department of Rehabilitation and Functional Recovery, IRCCS Ospedale San Raffaele, Milan, Italy)

    Massimo Filippi (Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, Neurorehabilitation Unit, Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy and Neurotech Hub, Milan Italy)

    Federica Agosta (Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy and Neurotech Hub, Vita-Salute San Raffaele University, Milan, Italy)

    Background and aims

    Handwriting is a complex activity requiring cognitive and motor abilities, often impaired in people with Parkinson’s Disease (pwPD). Proper handwriting assessment is essential to develop and evaluate the effect of rehabilitation protocols [1]. The aims of the study were to assess handwriting alterations in pwPD compared to healthy controls (HC) and to identify the functional neural correlates of handwriting changes using resting-state functional connectivity (RS-FC) analysis.

    Methods

    Forty pwPD and 30 age- and sex-matched HC underwent handwriting and hand dexterity assessments, neuropsychological evaluation, and RS-functional MRI (fMRI). A tablet-based handwriting assessment included four tasks: Systematic Screening for Handwriting Difficulties-SOS test (copying a text), funnel test (coloring a shape), closed loop task (drawing specific symbols), and repetitive cursive loop task (writing repeated symbols). SOS test was executed also on paper. RS-fMRI analysis used MELODIC to identify RS-FC differences, and correlations with clinical variables significantly differing between groups were assessed.

    Results

    Compared to HC, pwPD showed smaller word size, slower drawing speed, and poorer performance in the handwriting tasks on tablet. SOS test on paper confirmed slower writing speed, smaller size, and lower writing quality in pwPD. RS-FC analysis revealed decreased connectivity in the basal ganglia, cerebellum, ventral default mode, and visual networks, alongside increased RS-FC in the salience and executive control networks. Smaller writing amplitude and poorer handwriting quality were associated with altered RS-FC in motor and cognitive networks.

    Conclusion

    PwPD exhibited handwriting impairments that were correlated with RS-FC changes in motor and cognitive networks, highlighting the neurological basis of handwriting difficulties in pwPD. These findings underscore the multifaceted nature of handwriting deficits in pwPD, emphasizing the need for future studies investigating the effects of specific handwriting rehabilitation strategies on clinical, kinematic and MRI parameters.
    Fundings: Italian Ministry of Health, grant number GR-2018-12366005

    REFERENCES

    [1] Gardoni A, Sarasso E, Basaia S, Corbetta D, Zenere L, Grassi A, Canu E, Castelnovo V, Sibilla E, Malcangi M, Balestrino R, Emedoli D, Volontè MA, Filippi M, Agosta F. Handwriting, touchscreen dexterity and bradykinesia measures in Parkinson’s disease: a feature selection study. J Neurol. 2025 May 11;272(6):389. doi: 10.1007/s00415-025-13121-0. PMID: 40349278.

  • Instabilità posturale nei pazienti con neuropatia ereditaria: studio del ruolo del sistema somatosensoriale e motorio

    Instabilità posturale nei pazienti con neuropatia ereditaria: studio del ruolo del sistema somatosensoriale e motorio

    Postural instability in hereditary neuropathy patients: studying the role of somatosensory and motor involvement

    Autori

    Gardoni Andrea [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

    Sarasso Elisabetta [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; and Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, University of Genoa, Genoa, Italy]

    Sorrenti Benedetta [Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

    Pietroni Luca [Vita-Salute San Raffaele University, Milan, Italy]

    Bosco Luca [Neurology Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy]

    Strano Camilla Mirella Maria [Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

    Zenere Lucia [Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy]

    Falzone Yuri Matteo [Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy]

    Agosta Federica [Neuroimaging Research Unit, Division of Neuroscience, and Neurology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

    Previtali Stefano Carlo [Neurology Unit and Institute of Experimental Neurology and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy] Filippi Massimo [Neuroimaging Research Unit, Division of Neuroscience; Neurology Unit; Neurorehabilitation Unit; and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; and Vita-Salute San Raffaele University, Milan, Italy]

    Introduction

    People with peripheral neuropathy present an increased risk of falls due to an impaired balance control resulting from muscular weakness and/or reduced sensation. This study aimed at investigating the impact of muscular weakness and somatosensory deficits on steady-state and dynamic balance in people with peripheral neuropathy.

