Search Results (2,231)

Background: Alzheimer’s Disease (AD) is the most common form of dementia and is characterized by progressive cognitive decline and neurodegeneration. In Italy, AD represents a major public health and socio-economic challenge. This review aims to summarize current Italian research on pharmacological and non-pharmacological interventions, including preclinical studies, clinical trials, rehabilitative approaches, and emerging neuromodulation techniques, highlighting contributions and future directions. Methods: A narrative review of the literature was conducted, focusing on Italian preclinical and clinical studies, observational and real-world evidence, cognitive and physical interventions, music therapy, non-invasive brain stimulation (rTMS, tDCS, tACS), and digital or home-based rehabilitation programs. Results: Italian research has explored different pharmacological strategies, including multitarget compounds, eptastigmine, rotigotine, and combinatorial therapies (donepezil-memantine, citicoline addition). Non-pharmacological interventions, such as cognitive stimulation, motor rehabilitation, music therapy, and multidimensional programs, demonstrated benefits on cognition, behavior, daily functioning, and caregiver well-being. Non-invasive neuromodulation techniques, targeting the dorsolateral prefrontal cortex and precuneus, showed promising effects on memory, attention, and executive functions, especially when combined with cognitive training. Digital health technologies, including telerehabilitation and home-based brain stimulation programs, further enhanced accessibility and adherence. Challenges remain due to fragmented research, small sample sizes, and limited standardization. Conclusions: Italian research on AD reflects a growing emphasis on integrated, multidimensional, and technologically advanced approaches. Strengthening preclinical studies, promoting multicenter collaborations, and combining pharmacological, cognitive, and neuromodulatory strategies may enhance therapeutic efficacy and patient quality of life. Continued investment in innovation and multidisciplinary research positions Italy to contribute meaningfully to global AD management and prevention. Full article

Background/Objectives: Cognitive deficits are common after stroke and often compound motor impairments, hindering functional recovery—yet cognition remains under-addressed in stroke care. This pilot trial evaluated the feasibility and acceptability of a novel stroke telerehabilitation program—COG + OT—that delivers brief, functionally oriented cognitive rehabilitation as a primer to activity-based occupational therapy (OT). Methods: Twenty stroke survivors with arm/hand paresis participated in this single-arm pilot trial. The 8-week COG + OT program included 13 sessions across three phases: (1) cognitive rehabilitation (sessions 1–4), (2) application of cognitive strategies to task-practice OT (sessions 5–10), and (3) integration of cognitive skills into OT (sessions 11–13). Outcomes included feasibility (retention, adherence), acceptability (self-reported interest and usefulness of cognitive strategies, intervention acceptability), and engagement (digital literacy, barriers, and self-reported strategy use). Results: Retention was 95% and adherence was 99.6%. Participants reported moderate interest in cognitive strategies pre-intervention (M = 3.86/5) and found them moderately to very useful post-intervention (M = 4.42/5). Intervention acceptability and appropriateness were rated highly (M = 4.4/5). Common barriers included cognitive, environmental, and language factors; digital/technological barriers were infrequent. Self-reported use of cognitive strategies was moderate to high. Conclusions: The results of this trial strongly support the feasibility and acceptability of the COG + OT program for stroke survivors. Importantly, all participants were able to meaningfully engage in the program despite marked variability in cognitive and clinical characteristics. These findings support further investigation through randomized controlled trials to evaluate efficacy. Full article

