COVID-19 Prospective Registry of Neurological Sequelae
Local Investigator: Alessandra Del Felice
To date, there are no systematic reports of specific subacute or chronic complications post-COVID-19 infection. We need to remain vigilant to post-COVID-19 sequelae, with well-designed follow-up studies and surveillance, which may be achieved by linkage to national health databases. To accelerate knowledge building on COVID-19, the University of Melbourne, Sichuan University, University of Padova, UCL and Stichting Epilepsie Instellingen Nederland are collaborating to set up an international, collaborative, and open-access registry to follow prospectively large numbers of individuals who recover from COVID-19. Data sharing and international collaboration are particularly important and beneficial, when considering the gaps in research capabilities in countries with limited resources such as Africa, India and Latin America, where COVID-19 is raging now.

The database is under construction and will be available to any identified ORCID researcher for data sharing.

DIsturbi psico-patologici, cognitivi e del SOnno in sopravvissuti COvid-19.
PI: Alessandra Del Felice
ITA: Il progetto vuole studiare la prevalenza degli effetti a lungo termine a carico del sistema nervoso centrale in un campione di soggetti negativizzati e dimessi a domicilio dopo infezione da COVID-19. I soggetti verranno monitorati clinicamente e strumentalmente: verrà quantificata l'attività cerebrale a riposo e durante il sonno, i sintomi affettivi (es. depressione) e le funzioni cognitive (es. attenzione/memoria/funzioni esecutive).

EN:The project aims at identifying long-term central nervous system (CNS) sequelae in people who recovered from COVID-19. We will follow-up with clinical, neuropsychological and neurophysiological investigation this cohort.

web.unipd.it/covid19/ricerca

Prevention of falls: a synergic soft exoskeleton with integrated muscle and brain biosignals to minimize gait instability in the elderly
PI: Alessandra Del Felice
Gait performance and posture can be affected by aging. Falls due to lack of stability is one of the most common causes of injury and disability in the elderly. Multiple causative factors concur; older people are usually not aware of these risks and they do not report them to physicians. As a consequence, prevention of falling is often overlooked and technological solutions are proposed to detect the fall itself. The aim of this 3-y project is to develop a novel neuromuscular controller for a soft lower-limb exoskeleton to detect the loss of stability during walking or standing and apply the proper torques to restore stability. The project is structured on two consecutive phases: an offline acquisition of kinematic, cerebral activity and muscular signal during over-ground gait and during postural adjustments induced by an instrumented balance platform, and an online implementation of the closed-loop controller for detecting and preventing falls. At the end of the project, we expect to deliver a robust and efficient system, that should increase the stability and the safety of elderlies, with possible commercial exploitation.
Poster presented at The Hamlyn Symposium on Medical Robotics 2019 (London, UK).

Physiological and rehabilitation outcomes gains from automated interventions in stroke therapy
Local Investigator: Alessandra Del Felice
PI: Olive Lennon - University College Dublin
Developments in robotics allow people with profound neuromuscular deficits after stroke to walk with assistance (during the gait cycle) using an exoskeleton robot. Integrating a robotic device with individualised user electroencephalography (EEG /electrical activity in the motor areas in the brain) and EMG (muscle)feedback would allow more physiological and targeted gait parameters in response to effort, and confer neuroplastic training effects including neuromodulation of temporal and spatial features of gait.
Future integration of EEG/EMGsignals with robotic devices will allow patient initiated movement through thought and/or attempted effort, where currently parameters for devices are therapist set and usage is not functionally driven by the patient. Advancement in this regard is stalled primarily because of difficulty in 3D modelling of gait by EEG.
This collaborative consortium through secondments and return and built in knowledge sharing strategies will exchange knowledge and expertise across: Design, development and production of exoskeleton gait devices; neuro-rehabilitation; bioelectric EEG/EMG signal capture and interpretation; mathematical modelling and brain computer interface (BCI) platform development can advance the state of the art in gait rehabilitation after stroke rehabilitation. The proposal will allow development of 3D modelling of gait, for gait restoration and explore integration with robotics from multi-stakeholder perspectives. Aims:
1. Define current state of the art in EEG modelling of gait post stroke by systematic review and meta-synthesis;
2. Complete 3D modelling of gait as visualised gait, overground gait and robotic walking in healthy individuals and stroke survivors;
3. Develop and test a virtual reality BCI gait training device, including end-user feedback;
4. Explore integration of this prototype with robotic software platforms.
Website: www.progait.eu

