The environment gives us a multitude of auditory and visual stimuli that require our attention and our control. Many elderly people find it difficult to manage daily dual-tasking situations, as their cognitive reserves decrease with age. The increase in attentional requests and the performance of many actions simultaneously, put people with post-stroke neurological disorders in greater difficulties when compared to healthy subjects. In fact, following a stroke, neurological deficits can occur, characterized by reduction or total loss of motor control, alterations in sensitivity, impairment of cognitive functions and language. "Dual-Task"; means the simultaneous execution of two tasks. Subjects suffering from stroke outcomes manifest a decrease in performing in one of the two tasks or in both. The condition just described is defined as Cognitive-Motor Interference (CMI). It occurs when, during the simultaneous execution of a motor task and a cognitive task (e.g. walking and talking), mental processing is unable to manage competitive processes. The study was carried out in collaboration with the CdL in Physiotherapy, the data were collected at the SOD Clinic of Neurorehabilitation of the Ospedali Riuniti of Ancona during the training (2017-2021). Materials and Methods: the study (2017-2021) involved 15 subjects, two of which are Drop-outs. Four cognitive and motor assessments and two training sessions were carried out. The first training session was performed daily for three weeks (15 sessions), the second training session (Booster session) was performed three times a week for a 15-day period (9 sessions). During this academic year, three subjects were treated: one with cerebellar stroke outcomes, one with cerebral stroke outcomes and a drop-out subject, who did not adhere regularly to the training due to personal reasons. During the training, motor and cognitive exercises were proposed, first presented in single task and then in Dual-Task. During the training, the Dual-Task Index was collected seven times. The Dual-Task Index represents the measure to analyzes the performance trend during Dual-Task situations. The Dual-Task Index was measured during 5 executions of the TUG and the execution of the Digit Span Backward. This measure proved to be sensitive in all subjects treated along the 4 years of experimentation. The analysis of the cognitive outcomes reached by the two subjects treated (a.y. 2020/21) showed improvements in some tests such as: F.A.B., Tower of London (Violation score), Phonemic Fluency. The data of the present study, compared to the results collected from 2017 to 2021 involving 13 participants, confirmed the same improvements. The subjects also reported visible improvements in activities of daily living, especially regarding concentration and balance.
L’ambiente ci pone una molteplicità di stimoli uditivi e visivi che richiedono la nostra attenzione ed il nostro controllo. Molti anziani hanno difficoltà a gestire le situazioni di dual-tasking quotidiane, poiché le loro riserve cognitive con l’età diminuiscono. Questo aumento delle richieste attentive e del compimento di azioni in contemporanea mette in maggiore difficoltà persone con disordini neurologici conseguenti ad ictus, rispetto ai soggetti in salute. Infatti, a seguito di uno stroke, si può assistere alla comparsa di deficit neurologici che possono essere caratterizzati dalla riduzione o perdita del controllo motorio, da alterazioni della sensibilità, dalla compromissione di funzioni cognitive e del linguaggio. Per “Dual-Task” si intende l’esecuzione simultanea di due compiti. In soggetti affetti da esiti di ictus, si assiste al deterioramento della performance in uno dei due compiti o in entrambi. Il fenomeno appena descritto si definisce Interferenza Cognitivo-Motoria (Cognitive-Motor Interference, CMI). Si verifica quando, durante l’esecuzione simultanea di un compito motorio e di un task cognitivo (es. camminare e parlare), l’elaborazione mentale è poco efficiente nella gestione dei processi competitivi. Lo scopo dello studio è quello di elaborare un training per permettere al soggetto di adattarsi più efficacemente al mondo reale, incrementando l’autonomia e l’indipendenza funzionale nello svolgimento delle attività quotidiane e riducendo il rischio di cadute. Lo studio è stato effettuato in collaborazione con il CdL in Fisioterapia, i dati sono stati raccolti presso la SOD Clinica di Neuroriabilitazione degli Ospedali Riuniti di Ancona durante il periodo di sperimentazione del training (2017-2021). Materiali e Metodi: lo studio (2017-2021) ha coinvolto 15 soggetti, di cui due sono Drop-out. Sono state effettuate