Objectives: The objective of this prospective, controlled observational study embedded in routine spa care was to evaluate the effectiveness of integrating immersive virtual reality (VR) into a three-week spa-based rehabilitation program to reduce pain and improve physical mobility in adults with chronic musculoskeletal or neurogenic disorders. Methods: In this study, fifty-five adults with chronic musculoskeletal or neurogenic disorders completed a three-week spa regimen combining natural therapies, physiotherapy and rehabilitation. Participants were allocated in a preference- and availability-based manner either to the VR-enhanced group (n = 37), which completed interactive 25 min VR sessions three times per week, or to the control group (n = 18) receiving standard care. Pain was assessed using a 100 mm Visual Analog Scale (VAS) and shoulder-related joint mobility by goniometry before and after the intervention. Wilcoxon signed-rank and Mann–Whitney U tests evaluated within- and between-group differences, with subgroup analyses according to disease duration (≤5 vs. >5 years). Results: Both groups achieved significant post-treatment reductions in VAS pain scores (p < 0.001). The VR group exhibited a greater median decrease in pain compared to controls (p = 0.048), with the largest effect among patients with disease duration ≤ 5 years (p = 0.024). Goniometric measurements demonstrated significant mobility improvements across all tested angles in the VR group (p < 0.001), while improvements in the control group were smaller. Conclusions: VR integrated into spa-based rehabilitation was associated with greater pain reduction and mobility gains than standard care. These preliminary, hypothesis-generating findings require confirmation in larger randomized trials with standardized protocols and long-term follow-up. Full article

Background: Dystonia, the third most common movement disorder, is increasingly recognised as a network disorder with both motor and non-motor symptoms. Non-motor symptoms have been shown to be key determinants of quality of life in dystonia and include anxiety, depression, sleep disturbance, cognitive dysfunction and fatigue. Results: Emerging data suggests that dysfunction within cortico-striato-thalamo-cerebello-cortico circuits underpins both motor and non-motor symptoms. Genetic studies have highlighted shared gene clusters involved in synaptic function that are associated with both dystonia and psychiatric disorders. Neuroimaging studies reveal microstructural and functional alterations in patients with dystonia that correlate with non-motor symptoms. Discussion: Current research into both the pathophysiology and treatment of non-motor symptoms remains limited, heterogeneous and based on small sample sizes, which restricts the strength of the conclusions that can be drawn. Evidence for targeted therapies for non-motor symptoms is scarce. Conclusions: A greater understanding of the overlap between neural pathways underpinning motor and non-motor symptoms may provide a foundation for the development of novel pharmacological and non-pharmacological therapies. As understanding advances, treatment strategies will likely adopt a holistic model that integrates pharmacological options with non-pharmacological measures, including multi-disciplinary rehabilitation and supportive therapies. Full article

The brain in healthy adults shows language localization in the left hemisphere, and the evidence from the literature supports neural plasticity after traumatic injuries. What happens if an injury occurs early in brain development? How does early unilateral brain damage affect a child’s ability to acquire language? Evidence regarding language development after early unilateral brain damage is mixed. Therefore, this case report aims to present the language and cognitive status at the age of seven in a child who suffered a left-sided arterial presumed perinatal ischemic stroke (APPIS), with reference to her MRI findings. As part of her ongoing rehabilitation, she has received continuous speech therapy since age four and physiotherapy since six months of age. The current evaluation provides insights into long-term neurodevelopmental outcomes following early brain injury, highlighting the variability in clinical outcomes and considering the potential for functional restitution. Full article

Background: Diastasis rectus abdominis (DRA) is a frequent concern following childbirth, particularly following a cesarean section (CS). Mobile exercise applications offer promising opportunities for enhancing physical therapy services, with potential positive outcomes. Purpose: This study compared the effect of a specific DRA-targeted mobile app-based exercise program on inter-recti distance (IRD) and multiple clinical measures to a traditional abdominal exercise program in post-CS mothers with DRA. Methods: This two-armed, parallel-group, randomized controlled trial involved 40 primiparous women undergoing CS; they were classified into two equal groups. Group A participated in Just Fit, a mobile app-based abdominal exercise program, while Group B received a traditional abdominal exercise program. Both exercise programs lasted 30 min, 3 times/week, for 8 weeks as a home program with follow-up sessions once weekly at an outpatient physical therapy clinic. Ultrasonography was used to measure IRD, a manual muscle test assessed abdominal muscle strength, a tape measure gauged circumferences, and a questionnaire evaluated satisfaction. Results: Both programs showed significant improvements in pre- and post-treatment measures of IRD, muscle strength, and girth (p ≤ 0.001 for all comparisons). Women in Group A exhibited significant post-treatment improvements in IRD above the umbilicus, abdominal muscle strength, girth measurements, and satisfaction compared with those in Group B. However, there were non-significant differences in IRD below the umbilicus and hip circumference between the two groups. Conclusions: The mobile app-based exercise program was associated with greater improvements in IRD above the umbilicus, abdominal muscle strength, waist and umbilical circumferences, and patient satisfaction compared with the traditional exercise program for post-CS DRA. These findings suggest that mobile app-guided rehabilitation may serve as an effective and accessible adjunct to traditional post-CS exercise programs, although larger trials are recommended to confirm these results. Full article

