Evaluations, monitoring and rehabilitation in the field of severe acquired brain injury

Description

Research on severe brain injury is divided in several aspects:

1. DIAGNOSTIC AND PHARMACOLOGICAL CLINICAL ASPECTS

Strazzer Sandra & Galbiati Sara and Locatelli Federica in collaboration with the Clinical Pharmacology Service (Clementi Emilio and Pozzi Marco) and in collaboration with the Neurophysiology Service (Zucca Claudio).

The management of clinical and pharmacological problems in the field of acquired brain injury in the pediatric age is complex. There are no references to literature and national and international guidelines.

During this period we are monitoring and studying the following issues:

• Endocrinological aspects
• Nephrolithiasis and correlations with enteral feeding
• Epilepsy prophylaxis treatment in TBI
• Evaluation protocol for patients with pharmacoresistant epilepsy
• Monitoring the side effects of drugs
• Management protocol of Tracheostomized patient
• Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Clinical Factors and Pharmacological Management
• Description of hospital infections and their management

2. ASSESSMENT AND REHABILITATION PROTOCOL IN PATIENTS WITH DISORDERS OF CONSCIOUSNESS

Colombo Katia & Pastore Valentina, Galbiati Susanna, Recla Monica, Galbiati Sara, Locatelli Federica, Avantaggiato Paolo, Formica Francesca

The low levels of consciousness (vegetative state and minimally conscious state) are still scantly known. Lack of studies and literature leads to a very high diagnostic error. This lack of knowledge is even more relevant in the pediatric field.

Part of our research focuses on these aspects:

• Prognosis Study with Polysomnography and Functional Resonance with Electroencefalographic and Polygraphic Study in Correlation with Functional Scales
• Study of Clinical Assessment Scales in Children in Vegetative State
• Short and long term outcome studies in relation to rehabilitation pathways
• Psychological evaluation on the care givers / brothers

3. ASSESSMENT AND TREATMENT OF BEHAVIORAL ASPECTS AND NEUROPSYCHOLOGICAL DEFICIENCES

Pastore Valentina & Galbiati Susanna with Recla Monica, Colombo Katia, Manfredi Valentina, in collaboration with Bardoni Alessandra and Fedeli Claudia

Patients with acquired severe brain injury always show behavioral, psychological and neuropsychological deficits. Over the years, clinical and rehabilitative paths have been set up to reduce these problems. They are also intended to encourage the social reintegration of the child and his family. These paths are subject to study and research, in particular we are performing:

• outcome evaluations of Neuropsychological and Psychological Treatment
• functional changes through brain fMRI after specific cognitive treatment
• issues in adolescents with acquired severe brain injury (body image and impact of social inclusion)
• Psychological evaluation on the care givers / brothers

4. MOTOR REHABILITATION

Beretta Elena, in collaboration with Clinical Engineering (Biffi Emilia, Cesareo Ambra) and CESNE (Dr. Arrigoni Filippo) and the physiotherapy sector (Panzeri Daniele).

The creation of rehabilitation pathways in the motor field has allowed an assessment of their outcome. In particular we are studying:

• motor and functional outcome
• the outcome after robotic treatment and after virtual reality (gait)
• the effectiveness of traditional treatment vs ARMEO vs. CIMT (upper limb)
• Evaluation of brain network activation after rehabilitation paths
• Innovative orthosis evaluations
• Mechanized Passive Mechanism Activated Assessments on Brain Activation
• Modification of muscle structure after treatment with Lokomat

