Alessandra Del Felice

• MD, PhD
• Professor (Assistant) at University of Padua

Robotic lower limb exoskeletons are wearable devices designed to augment human motor functions and enhance physical capabilities mostly adopted in healthcare and rehabilitation. The field is strongly dominated by rigid exoskeletons driven by electromagnetic actuators constituted by electrical motors, gearboxes, and cylinders. This review focuses on...

Robotic technology to assist rehabilitation provides practical advantages compared with traditional rehabilitation treatments, but its efficacy is still disputed. This controversial effectiveness is due to different factors, including a lack of guidelines to adapt devices to users’ individual needs. These needs include the specific clinical conditi...

Muscle spindles have unique anatomical characteristics that can be directly affected by the surrounding tissues under physiological and pathological conditions. Understanding their spatial distribution and density in different muscles is imperative to unravel the complexity of motor function. In the present study, the distribution and number/densit...

The overlap between motor and cognitive signs resulting from posterior parietal cortex (PPC) and cerebellar lesions can mask their relative contribution in the sensorimotor integration process. This study aimed to identify distinguishing motor and cognitive features to disentangle PPC and cerebellar involvement in two sensorimotor-related functions...

The overlap between motor and cognitive symptoms resulting from posterior parietal cortex (PPC) and cerebellar lesions can mask their relative contribution in sensorimotor integration processes. This study aimed to identify distinguishing motor and cognitive features to disentangle PPC and cerebellar involvement in two sensorimotor-related function...

Time delays are a signature of many physical systems, including the brain, and considerably shape their dynamics; moreover, they play a key role in consciousness, as postulated by the temporo-spatial theory of consciousness (TTC). However, they are often not known a priori and need to be estimated from time series. In this study, we propose the use...

Neurorehabilitation with robotic devices requires a paradigm shift to enhance human-robot interaction. The coupling of robot assisted gait training (RAGT) with a brain-machine interface (BMI) represents an important step in this direction but requires better elucidation of the effect of RAGT on the user's neural modulation. Here, we investigated ho...

Stroke recovery trajectories vary substantially. The need for tracking and prognostic biomarkers in stroke is utmost for prognostic and rehabilitative goals: electroencephalography (EEG) advanced signal analysis may provide useful tools toward this aim. EEG microstates quantify changes in configuration of neuronal generators of short-lasting period...

Robot-aided gait training (RAGT) plays a crucial role in providing high-dose and high-intensity task-oriented physical therapy. The human-robot interaction during RAGT remains technically challenging. To achieve this aim, it is necessary to quantify how RAGT impacts brain activity and motor learning. This work quantifies the neuromuscular effect in...

Our brain processes the different timescales of our environment's temporal input stochastics. Is such a temporal input processing mechanism key for consciousness? To address this research question, we calculated measures of input processing on shorter (alpha peak frequency, APF) and longer (autocorrelation window, ACW) timescales on resting-state h...

Objective : To develop and validate a quick observational clinical tool, the Functional ASsessment Test for Upper Limb (FAST-UL), for the evaluation of upper limb impairment in goal-directed functional-oriented motor tasks after stroke. Design : Observational, cross-sectional, psychometric study. Setting : Inpatient and outpatient rehabilitation...

Stage 2 sleep spindles are considered useful biomarkers for the integrity of the central nervous system and for cognitive and memory skills. We investigated sleep spindles patterns in subjects after 12 months of their hospitalization in the intensive care unit (ICU) of the Padova Teaching Hospital due to COVID-19 between March and November 2020. Be...

Background Brain-computer interfaces (BCIs) are systems capable of translating human brain patterns, measured through electroencephalography (EEG), into commands for an external device. Despite the great advances in machine learning solutions to enhance the performance of BCI decoders, the translational impact of this technology remains elusive. Th...

Severe acute respiratory syndrome coronavirus 2 is a worldwide public health issue. Almost 2 years into the pandemic, the persistence of symptoms after the acute phase is a well-recognized phenomenon. We conducted a scoping review to map cognitive domain impairments, their frequency, and associated psycho-affective disorders in people with a previ...

Objective To disentangle the physiopathology of cognitive/affective impairment in Coronavirus disease-2019 (COVID-19), we studied long-term cognitive and affective sequelae and sleep high-density electroencephalography (EEG) at 12-month follow-up in people with a previous hospital admission for acute COVID-19. Methods People discharged from an int...

Dravet syndrome (DS) is a rare and severe form of genetic epilepsy characterized by cognitive and behavioural impairments and progressive gait deterioration. The characterization of gait parameters in DS needs efficient, non-invasive quantification. The aim of the present study is to apply nonlinear indexes calculated from inertial measurements to...