Background: SPATA5L1-related neurodevelopmental disorder is a recently described condition characterized by psychomotor delay, sensorineural hearing loss, and variable motor dysfunction. Because only a few cases have been reported, the full phenotypic spectrum remains poorly defined. Expanding clinical characterization is crucial for improving early diagnosis and targeted management. Case Presentation: We report a 24-month-old female with compound heterozygous SPATA5L1 variants c.1918C>T (p.Arg640Ter) and c.2066G>T (p.Gly689Val). She presented with global psychomotor delay, bilateral sensorineural hearing loss, strabismus, and craniofacial dysmorphism. Brain MRI showed cortical and white matter atrophy, delayed myelination, and a thin corpus callosum. Vojta neurodevelopmental assessment demonstrated an 11-month motor delay, abnormal responses in all seven Vojta postural reactions, and persistent primitive reflexes. Early EEG recordings were without significant changes, whereas abnormalities emerged later in the clinical course. Genetic testing confirmed the variants in trans. Management and Outcomes: Early rehabilitation including reflex locomotion therapy was initiated. The persistence of primitive reflexes, central hypotonia, and pathological postural reactions provided a coherent neuromotor profile and indicated a high vulnerability to atypical motor development, and do not rule out the possibility of later evolution toward a spastic–dystonic motor pattern. These findings, combined with neuroimaging abnormalities, refined the patient’s neuromotor phenotype and guided individualized therapeutic planning. Conclusions: This case expands the clinical and neurodevelopmental spectrum associated with SPATA5L1 variants and highlights the diagnostic value of integrating genomic sequencing with structured motor assessments. Early, multidimensional evaluation may improve recognition of rare neurodevelopmental disorders and support more precise prognostication and rehabilitation strategies. Full article

Introduction: Cerebral palsy (CP) affects motor function development, requiring intensive rehabilitation. Virtual reality (VR) interventions show promise for improving motor learning through immersive, engaging experiences. This systematic review and meta-analysis evaluated VR effectiveness for motor function improvement in children with CP. Methods: Following PRISMA 2020 guidelines, we searched six electronic databases from inception to 15 June 2025. Included studies compared VR interventions versus control conditions in children with CP (ages 4–18 years), measuring motor function outcomes. Sixteen studies (n = 397 participants) met the inclusion criteria for qualitative synthesis. Random-effects models, subgroup analyses, and meta-regression were performed. Evidence certainty was evaluated using GRADE methodology. Results: Five randomized controlled trials with complete extractable data (N = 190 participants, 40 effect sizes) were included in the primary quantitative meta-analysis. The primary meta-analysis demonstrated moderate overall effects favoring VR interventions (standardized mean difference [SMD] = 0.41, 95% CI [0.16, 0.66], p = 0.001; I² = 74%); however, GRADE quality was rated LOW due to risk of bias and imprecision. Technology type critically moderated outcomes: robotic exoskeleton systems showed large effects (SMD = 1.00, p = 0.002), commercial gaming platforms showed small-to-moderate effects (SMD = 0.38, p = 0.013), while custom VR systems showed no significant benefit (SMD = 0.01, p = 0.905; Q = 29.00, p < 0.001). Age emerged as the strongest moderator: children (<6 years) demonstrated significant benefits (SMD = 0.98, p < 0.001), whereas school-age children (6–12 years) showed no effect (SMD = −0.01, p = 0.903; meta-regression slope = −0.236 per year, p < 0.001). Dose–response was non-linear, with optimal benefits at 30–40 intervention hours and diminishing returns beyond 50 h. VR proved superior to standard care (SMD = 0.83) but not to active intensive therapies (SMD = 0.09). The safety profile was favorable (1.3% adverse event rate, no serious events). No publication bias was detected. Conclusions: VR interventions demonstrated moderate, technology-dependent motor function improvements in children with CP, with benefits concentrated in young children using robotic systems. Evidence certainty is low, requiring further high-quality trials. Implementation should prioritize robotic VR for children with 30–40 h protocols. Full article

