Daniele Borzelli

Background: Attention-deficit/hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation, socio-emotional difficulties, and low self-esteem. Narrative-based approaches, including therapeutic writing, may support identity development and promote adaptive self-representations. However, there is limited evidence regarding structured, group-based therapeutic writing interventions for this population, particularly for female subjects. This case series provides preliminary and exploratory evidence regarding the feasibility of and potential changes associated with this approach in female adolescents with ADHD. Methods: This case series included four adolescents (aged 11–14 years) with a clinical diagnosis of ADHD and presenting with emotional and socio-emotional difficulties. Participants underwent a structured group intervention consisting of seven sessions integrating therapeutic writing techniques and cognitive–behavioral principles, supervised by a specialized psychotherapist. The following outcome measures were collected at baseline (t0) and post-intervention (t1): Difficulties in Emotion Regulation Scale (DERS-SF), Difficulties in Emotion Regulation Scale (SSIS-SEL), and Rosenberg Self-Esteem Scale (RSE_TOT). Data were analyzed using linear mixed-effects models, with results interpreted as exploratory estimates of pre–post changes. Results: Following the intervention, positive pre–post changes were observed in socio-emotional competencies and self-esteem. Statistically significant pre–post changes were observed in self-esteem and in socio-emotional competencies, particularly in self-awareness and self-regulation. Reductions were observed in emotional regulation difficulties, although these changes did not reach statistical significance. Conclusions: This case series suggests that a structured group-based therapeutic writing intervention may be associated with improvements in self-esteem and selected aspects of socio-emotional functioning in adolescents with ADHD. Given the small sample size and exploratory design, findings should be interpreted cautiously and require confirmation in larger controlled studies. These findings contribute preliminary evidence to an underexplored area in the underrepresented female ADHD population and highlight the potential value of integrating narrative processes within group interventions to support both individual meaning-making and interpersonal validation.

Background/Objectives: Digital technologies are increasingly explored as complementary tools in speech and language therapy for children with neurodevelopmental disorders. However, evidence on virtual reality-based interventions for children with developmental language disorder (DLD) remains limited. This study aimed to evaluate the effects of a Virtual Reality Rehabilitation System (VRRS)-based language intervention combined with standard speech therapy in preschool children with DLD. Secondary objectives included assessing the feasibility, usability, and safety of the VRRS-integrated intervention. Methods: A randomized controlled pilot study was conducted in preschool children diagnosed with DLD. Participants were allocated to an experimental group receiving VRRS-based language intervention integrated with conventional therapy or to a control group receiving standard speech therapy alone. Both groups attended two 60 min sessions per week for six months. Clinical language outcomes were assessed at baseline (T0) and post-intervention (T1). Feasibility was evaluated through adherence and retention rates, usability through a therapist-completed questionnaire, and safety through monitoring of adverse events during sessions. Results: All participants in the experimental group completed the intervention (100% retention). No adverse events were observed. Therapists reported good usability of the VRRS system, highlighting ease of exercise customization, intuitive monitoring of progress, and good integration into routine therapy. Conclusions: VRRS-based activities integrated into conventional speech therapy appear feasible, safe, and well accepted in preschool children with DLD. Further controlled studies with larger samples are needed to confirm these findings. Trial Registration: ClinicalTrials.gov (NCT07438639).