Robotic-Assisted Gait training (RAGT) offers an innovative therapeutic option for restoration of functional gait in stroke survivors, complementing existing physical rehabilitation strategies. However, there is a limited understanding of the neurophysiological response induced by this training in end-users. Neural desynchronization and Cortico-Musc...

Standing and concurrently performing a cognitive task is a very common situation in everyday life. It is associated with a higher risk of falling in the elderly. Here, we aim at evaluating the differences of the P300 evoked potential elicited by a visual oddball paradigm between healthy younger (< 35 y) and older (> 64 y) adults during a simultaneo...

The body sway during standing displays fractal properties that can possibly describe motion complexity. This study aimed to use the Higuchi's fractal dimension (HFD) and Tortuosity on lower back accelerations recorded on younger (< 35 y) and older adults (> 64 y). One wearable sensor was secured on participants lower back (i.e., fifth lumbar verteb...

Fast rhythms excess is a hallmark of Parkinson’s Disease (PD). To implement innovative, non-pharmacological, neurostimulation interventions to restore cortical-cortical interactions, we need to understand the neurophysiological mechanisms underlying these phenomena. Here, we investigated effective connectivity on source-level resting-state electroe...

Exoskeleton gait rehabilitation is an emerging area of research, with potential applications in the elderly and in people with central nervous system lesions, e.g., stroke, traumatic brain/spinal cord injury. However, adaptability of such technologies to the user is still an unmet goal. Despite important technological advances, these robotic system...

Falls are the second most frequent cause of injury in the elderly. Physiological processes associated with aging affect the elderly’s ability to respond to unexpected balance perturbations, leading to increased fall risk. Every year, approximately 30% of adults, 65 years and older, experiences at least one fall. Investigating the neurophysiological...

Purpose: A dysfunction of beta oscillatory activity is the neurophysiological hallmark of Parkinson disease (PD). How cortical activity reacts to external perturbations may provide insight into pathophysiological mechanisms. This study aims at identifying modifications in EEG rhythms after transcranial magnetic stimulation (TMS) in PD. We hypothes...

Stroke is the commonest cause of disability. Novel treatments require an improved understanding of the underlying mechanisms of recovery. Fractal approaches have demonstrated that a single metric can describe the complexity of seemingly random fluctuations of physiological signals. We hypothesize that fractal algorithms applied to electroencephalog...

Falls due to balance impairment are a major cause of injury and disability in the elderly. The study of neurophysiological correlates during static and dynamic balance tasks is an emerging area of research that could lead to novel rehabilitation strategies and reduce fall risk. This review aims to highlight key concepts and identify gaps in the cur...

Dravet syndrome (DS) is a rare severe epilepsy syndrome associated with slowed psychomotor development and behavioral disorders from the second year onward in a previously seemingly normal child. Among cognitive impairments, visuospatial, sensorimotor integration, and expressive language deficits are consistently reported. There have been independe...

Background: Many non-conclusive studies have been conducted on low back pain (LBP) in adolescents and associated factors. Objective: The aim was to assess lifetime prevalence and associated factors of LBP in adolescents. Materials and methods: A questionnaire was administered in high-schools (14-19 years old participants) in Veneto region (Ita...

Fibromyalgia syndrome (FMS) is a complex pain disorder, characterized by diffuse pain and cognitive disturbances. Abnormal cortical oscillatory activity may be a promising biomarker, encouraging non-invasive neurostimulation techniques as a treatment. We aimed to modulate abnormal slow cortical oscillations by delivering transcranial alternating cu...

Different cortical regions respond with distinct rhythmic patterns of neural oscillations to Transcranial Magnetic Stimulation (TMS). We investigated natural frequencies induced by TMS in left and right homologous dorsolateral prefrontal cortices (DLPFC) and related hemispheric differences. In 12 healthy young adults, single-pulse TMS was delivered...

Background Dravet Syndrome (DS) is a developmental and epileptic encephalopathy characterized by severe drug-resistant seizures and associated with cognitive and motor impairments. Walking problems are frequently observed. As the foot plays a key role during walking, compromised foot function can be a feature of deviant gait. Aim To investigate fo...

Falls are the second leading cause of injury for the elderly worldwide. Physiological aging processes alter the ability to address unexpected balance perturbations and increase the probability of falling. Indeed, approximately 30% of adults older than 65 years experiences up to one fall/year. Investigating the neurophysiological patterns of static...

Aim To investigate the relation between cognitive and motor development in preschool aged children with Dravet syndrome, in particular between the age of independent walking and cognitive development. Method Results of cognitive and motor developmental assessments and the age of independent walking were retrieved retrospectively from the medical r...