Background: Carpometacarpal (CMC-I) arthritis is a frequent and disabling condition. Standard surgical options include trapeziectomy and prosthetic arthroplasty. While quantitative outcomes have been widely studied, little is known about patient perspectives regarding function, aesthetics, and rehabilitation. Methods: We conducted semi-structured interviews with ten patients who had undergone trapeziectomy on one side and prosthesis implantation on the contralateral side. Interviews were performed ≥6 months postoperatively, audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Researcher triangulation and member checking were applied to enhance trustworthiness. Results: Four overarching themes were identified. (1) Strength: Most patients reported greater strength and endurance on the prosthetic side, though both hands were generally adequate for daily activities. (2) Rehabilitation: Recovery after prosthesis implantation was described as markedly faster and less burdensome, with reduced need for therapy compared to trapeziectomy. (3) Aesthetics: Trapeziectomy was often associated with dissatisfaction due to thumb shortening and collapse, while prostheses were perceived as restoring a more natural appearance. (4) Surgical preference: When asked which procedure they would hypothetically choose again, all participants favored prosthesis implantation, citing superior function, faster recovery, and more favorable aesthetics. Conclusions: Patients who experienced both procedures consistently preferred prosthesis implantation. Their narratives highlight dimensions beyond standard clinical scores, including rehabilitation burden, appearance, and psychosocial impact. Incorporating patient-reported outcomes into surgical counseling is essential to align treatment of CMC-I arthritis with patient priorities and to support shared decision-making. Full article

Chronic obstructive pulmonary disease (COPD) remains a major global health burden, characterized by persistent airflow limitation, progressive lung tissue destruction, and systemic comorbidities. Conventional pharmacological therapies alleviate symptoms but have limited efficacy in halting disease progression. Epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs, are increasingly recognized as important regulators of the inflammatory and oxidative pathways involved in COPD pathogenesis. Exercise is a cornerstone of pulmonary rehabilitation and consistently improves exercise capacity, symptoms, and systemic inflammatory markers in COPD. Emerging studies suggest that exercise is associated with changes in epigenetic regulators. This review summarizes current clinical and preclinical findings on how aerobic training, resistance exercise, and high-intensity interval training are linked to alterations in DNA methylation, histone marks, and non-coding RNA expression, and discusses the biological plausibility that these changes could influence COPD-related pathways such as antioxidant responses, protease and antiprotease balance, and inflammatory signaling. Critical gaps remain regarding tissue specificity, temporal dynamics, and causal mechanisms. Future research should prioritize longitudinal and mechanistic studies to clarify whether epigenetic responses contribute to the benefits of exercise in COPD and to assess their potential as biomarkers or therapeutic targets. Full article