    Methods

    Twenty patients with Charcot-Marie-Tooth (CMT), 17 patients with predominantly motor disorders (MOT) (hereditary motor neuropathy or distal myopathy), 9 patients with sensory neuropathy (SENS) and 10 healthy controls were included. Subjects underwent: lower limb muscle strength tests; tactile sensitivity and pallesthesia assessments; evaluation of tactile-pressure sensory threshold of plantar surface of the foot with Semmes-Weinstein monofilaments; measure of passive range of motion of the ankle; static and dynamic balance tests with the Balance Evaluation Systems Test (BESTest). Specific items from the BESTest were performed on a force platform to observe center of pressure (COP) displacement during the exploration of stability limits, the anticipatory postural adjustments (APA) and the maintenance of orthostatism under sensory deprivation conditions.

    Results

    Assessments confirmed the presence of sensory deficit in CMT and SENS patients. CMT and MOT groups were weaker than the controls; SENS had no significant differences with healthy subjects on lower limb strength. CMT, MOT and SENS patients showed significant impairment in steady-state and dynamic balance compared with controls. No statistically significant difference was observed between CMT, SENS and MOT patients in reactive balance. SENS performed better than CMT patients in proactive balance. Stability limits were similar among the different groups, while the amplitude of APA was on average greater in patients than in controls. In static balance, patients with sensory deficits had greater COP oscillations than MOT and controls. On the other hand, the latter groups performed similarly in static oscillations. In the CMT group, increased time at the Timed-Up-and-Go test and reduced BESTest score correlated with sensory deficit, dorsal and plantar flexor weakness, and disease severity.

    Discussion and Conclusion

    Somatosensory deficit and muscular weakness play different roles in postural instability in individuals with peripheral neuropathies. Isolated distal muscle recruitment deficits do not seem to affect steady-state balance, whereas sensory deficits play a pivotal role on instability in static conditions. Both strength and sensory deficits impact on the ability to maintain balance on unstable surface and on dynamic balance, with the latter being mostly dependent on the integrity of the motor system. These findings provide new insights into the systems responsible for postural instability in patients with peripheral neuropathies and justify further research on the efficacy of rehabilitative treatments focused on improving balance in patients with distal deficits, whether they are motor or sensory.

    REFERENCES

    • Pareyson D, Marchesi C. Diagnosis, natural history, and management of Charcot-Marie-Tooth disease. Lancet Neurol. 2009 Jul;8(7):654-67. doi: 10.1016/S1474-4422(09)70110-3.
    • Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006 Sep;35 Suppl 2:ii7-ii11. doi: 10.1093/ageing/afl077.
    • de França Costa IMP, Nunes PS, de Aquino Neves EL, Lima Santos Barreto LC, Garcez CA, Souza CC, Pereira Oliveira PM, Sales Ferreira LA, Brandão Lima VN, de Souza Araújo AA. Evaluation of muscle strength, balance and functionality of individuals with type 2 Charcot-Marie-Tooth Disease. Gait Posture. 2018 May;62:463-467. doi: 10.1016/j.gaitpost.2018.04.001.
    • Nardone A, Grasso M, Schieppati M. Balance control in peripheral neuropathy: are patients equally unstable under static and dynamic conditions? Gait Posture. 2006 Apr;23(3):364-73. doi: 10.1016/j.gaitpost.2005.04.002.

  • CORRELATI NEURALI DELLA BRADICINESIA NELLA MALATTIA DI PARKINSON: STUDIO CINEMATICO E DI FMRI

    NEURAL CORRELATES OF BRADYKINESIA IN PARKINSON’S DISEASE: A KINEMATIC AND FMRI STUDY

    Introduction

    Bradykinesia is one of the cardinal signs of Parkinson’s disease (PD) and is usually assessed during repetitive movements [1, 2]. The aim of the study was to investigate the neural correlates of hand tapping performance in patients with PD relative to healthy controls.

    Methods

    Fifteen PD patients and 15 age- and sex-matched healthy controls were included. All the subjects underwent brain magnetic resonance imaging (MRI) including a hand tapping functional MRI (fMRI) task: subjects were asked to alternatively open and close (hand tapping) their right hand as fast and as ample as possible. Hand tapping speed and amplitude was measured during the fMRI task using an optical fiber data glove.