Severe acquired brain injury (ABI) is a major cause of long-term disability and is the main determinant of health and societal costs. Early identification of favourable long-term recovery would allow personalized rehabilitative programs and better health care resources allocation. In light of the higher survival rate from intensive care units (ICU)...

Background: Stroke is a disease with a high associated disability burden. Robotic-assisted gait training offers an opportunity for the practice intensity levels associated with good functional walking outcomes in this population. Neural interfacing technology, electroencephalography (EEG), or electromyography (EMG) can offer new strategies for robo...

Assessment of consciousness following severe brain-injury is challenging. Our hypothesis is that electroencephalography (EEG) can provide information on awareness, in terms of oscillatory activity and network task–related modifications, in people with disorders of consciousness. Similar results were obtained with neuroimaging techniques; we aim at...

Objective: to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength (NS) and betweenness centrality (BC), induced by a single trial of exoskeleton assisted gait in chronic stroke survivors. Design: Study design was randomized cross-over. Sixtyfour channels EEG were recorded before gait (baseline,...

Hydrokinesiotherapy has antalgic and muscle relaxant properties, as well as anti-edema and anti-inflammatory effects. Currently, the management of persons with total hip replacement (THR) consists of multiple pharmacologic and non-pharmacologic therapies, which include therapeutic exercise, physical therapies, and education. Our hypothesis is that...

Musculoskeletal disorders are the most common cause of pain and functional limitation in the general population. The study aim was to evaluate short-wave diathermy (SWD) effects on pain and quality of life in people with musculoskeletal disorders. Eighty participants (31 men, mean age 56 ± 12.49 years) were enrolled, recruiting from outpatient clin...

Objective: To quantify gait abnormalities in people with Dravet syndrome (DS). Methods: Individuals with a confirmed diagnosis of DS were enrolled, and stratified according to knee flexion at initial contact (IC) and range of motion (ROM) during stance (atypical crouch: knee flexion >20° at IC and knee ROM >15° during stance; straight: knee flex...

Background Restoration of independent gait after stroke is a principal goal of survivors. Exoskeleton overground gait training provides trunk support and inter-limb coordination based on fine-tuning of the robot control parameters. The aim of our study was to identify short-term plasticity based on electroencephalography (EEG) data induced by a sin...

Abnormal cortical oscillations are markers of Parkinson’s Disease (PD). Transcranial alternating current stimulation (tACS) can modulate brain oscillations and possibly impact on behaviour. Mapping of cortical activity (prevalent oscillatory frequency and topographic scalp distribution) may provide a personalized neurotherapeutic target and guide n...

There is growing interest in non-invasive brain stimulation as a novel treatment option for substance use disorders (SUDs). Recent momentum stems from a foundation of preclinical neuroscience research demonstrating causal and associative links between neural circuit activity and drug consuming behavior, as well as recent FDA-approval of non-invasiv...

Axillary nerve injuries are uncommon, although the incidence is higher in athletes, both related to direct contusion or quadrilateral space syndrome. While few studies have investigated conservative strategies that could be proposed to avoid surgery, no previous case report documented the possible role of rehabilitation in axillary nerve reinjuries...

Background Pisa syndrome is a lateral deviation of the trunk described in Parkinson’s disease (PD). Its etiology is still unknown; advanced muscular signal analysis techniques, such as inter-muscular coherence, could help clarifying its pathophysiology and suggest therapeutic strategies. Methods Fourteen idiopathic PD subjects with a lateral devia...

Complex regional pain syndrome (CRPS) is characterized by hyperalgesia, autonomic and trophic alterations of bones, muscles and skin. It is supported by neurogenic inflammation and impairment of sympathetic nervous system. Botulinum Toxin (BTX) is an option for the management of pain, with level B evidence of efficacy in neuropathic, joint and myof...

Abnormal cortical oscillations are markers of Parkinson's Disease (PD). Transcranial alternating current stimulation (tACS) can modulate brain oscillations and possibly impact on behaviour. Mapping of cortical activity (prevalent oscillatory frequency and topographic scalp distribution) may provide a personalized neurotherapeutic target and guide n...

Many authors showed that aquatic physiotherapy could improve quality of life and reduce postural instability and risk of falling in elderly subjects. The aim of this research was to explore if the thermal aquatic environment is a suitable place for rehabilitative training in person with Parkinson disease (PwP) with results comparable to the standar...

Introduction: Myotonic dystrophy type 1 is the most common muscular dystrophy in adults. Although brain involvement is well recognized, the relationship between cortical motor control and voluntary movement has not been sufficiently explored. This study aims at assessing magnetoencephalographic (MEG) rhythms at oscillatory and connectivity levels...

