Thesis title: Factors Influencing Outcomes in Technologically-assisted Neurorehabilitation and Return to Work of Patients with Stroke
This thesis is divided in five chapters and it is the results of my Ph.D. conducted in collaboration with the Laboratory for the Study of Mind and Action in Rehabilitation Technologies. The first chapter is an overview of stroke deficits, including cognitive and motor ones, often strictly intertwined, the assessment tools and the conventional rehabilitation intervention. The second chapter is the results of two reviews (already published) in which I have participated and aiming at exploring a new rehabilitative approach based on a top-down intervention differentiating by different types of feedback. Top-down rehabilitative approach has been defined as a therapeutic intervention based on the main involvement of brain functions, and it is in contrast with the previous buttom-up approach of passive mobilization of subjects’ limbs for motor recovery. In the second review, we have highlighted that the feedback given to subjects is an essential feature of the top-down approach, but in literature, the terms feedback, biofeedback, and neurofeedback are often confused and used in an improper manner. It emerged the importance of using specific neuroscientific concepts, especially when rehabilitation was administered using technological devices for favoring a top-down approach.
In the third chapter, I have reported the results of an original study divided into two main experiments in which patients with stroke, compared to healthy subjects, should perform bilateral hand coordinated movements under different conditions: with or without visual control (in experiment 1) and with or without an external stimulus provided on a monitor (in experiment 2). For conducting this experiment, a sensor prototype was used. Interesting results were found in terms of factors potentially affecting the visuomotor strategies of patients with stroke.
In the fourth chapter, there are the results of the STAR project, in which I was involved for two years. The STAR project ("innovative STrategies, and Approaches for the motor and functional Rehabilitation of subjects with neurovascular adverse event outcomes for reintegration into work") was supported by the Italian National Institute for Insurance against Industrial Injuries (INAIL), in the framework of BRIC projects. The aim of this study was to assess if technological rehabilitation may improve the possibilities of return to work in patients with stroke. Despite the results showed a slight effect, a deeper insight has been provided about the factors that may favor the return to work of patients with stroke.
The last chapter summarises the conclusions of the two reviews and the three studies.