    Results

    During the fMRI hand tapping task, patients with PD showed reduced hand tapping amplitude and reduced activity of frontoparietal areas and sensorimotor regions including supplementary motor area (SMA), pre/postcentral gyri, pallidum and cerebellum compared to healthy controls. Decreased activity of SMA, cerebellum lobule VIII and caudate correlated with reduced hand tapping amplitude.

    Discussion and Conclusion

    As expected, patients with PD showed a worse hand tapping performance in terms of reduced movement amplitude relative to healthy controls. Interestingly, we found a correlation between bradykinesia and brain activity. In particular, areas strongly involved in motor planning such as SMA and caudate correlated with reduced movement amplitude. This study has the major strength of collecting objective motor parameters and brain activity simultaneously, providing a unique opportunity to investigate the neural correlates of bradykinesia in PD. A reduced recruitment of cortical, cerebellar and basal ganglia areas implicated in motor programming is a hallmark of bradykinesia in patients with PD. 

     

    Funding: Italian Ministry of Health grant GR-2018-12366005

    REFERENCES

    [ 1 ] Prange-Lasonder GB, et al. European evidence-based recommendations for clinical assessment of upper limb in neurorehabilitation (CAULIN): data synthesis from systematic reviews, clinical practice guidelines and expert consensus. Journal of Neuroengineering and Rehabilitation. 2021. Doi: 10.1186/s12984-021-00951-y

    [ 2 ] Holiga S, et al. Accounting for movement increases sensitivity in detecting brain activity in Parkinson’s disease. PLoS One. 2012. Doi: 10.1371/journal.pone.0036271

    [ 3 ] Bologna M, et al. Neurophysiological correlates of bradykinesia in Parkinson’s disease. Brain. 2018. Doi: 10.1093/brain/awy155

  • VALUTAZIONE DELLA DESTREZZA MANUALE USANDO UNO SMARTPHONE IN SOGGETTI CON MALATTIA DI PARKINSON

    ASSESSMENT OF MANUAL DEXTERITY USING A SMARTPHONE IN SUBJECTS WITH PARKINSONS’S DISEASE

    Introduction

    People with Parkinson’s disease (PD) often complain difficulties in activities involving precise, ample, and rapid hand movements such as the use of a smartphone [1, 2]. The aim of the study was to assess hand dexterity abilities using a smartphone in PD relative to healthy controls using customized tests and software.

    Methods

    Ten PD and 15 age/sex-matched healthy controls underwent hand dexterity assessments. We assessed hand function using Manual Ability Measure (MAM-36) and the Purdue Pegboard Test (PPT). To obtain objective data on movement speed and amplitude, we developed tests involving the most commonly used gesture when using a smartphone (i.e. tap, swipe, slide). These tests were performed on the touchscreen of a smartphone and consisted in: a) alternatively tap with the thumb on two rectangles (TAP); b) perform swipe gestures to browse pages (SWIPE); c) perform thumb movements to link dots of a grid according to a defined path (Swipe-Slide Pattern – SSP).

    Results

    Relative to healthy controls, PD showed a lower score in the MAM-36, reduced movement amplitude and speed in TAP, SWIPE and SSP tests and a reduced number of correct sequences in SWIPE and SSP tests. Moreover, a higher number of correct gestures during the SWIPE test correlated with a better motor performance assessed with the UPDRS-III both on and off medication (r>0.66).

    Discussion and Conclusion

    As expected, PD showed reduced hand dexterity abilities. Interestingly hand dexterity objective outcome measures obtained with the smartphone correlated with the motor performance assessed with clinical scales. This study showed that technological devices can be used to assess dexterity in PD providing objective and task-specific outcome measures of hand dexterity rehabilitation in PD.

     

    Funding: Italian Ministry of Health grant GR-2018-12366005.

    REFERENCES

    [ 1 ] Ponsen MM, et al. Impairment of complex upper limb motor function in de novo Parkinson’s disease. Parkinsonism and Related Disorders. 2008. Doi: 10.1016/j.parkreldis.2007.07.019

    [ 2 ] Lee SH, et al. Impaired finger dexterity and nigrostriatal dopamine loss in Parkinson’s disease. Journal of Neural Transmission. 2018. Doi: 10.1007/s00702-018-1901-5