Background: Stroke remains a primary cause of long-term disability worldwide, with upper-limb deficits affecting up to 80% of survivors acutely and 40% chronically. These deficits lead to considerable effects on their independence and overall quality of life. Conventional rehabilitation therapies are most effective when initiated shortly after a stroke, yet many patients face barriers to ongoing therapy post discharge. Recent advancements in low-cost rehabilitation systems, particularly those using virtual reality (VR) technologies, offer promising alternatives for enhancing upper-limb recovery. Objective: Given the burden on health care systems and the limitations in access to high-intensity postdischarge rehabilitation, this study aimed to evaluate the feasibility, acceptability, and usability of an upper-limb adaptive mirror therapy using VR and myoelectric control for the rehabilitation of patients with chronic stroke developed through a user-centered design approach. Methods: In this study, a total of 12 community-dwelling survivors of chronic stroke (mean age 52.9, SD 16.0 years; 4 female) with moderate to severe upper-limb impairments were enrolled. Participants were stratified by age (young: 18-55 years; older: 56-80 years) and impairment level (Fugl-Meyer Assessment-Upper Extremity score: 18-36=severe; 37-54=moderate). Acceptability was assessed for each session by patient self-evaluation of satisfaction and motivation through a visual analog scale, while the therapist assessed the patient’s participation in therapy using the Pittsburgh Participation Rehabilitation Scale. Usability was measured with the User Satisfaction Evaluation Questionnaire scale and feasibility through the NASA (National Aeronautics and Space Administration) Task Load Index cognitive workload indices. Results: Patients reported a significant increase in satisfaction from the intermediate to the final assessment (T1: 72% vs T2: 85%; P=.01) and stable high motivation levels. Differences in participation and motivation were observed based on impairment levels, with no effect of age. Usability ratings remained high (>80%) throughout the intervention, with no significant differences between baseline and end line (P=.56). Cognitive workload assessments showed a significant reduction over time, in perceived cognitive (P=.04), performance (P=.007), and effort demands (P<.001). Impairment level significantly influenced perceived workload, with participants with more severe impairment reporting higher cognitive, physical, temporal, and effort demands (all P<.001), while age did not contribute to variability in acceptability, usability, or workload measures. Conclusions: VR therapy was found to be feasible, under adaptive task conditions, ensuring stable performance across patients. The protocol was usable and acceptable among patients with chronic stroke, especially those with moderate impairment, supporting its potential as a user-centered digital rehabilitation tool, warranting further investigation in controlled and home-based settings. Trial Registration: ClinicalTrials.gov NCT07103122; https://clinicaltrials.gov/study/NCT07103122

Introduction: Motor tasks require the flexible selection and coordination of multiple muscles, which may be achieved through the organization and combination of muscle synergies. Although multiple muscles may receive a shared neural drive, and each muscle may also receive distinct neural inputs, there is ongoing debate about whether synergies accurately reflect shared neural drives. This study aimed to compare the spectral characteristics of the common drive shared among muscles within the same synergy to those shared among muscles belonging to different synergies. Methods: Electromyographic signals were recorded from upper limb muscles during an isometric multi-directional force generation task. Synergies were identified using non-negative matrix factorization (NMF), and coherence analysis was conducted to evaluate common drives among muscles within and across synergies. A methodological limitation of previous studies was to segment muscle activity into standard frequency bands. Here, we overcome it by proposing to automatically detect subject-specific and physiologically relevant frequency layers. The application of NMF on the coherence spectra of muscle pairs as a method for automatically detecting physiologically relevant frequency bands sheds light into the neural basis of muscle coordination. Results: Six frequency layers were identified, and muscle recruited within the same synergy showed a higher coherence within layers in the delta, alpha, and low-beta bands. Discussion: Our findings enhance the understanding of physiological mechanisms of motor coordination by elucidating the relationship between muscle synergies and the spectral characteristics of intermuscular coherence.