(1) Background: Post-stroke spasticity limits motor recovery and independence. Combining botulinum toxin type-A (BoNT-A) injection with intensive, task-specific robot-assisted therapy (RAT) might enhance neuroplasticity and functional gains, but its additive effect and optimal timing are uncertain. (2) Methods: We systematically searched major medical databases and trial registries up to April 2025 for randomized controlled trials in adults with post-stroke spasticity comparing botulinum toxin type-A injection plus RAT with toxin injection plus conventional therapy, or RAT alone with RAT combined with toxin injection. Risk of bias was assessed using the RoB 2 tool, and findings were synthesized narratively. (3) Results: Seven trials (n = 229) were included. Across all studies, toxin treatment reduced spasticity within groups, whereas additional spasticity reduction with RAT versus conventional rehabilitation was inconsistent. In contrast, several lower-limb trials reported greater improvements in walking capacity and balance when RAT was added, while upper-limb trials showed comparable motor recovery across treatment arms with occasional advantages in strength and movement quality. A pilot four-arm study suggested that starting RAT around four weeks after injection may maximize upper-limb motor gains. (4) Conclusions: The combination of BoNT-A with RAT appears safe and is particularly promising for gait rehabilitation, but further research is needed to define optimal timing and protocols. Full article

Background/Objectives: Rotator cuff disease (RCD) is one of the most common causes of shoulder dysfunction, often resulting in pain, limited range of motion (ROM), and reduced function. Mulligan Mobilization with Movement (MWM) has been proposed as an effective adjunct to conventional therapy by correcting positional faults and improving joint mechanics. However, the overall evidence in RCD remains inconclusive. This meta-analysis aimed to evaluate the efficacy of Mulligan mobilization combined with conventional therapy versus conventional therapy alone on pain, functionality, ROM, joint position sense, and quality of life (QoL) in patients with RCD. Methods: A comprehensive literature search was carried out in PubMed, Web of Science, Scopus, and the Cochrane Library from database inception to 12 October 2025, with no restrictions on publication year. We included randomized controlled trials (RCTs) that compared Mulligan mobilization combined with conventional therapy against conventional therapy alone in individuals with rotator cuff-related pain. The predefined outcomes were pain intensity, range of motion (ROM), quality of life (QoL), joint position sense, and functional performance. All statistical analyses were conducted using R version 4.3.1. Heterogeneity was assessed using the I² statistic and the Cochrane Q test. Pooled mean differences (MDs) were calculated using the Inverse Variance approach with a restricted maximum-likelihood (REML) random-effects model. The review protocol was prospectively registered in PROSPERO (ID: CRD420251166854). Results: Four RCTs met the eligibility criteria and were included in the meta-analysis, comprising a total of 160 participants. Of these, 80 (50%) received Mulligan mobilization in combination with conventional therapy (mean age: 51 years; mean proportion of females: 45%). In the pooled analysis, Mulligan mobilization significantly improved pain at rest (MD −1.19; 95% CI [−1.64; −0.74]; p = 0.01; I² = 0%), pain during activity (MD −2.25; 95% CI [−3.18; −1.31]; p = 0.01; I² = 67%), functionality (MD −14.71; 95% CI [−20.10; −9.33]; p = 0.01; I² = 51%), ROM (MD 19.92; 95% CI [11.25; 28.39]; p = 0.01; I² = 58%), and joint position sense (MD −3.31; 95% CI [−6.22; −0.40]; p = 0.03; I² = 80%) compared with conventional therapy alone. No significant difference was observed for QoL (MD 10.58; 95% CI [−3.18; 24.34]; p = 0.13; I² = 76%). Conclusions: Mulligan mobilization combined with conventional therapy provides significant improvements in pain, functionality, ROM, and joint position sense in RCD. However, no statistically significant differences were observed in QoL between the groups. Integration of this technique into rehabilitation protocols may enhance clinical outcomes and functional recovery. Full article