quattro valutazioni cognitive e motorie e due sessioni di training. La prima sessione di training ha avuto una durata di tre settimane con cadenza giornaliera (15 sedute), il secondo training (Booster session) ha avuto una durata di 15 giorni con cadenza trisettimanale (9 sedute). Durante quest’anno accademico sono stati trattati tre soggetti: uno con esiti di ictus cerebellare, uno con esiti di ictus cerebrale e un soggetto che rappresenta un Drop-out poiché per problemi personali non ha aderito intensivamente al training. Durante il training venivano proposti esercizi motori e cognitivi, dapprima presentati in Single-Task e successivamente in Dual-Task. Durante il training è stato registrato sette volte l’indice Dual-Task che rappresenta una misura che analizza l’andamento delle prestazioni in Dual-Task. L’indice Dual-Task è stato proposto svolgendo il TUG x5 volte e il Digit Span Backward. Tale misura si è mostrata sensibile in tutti i soggetti trattati nei 4 anni di sperimentazione. Analizzando gli outcome cognitivi ottenuti dai due soggetti che abbiamo trattato (a.a. 2020/21) si notano miglioramenti comuni in alcuni test come: F.A.B., Torre Di Londra (Violation score), Fluenza Fonemica. Analizzando i risultati dei 13 partecipanti allo studio dall’anno 2017 al 2021, si confermano i medesimi miglioramenti. I soggetti, inoltre riferiscono notevoli miglioramenti nelle attività di vita quotidiana, riscontrando maggiori performance nella concentrazione ed equilibrio.
Ricaduta funzionale di un Dual-Task training nel trattamento degli esiti cognitivo-motori dell'ictus
CAROSI, ALESSIA
2020/2021
Abstract
The environment gives us a multitude of auditory and visual stimuli that require our attention and our control. Many elderly people find it difficult to manage daily dual-tasking situations, as their cognitive reserves decrease with age. The increase in attentional requests and the performance of many actions simultaneously, put people with post-stroke neurological disorders in greater difficulties when compared to healthy subjects. In fact, following a stroke, neurological deficits can occur, characterized by reduction or total loss of motor control, alterations in sensitivity, impairment of cognitive functions and language. "Dual-Task"; means the simultaneous execution of two tasks. Subjects suffering from stroke outcomes manifest a decrease in performing in one of the two tasks or in both. The condition just described is defined as Cognitive-Motor Interference (CMI). It occurs when, during the simultaneous execution of a motor task and a cognitive task (e.g. walking and talking), mental processing is unable to manage competitive processes. The study was carried out in collaboration with the CdL in Physiotherapy, the data were collected at the SOD Clinic of Neurorehabilitation of the Ospedali Riuniti of Ancona during the training (2017-2021). Materials and Methods: the study (2017-2021) involved 15 subjects, two of which are Drop-outs. Four cognitive and motor assessments and two training sessions were carried out. The first training session was performed daily for three weeks (15 sessions), the second training session (Booster session) was performed three times a week for a 15-day period (9 sessions). During this academic year, three subjects were treated: one with cerebellar stroke outcomes, one with cerebral stroke outcomes and a drop-out subject, who did not adhere regularly to the training due to personal reasons. During the training, motor and cognitive exercises were proposed, first presented in single task and then in Dual-Task. During the training, the Dual-Task Index was collected seven times. The Dual-Task Index represents the measure to analyzes the performance trend during Dual-Task situations. The Dual-Task Index was measured during 5 executions of the TUG and the execution of the Digit Span Backward. This measure proved to be sensitive in all subjects treated along the 4 years of experimentation. The analysis of the cognitive outcomes reached by the two subjects treated (a.y. 2020/21) showed improvements in some tests such as: F.A.B., Tower of London (Violation score), Phonemic Fluency. The data of the present study, compared to the results collected from 2017 to 2021 involving 13 participants, confirmed the same improvements. The subjects also reported visible improvements in activities of daily living, especially regarding concentration and balance.| File | Dimensione | Formato | |
|---|---|---|---|
|
Carosi Alessia tesi Logopedia PDFA.pdf
embargo fino al 11/11/2024
Dimensione
3.1 MB
Formato
Adobe PDF
|
3.1 MB | Adobe PDF |
I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.12075/803