BACKGROUND Stroke remains a primary cause of long-term disability worldwide, with upper-limb deficits affecting up to 80% of survivors acutely and 40% chronically. These deficits lead to considerable effects on their independence and overall quality of life. Conventional rehabilitation therapies are most effective when initiated shortly after a stroke, yet many patients face barriers to ongoing therapy post discharge. Recent advancements in low-cost rehabilitation systems, particularly those using virtual reality (VR) technologies, offer promising alternatives for enhancing upper-limb recovery. OBJECTIVE Given the burden on health care systems and the limitations in access to high-intensity postdischarge rehabilitation, this study aimed to evaluate the feasibility, acceptability, and usability of an upper-limb adaptive mirror therapy using VR and myoelectric control for the rehabilitation of patients with chronic stroke developed through a user-centered design approach. METHODS In this study, a total of 12 community-dwelling survivors of chronic stroke (mean age 52.9, SD 16.0 years; 4 female) with moderate to severe upper-limb impairments were enrolled. Participants were stratified by age (young: 18-55 years; older: 56-80 years) and impairment level (Fugl-Meyer Assessment-Upper Extremity score: 18-36=severe; 37-54=moderate). Acceptability was assessed for each session by patient self-evaluation of satisfaction and motivation through a visual analog scale, while the therapist assessed the patient’s participation in therapy using the Pittsburgh Participation Rehabilitation Scale. Usability was measured with the User Satisfaction Evaluation Questionnaire scale and feasibility through the NASA (National Aeronautics and Space Administration) Task Load Index cognitive workload indices. RESULTS Patients reported a significant increase in satisfaction from the intermediate to the final assessment (T1: 72% vs T2: 85%; P=.01) and stable high motivation levels. Differences in participation and motivation were observed based on impairment levels, with no effect of age. Usability ratings remained high (>80%) throughout the intervention, with no significant differences between baseline and end line (P=.56). Cognitive workload assessments showed a significant reduction over time, in perceived cognitive (P=.04), performance (P=.007), and effort demands (P<.001). Impairment level significantly influenced perceived workload, with participants with more severe impairment reporting higher cognitive, physical, temporal, and effort demands (all P<.001), while age did not contribute to variability in acceptability, usability, or workload measures. CONCLUSIONS VR therapy was found to be feasible, under adaptive task conditions, ensuring stable performance across patients. The protocol was usable and acceptable among patients with chronic stroke, especially those with moderate impairment, supporting its potential as a user-centered digital rehabilitation tool, warranting further investigation in controlled and home-based settings. CLINICALTRIAL ClinicalTrials.gov NCT07103122; https://clinicaltrials.gov/study/NCT07103122

The COVID-19 pandemic significantly challenged healthcare systems worldwide, highlighting the critical role of early and multidisciplinary rehabilitation interventions. There remains uncertainty about whether these rehabilitation principles developed in response to COVID-19 can be effectively generalized to chronic respiratory diseases. This opinion paper evaluates retrospective data from early stages of the COVID-19 pandemic to propose a comprehensive early multidisciplinary rehabilitation model, potentially applicable across various chronic respiratory conditions. We retrospectively analyzed data from 62 COVID-19 patients hospitalized at the University Hospital of Messina, Italy, between March and June 2020. The patients underwent structured multidisciplinary rehabilitation sessions initiated upon achieving clinical stability. Functional improvements were assessed weekly using the Barthel Index (BI). Significant correlations were observed between initial BI scores and functional improvements at discharge (p < 0.001) and between functional gains and the number of rehabilitation sessions administered (p = 0.025). Early physiatric evaluation significantly enhanced functional recovery (p = 0.036). Early structured multidisciplinary rehabilitation during acute hospitalization demonstrated clear benefits in COVID-19 patients, indicating potential for broad applicability in chronic respiratory disease management. Systematic implementation could improve clinical outcomes, reduce healthcare resource utilization, and enhance patients’ quality of life.

Background/Objectives: Minimally verbal autistic children face significant communication challenges, often unmet by traditional therapies. Social robots, like NAO, offer predictable, structured interactions that may improve engagement and language skills. This study aimed to evaluate the effectiveness of NAO-assisted therapy in improving communication and social interaction in minimally verbal autistic children compared to standard therapeutic approaches. Methods: In a single-blind, randomized, controlled study, 37 autistic children aged 4–12 years were assigned to either NAO-assisted therapy or standard speech therapy. Participants were assigned to either an NAO-assisted therapy group or a standard speech therapy control group. The intervention included 12 weekly 45 min sessions. Communication outcomes were measured using the Language Development Level Test (TVL) and mand request observations. Results: All 37 participants completed the 12 sessions without adverse events, highlighting the intervention’s feasibility and safety. Children in the NAO-assisted therapy group showed greater improvements in verbal communication (on average, 159 ± 49% more children exhibited improvement across verbal aspects (range: 107–284%; p < 0.001)) particularly in spontaneous communication, compared to the control group. The therapy also increased mand production (from 6.8 ± 4.3 in session 1 to 16.7 ± 7.7 in session 12; p < 0.001; average gain: 0.9 per session), demonstrating steady growth in communicative initiative. These findings underscore the structured and engaging nature of NAO-assisted therapy in supporting consistent progress in communication skills. Conclusions: NAO-assisted therapy is a promising, safe, and effective intervention for enhancing communication in minimally verbal autistic children, offering unique benefits in promoting spontaneous and consistent verbal engagement.