Selected publications

• Pozzi M, Galbiati S, Locatelli F, Granziera M, Santi M, Colombo D, Pellegrino P, Radice S, Clementi E, Strazzer S. Prevention of respiratory infections in tracheostomized patients of a pediatric long-term rehabilitation setting. Am J Infect Control. 2015 Feb 8.
• Beretta E, Romei M, Molteni E, Avantaggiato P, Strazzer S. Combined robotic-aided gait training and physical therapy improve functional abilities and hip kinematics during gait in children and adolescents with acquired brain injury. Brain Inj. 2015 Apr 27:1-8. [Epub ahead of print] PubMed PMID: 25915458.
• Pastore V, Colombo K, Maestroni D, Galbiati S, Villa F, Recla M, Locatelli F, Strazzer S. Psychological problems, self-esteem and body dissatisfaction in a sample of adolescents with brain lesions: A comparison with a control group. Brain Inj. 2015 May 7:1-9. [Epub ahead of print] PubMed PMID: 25950267.
• Avantaggiato P, Molteni E, Formica F, Gigli GL, Valente M, Lorenzut S, de Biase S, Arcieri S, Locatelli F, Strazzer S. Polysomnographic Sleep Patterns in Children and Adolescents in Unresponsive Wakefulness Syndrome. J Head Trauma Rehabil. 2015 Sep-Oct;30(5):334-46.
• Pozzi M, Conti V, Locatelli F, Galbiati S, Radice S, Citerio G, Clementi E, Strazzer S. Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Clinical Factors and Acute Pharmacological Management. J Head Trauma Rehabil. 2015 Sep-Oct;30(5):357-363.
• Pozzi M, Locatelli F, Galbiati S, Clementi E, Strazzer S. Re: "Paroxysmal Sympathetic Hyperactivity: A New Era for Diagnosis and Treatment". J Head Trauma Rehabil. 2015 Sep-Oct;30(5):366-7.
• Dilena R, Strazzer S, Esposito S, Paglialonga F, Tadini L, Barbieri S, Giannini A. Locked-in-like fulminant infantile Guillain-Barré syndrome associated with herpes simplex virus 1 infection. Muscle Nerve. 2015 Sep 15.
• Strazzer S, Rocca MA, Molteni E, De Meo E, Recla M, Valsasina P, Arrigoni F, Galbiati S, Bardoni A, Filippi M. Altered Recruitment of the Attention Network Is Associated with Disability and Cognitive Impairment in Pediatric Patients with Acquired Brain Injury. Neural Plast. 2015;2015:104282.
• Molteni E, Beretta E, Altomonte D, Formica F, Strazzer S. Combined robotic-aided gait training and 3D gait analysis provide objective treatment and assessment of gait in children and adolescents with Acquired Hemiplegia. ConfProc IEEE Eng Med Biol Soc. 2015 Aug;2015:4566-9. doi: 10.1109/EMBC.2015.7319410. PubMed PMID: 26737310.
• Garavaglia L, Molteni E, Beretta E, Vassena E, Strazzer S, Pittaccio S. Pilot study of the cortical correlates and clinical effects of passive ankle mobilisation in children with upper motorneuron lesions. Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:6614-7. doi: 10.1109/EMBC.2015.7319909. PubMed PMID:26737809.
• Biffi E, Beretta E, Diella E, Panzeri D, Maghini C, Turconi AC, Strazzer S, Reni G. Gait rehabilitation with a high tech platform based on virtual realityconveys improvements in walking ability of children suffering from acquired brain injury. Conf Proc IEEE Eng Med Biol Soc. 2015 Aug;2015:7406-9. doi: 10.1109/EMBC.2015.7320103. PubMed PMID: 26738003.
• Strazzer S, Pozzi M, Avantaggiato P, Zanotta N, Epifanio R, Beretta E, Formica F, Locatelli F, Galbiati S, Clementi E, Zucca C. Late Post-traumatic Epilepsy in Children and Young Adults: Impropriety of Long-Term Antiepileptic Prophylaxis and Risks in Tapering. Paediatr Drugs. 2016 Feb 25. [Epub ahead of print] PubMed PMID: 26913859.
• Molteni E, Avantaggiato P, Formica F, Pastore V, Colombo K, Galbiati S, Arrigoni F, Strazzer S. Sleep/Wake Modulation of Polysomnographic Patterns has Prognostic Value in Pediatric Unresponsive Wakefulness Syndrome. J Clin Sleep Med. 2016 May 3. pii: jc-00048-16. [Epub ahead of print] PubMed PMID: 27166297.
• Pozzi M, Conti V, Locatelli F, Galbiati S, Radice S, Clementi E, Strazzer S. Paroxysmal Sympathetic Hyperactivity in Pediatric Rehabilitation: Pathological Features and Scheduled Pharmacological Therapies. J Head Trauma Rehabil. 2017 Mar/Apr;32(2):117-124.
• Molteni E, Rocca MA, Strazzer S, Pagani E, Colombo K, Arrigoni F, Boffa G, Copetti M, Pastore V, Filippi M. A diffusion tensor magnetic resonance imaging study of paediatric patients with severe non-traumatic brain injury. Dev Med Child Neurol. 2017 Feb;59(2):199-206.
• Biffi E, Beretta E, Cesareo A, Maghini C, Turconi AC, Reni G, Strazzer S. An Immersive Virtual Reality Platform to Enhance Walking Ability of Children with Acquired Brain Injuries. Methods Inf Med. 2017 Mar 23;56(2):119-126.
• Galbiati S, Pastore V, Locatelli F, Recla M, Galbiati S, Mansi G, Arrigoni F, Scandroglio AM, Beretta L, Strazzer S. Neurocognitive and behavioral outcomes in a nearly drowned child with cardiac arrest and hypothermia resuscitated after 43min of no flow-time: A case study. Resuscitation. 2017 Sep;118:e3-e4.
• Beretta E, Molteni E, Galbiati S, Stefanoni G, Strazzer S. Five-year motor functional outcome in children with acquired brain injury. Yet to the end of the story? Dev Neurorehabil. 2017 Aug 17:1-8.

Partnerships

• Emilio Clementi - University of Milan, Milano- Department of Biomedical and Clinical Sciences "Luigi Sacco"
• Dr.ssa Sonia Radice - Servizio Farmacovigilanza, unità di Farmacologia clinica ASST FBF-Sacco, Milano.
• Erika Molteni Associate Researcher - University College London, London - Department of Medical Physics and Bioengineering
• Simone Pittaccio, Researcher - Italian National Research Council, Rome - Institute for Energetics and Interphases IENI
• Giovanna Rizzo, Senior Researcher -Italian National Research Council, Rome - Institute of Molecular Bioimaging and Physiology IBFM
• Enrico Castelli, Director, Pediatric Neurorehabilitation Units - Ospedale Pediatrico Bambino Gesù, Rome - Department of Neurosciences and Neurorehabilitation