Quantification of movement abnormalities in Dravet Syndrome
PI: Alessandra Del Felice
Gait impairment is frequently seen in people with Dravet syndrome but little attention has been payed to this. The scarce literature on this feature reports a gait pattern, developing between ages 9 and 13 years, characterized by marked hip intra-rotation, hip and knee flexion and pelvic antiversion, described as “crouch gait”. A direct consequence of the still missing definition of gait disturbance is the lack of specific rehabilitation programs to hinder progression and optimize residual capabilities. This project aims to ascertain the walk of people with Dravet in a Gait Analysis Laboratory. This will allow to: 1) fully characterize the spectrum of gait patterns; 2) verify if and when unusual patterns develop; 3) correlate different gait patterns with clinical and laboratory data (epilepsy and drugs history, neuroimaging, neurophysiology and genetics) to speculate on possible causative factors; 4) categorization of neurocognitive impairment and its correlation to the motor domain; and 5) to develop ad-hoc rehabilitation programs.
To this purpose, the gait analysis will be performed via stereophotogrammetry and force plates is used to objectively assess the patient kinematics. The high complexity of this technique and the severe cognitive impairment often hamper full instrumented analysis in cognitively impaired populations. With the aim of introducng surrogate techniques to provide informtaion on movement parameters and to broaden the populations eligible for this exams we will: collect pressure footprints via a pressure matrix, complemented with data gathered from wearable sensors, to gather data to characterize the gait pattern and abnormalities. In particular, a new methodology based on these data, already validated on normally developing children and healthy adults, quantifies the movement complexity and instability, potentially allowing also for risk of fall detection.
The project sees collaboration with the Movement Antwerpen – MOVANT, Multidisciplinary Motor Centre Antwerp – M²Ocean, University of Antwerp, and the Deparetment of Engineering, University of Bologna. It is co-funded by Dravet Syndrome Italian associations.
DRAVET ITALIA Onlus website: www.dravet-italia.org
Gruppo Famiglie Dravet Onlus website: www.sindromedidravet.org

La stimolazione transcranica diretta (tDCS) come strumento per migliorare l’apprendimento in sonno nei soggetti pediatrici con epilessia del lobo temporale
PI: Alessandra Del Felice
Sleep spindles play an important role in memory encoding, particularly in the so-called explicit memory: improvements after a nap are related to an increase in the spindles density. Epilepsy, especially temporal epilepsy, is associated to cognitive dysfunctions, including memory impairment.
The aim of this study is to verify if memory performances in children/adolescents with a diagnosis of drug-resistant temporal epilepsy improve after sleep (nap) with and without slow oscillating direct transcranial stimulation (tDCS), which is reported to increase spindle density. The same protocol, applied to adult subjects with temporal epilepsy (Del Felice et al., 2015), increased verbal and visuospatial memory after a single stimulation session. This effect was associated with a redistribution and increased number of sleep spindles’ activity during the nap.
The design of the study is a cross-over randomized-clinical trial; 15 subjects will be recruited and then divided in 2 groups. Both subjects and clinicians will be blinded: the stimulation during the nap will be either real (tDCS) or sham (random-noise). Memory performances will be then tested using the Short Story Test and the Rey–Osterrieth Complex Figure Test. A second evaluation session will be done after a wash-out period, the group stimulation will be crossed and parallel versions of memory tests will be administered.
EEG data will be collected during the two sessions; sleep spindles’ density and their localization will be compared between the two groups and with the previously collected and published data of adult subjects (epileptic and healthy norms).