Background: Interventional physiatry is a branch of medicine that uses minimally invasive ultrasound-guided techniques for diagnosis and treatment in the musculoskeletal system. The aim of this scoping review is to investigate the sterilisation techniques used and the rate of infection with ultrasound-guided injections. Methods: PubMed was searched up to 30 September 2024 using the following search terms (“Ultrasound, Interventional”[mesh]) AND “Injections, Intra-Articular”[mesh]; “Ultrasound-guided intra-articular injection”. The inclusion criteria were randomised clinical trials, written in English, involving US-guided mini-invaexercissive procedures. Results: The search identified a total of 256 potentially relevant publications. After screening for duplication, inclusion, and exclusion criteria, 105 articles were eligible for data extraction. In 51 studies, the method of skin disinfection was not specified, 18 RCT reported a ’sterile condition’, 9 studies used povidone–iodine solution, 5 used alcohol, and 2 used chlorhexidine 0.5%. In 64 trials, the method of probe preparation was not specified, 11 trials described the use of sterile gel, 10 trials reported the use of a probe cover, sterile pad, or barrier, and 2 trials reported the use of chlorhexidine 0.5%; 41 studies reported mild adverse events and 4 serious adverse events. Conclusions: Taken together, the findings of this scoping review did not show a clear relationship between current sterilisation protocols and the prevention of the microbial contamination of the probes or the patient’s skin. The variation in protocols highlights the need for standardised guidelines and more rigorous studies to accurately determine the most effective disinfection practices.

The coordination of the multiple degrees-of-freedom of the human body may be simplified by muscle synergies, motor modules which can be flexibly combined to achieve various goals. Studies investigating adaptation to novel relationships between muscle activity and task outcomes found that altering the recruitment of such modules is faster than the learning of their structures de novo . However, how learning new synergy recruitments or new synergy structures may occur remains unclear. While trial-by-trial learning of novel sensorimotor tasks has been successfully modeled at the level of task variables, few models accounted for the redundancy of the motor system, particularly at the muscular level. However, these models either did not consider a modular architecture of the motor system, or assumed a priori knowledge of the sensorimotor task. Here, we present a computational model for the generation of redundant muscle activity where explicitly defined modules, implemented as spatial muscle synergies, can be updated together with their recruitment coefficients through an error-based learning process dependent on a forward model of the sensorimotor task, which is not assumed to be known a priori. Our model can qualitatively reproduce the experimental observations of slower learning and larger changes in the structure of the muscle activity under sensorimotor tasks that require the learning of novel patterns of muscle activity, providing further insights into the modular organization of the human motor system. Author summary: It has been proposed that muscles are recruited in modules, called muscle synergies, rather than on a muscle-by-muscle basis. This modular organization was shown to affect the learning of novel tasks, where simulated remapping of the forces generated by the muscles (“virtual surgeries”) that make the synergies ineffective are more difficult to learn. Previous models of trial-by-trial learning in a modular architecture have assumed prior knowledge of the motor task (in particular, how to modify the muscles / synergies recruitment given an error), which might not be the case for tasks in which novel patterns of muscle activity are required. In contrast, models which assumed no prior knowledge of the task have not investigated the role of modularity. Here, we propose a computational model of the trial-by-trial adaptation of muscle synergies, their recruitment, and the concurrent learning of the internal model of the musculoskeletal system responsible for error correction. Our results show that this model replicates experimental observations of slower learning and larger changes in the structure of the muscle activity in sensorimotor tasks that require the learning of novel patterns of muscle activity, providing insight into learning-related changes of muscle activity in novel sensorimotor tasks.