Introduction: Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) is associated with changes in the brain’s pain processing. This is often due to problems with the body’s natural way of handling the pain management system. Exercise therapy, such as motor control and spinal stabilization, can help reduce pain and disability. However, exercise alone may not be sufficient. Approaches that consider both body mechanics and brain function are gaining popularity. Since brain changes play a role in muscle and bone problems, noninvasive brain stimulation (NIBS) is considered a helpful adjunctive treatment. Studies have shown that NIBS may help people with spinal pain and mood disorders. The aim of this study is to assess the impact of combining tDCS targeting the dorsolateral prefrontal cortex with spinal motor control exercises in patients diagnosed with PSPS-T2. This investigation is based on the hypothesis that such a combined intervention could result in a more significant reduction in disability. Methods/Materials: This randomized controlled trial (RCT) is structured as a double-blind, comparative, longitudinal design in accordance with the CONSORT guidelines. This RCT has been registered at ClinicalTrials.gov (NCT06969456). Forty-two participants diagnosed with PSPS-T2 will be randomized in a 1:1 ratio into two groups: tDCS + rehabilitation (E_tDCS) or sham tDCS + rehabilitation (E_SHAM). The intervention will use tDCS to deliver low-intensity direct current to modulate cortical excitability. The intervention will consist of 24 supervised sessions (2 per week, 60 min each) over 12 weeks. Neuromodulation and exercise protocols will be adapted to the intervention phases based on previous research. The sample size has been calculated using GPower^®, assuming an effect size of 0.81, α = 0.05, power = 0.95, and a 40% dropout rate. Data will be collected from October 2025 to January 2027. Impact Statement: This study integrates neurophysiological modulation via tDCS with targeted exercise therapy, presenting an innovative approach to enhance pain modulation, functional recovery, and cortical reorganization in patients with PSPT-2. This approach has the potential to inform future evidence-based strategies for neurorehabilitation and pain management. Full article

Functional hand rehabilitation requires adaptive and quantitative tools capable of addressing grip-specific challenges. This study presents Handly, an interactive virtual-reality (VR) platform that integrates surface electromyography (sEMG) and markerless optical tracking for the assessment and training of six functional grips (Card, Cylindrical, Spherical, Hook, Grain, Pencil). A total of 10 healthy adults (5 males, 5 females; 18–30 years) participated in a feasibility study involving virtual object manipulation tasks across three difficulty levels. Performance metrics included the execution time, success rate, and number of objects collected. An individualized calibration protocol based on root mean square (RMS) analysis was implemented, using standardized isometric contractions (125–147 N) measured with a handheld dynamometer to establish subject-specific dynamic thresholds. A repeated-measures ANOVA confirmed significant effects of grip type and task level on execution time ($p<0.001$, ${\eta }_p^2=0.68$) and success rate ($p<0.01$, ${\eta }_p^2=0.54$), whereas the number of objects collected showed no significant differences ($p=0.12$). These findings demonstrate that Handly can reliably discriminate functional differences in neuromotor performance while adapting to individual EMG activation profiles. Although EMG data were sampled at 100 Hz, this rate proved sufficient for amplitude-based event detection. The platform’s dual capacity for quantitative assessment and adaptive motor training supports its potential for personalized neurorehabilitation, pending clinical validation in populations with upper-limb impairments. Full article

Objectives: The aim of this study is to summarize recent evidence of the effectiveness of rehabilitation interventions in managing symptoms related to endometriosis and adenomyosis. Methods: The review protocol was registered previously (CRD42022236516). A systematic search was conducted in the Medline, Web of Science, and Scopus databases for studies published up to 23 July 2025 that reported the effects of any rehabilitation intervention in women diagnosed with endometriosis or adenomyosis. Risk of bias was assessed, and meta-analyses were performed. Results: A total of 970 studies were identified, of which 19 reports from 17 trials met the inclusion criteria. Approximately one-third of the trials focused on electrophysical agents, another third on exercise programs, and the remaining studies included manual therapy-based interventions—such as pelvic floor physiotherapy (PFP), or Swedish massage—as well as other modalities. Most trials assessed changes in pain, quality of life (QoL), and mental health, showing consistent improvements following intervention. Additional outcomes evaluated included lumbopelvic impairments, sexual function, and bone mineral density. Meta-analyses of eleven studies on pain and five on QoL revealed significant effects, favoring the intervention groups. Conclusions: This review highlights promising benefits of physical rehabilitation, particularly in patients with endometriosis. A range of approaches—including therapeutic exercise, electrophysical agents, and PFP—may contribute to improvements in endometriosis-related clinical outcomes, especially pain and QoL. Full article