Introduction/Background Hypersynchronization of oscillatory brain activity, prevalent in the beta band, is a neurophysiological signature of Parkinson's disease (PD). Transcranial alternating current stimulation (tACS) can entrain cortical activity at the stimulation frequency. The aim of this study was to provide a personalized neurostimulation tr...

Introduction/Background Clinical Care Pathways (CCP) optimize quality of care and resource allocation in health systems. They translate guidelines or evidence into local practice. This work aims to provide a methodological approach for drafting a CCP, referring to a model for the prevention, diagnosis and treatment of post-stroke disability. Mater...

Neurological conditions are the most common cause of severe disability in the elderly and constitute a heavy burden on healthcare and social services.

Background: Cardiac arrest (CA) is a common cause of disability. Multimodal evaluation has improved prognosis but precocious biomarkers are not appropriate in determining long-term functional outcome. Aim: to identify early prognostication markers of long-term functional outcome in post-anoxic coma. Design: retrospective assessment of outcomes...

In progressive myoclonic epilepsy (PME), a rare epileptic syndrome caused by a variety of genetic disorders, the combination of peripheral stimulation and functional magnetic resonance imaging (fMRI) can shed light on the mechanisms underlying cortical dysfunction. The aim of the study is to investigate sensorimotor network modifications in PME by...

People with temporal lobe epilepsy (TLE) who have not undergone epilepsy surgery often complain of memory deficits. Cognitive rehabilitation is employed as a remedial intervention in clinical settings, but research is limited and findings concerning efficacy and the criteria for choosing different approaches have been inconsistent. We aimed to appr...

Passive and imagined limb movements induce changes in cerebral oscillatory activity. Central modulatory effects play a role in plastic changes, and are of uttermost importance in rehabilitation. This has extensively been studied for upper limb (UL), but less is known for lower limb (LL). The aim of this study is to investigate the topographical dis...

Background: Gold standard for spine deformities assessment is X rays, but the procedure bears a risk of exposure. Objective: To investigate intra-rater and inter-rater reliability of a pocket compass needle goniometer (IncliMed®, University of Padua) to non-invasively evaluate spine curves in children and adolescents. Methods: Prospective reli...

Passive and imagined limb movements induce changes in cerebral oscillatory activity. Central modulatory effects play a role in plastic changes, and are of uttermost importance in rehabilitation. This has extensively been studied for upper limb, but less is known for lower limb. The aim of this study is to investigate the topographical distribution...

This presentation reports preliminary findings on gait abnormalities in Dravet syndrome using 3D gait analysis. We hypothesized there would be a crouched gait pattern. A polyflexed gait pattern was indeed observed but also other gait abnormalities could be identified.

Background Dependence is associated with dorso-lateral prefrontal cortex (DLPFC) dysfunction and altered brain-oscillations. High frequency repetitive transcranial magnetic stimulation (HFrTMS) over DLPFC reportedly reduces drug craving. Its effects on neuropsychological, behavioural and neurophysiological are unclear. Methods We assessed psycholo...

Background Different transcranial direct current stimulation (tDCS) paradigms have been implemented to treat post-stroke spasticity, but discordant results have been reported. Objective To determine the efficacy and persistence of dual-tDCS (anode over the affected motor cortex (M1) and cathode over the contralateral) compared to cathodal tDCS (ca...

Background: Different transcranial direct current stimulation (tDCS) paradigms have been implemented to treat poststroke spasticity, but discordant results have been reported. Objective: This study aimed to determine the efficacy and persistence of dual tDCS (anode over affected motor cortex [M1] and cathode over contralateral M1) compared with...

Background: This is an updated version of the original Cochrane review published in Issue 6, 2012.Epilepsy is one of the most common chronic neurological disorders. Despite the plethora of antiepileptic drugs (AEDs) currently available, 30% of people continue having seizures. This group of people requires a more aggressive treatment, since monothe...

Prevalence of oropharyngeal dysphagia among the elderly is high, but underestimated and underdiagnosed. It may give raise to relevant complications impacting on morbidity, hospital length of stay and health care costs. Dysphagia evaluation and management is a multidisciplinary task; it includes a detailed history taking, clinical and instrumental e...

Background: radiographic examination is the gold standard to evaluate spine curves, but ionising radiations limit routine use. Non-invasive methods, such as skin-surface goniometer (IncliMed®) should be used instaed. Objective: to evaluate intra- and interrater reliability to assess sagittal curves and mobility of the spine with IncliMed®. Meth...

Temporal lobe epilepsy (TLE) is often associated with memory deficits. Given the putative role for sleep spindles in learning and encoding, the distribution of spindle generators skewed toward the affected lobe in TLE subjects may be a neurophysiological marker of defective memory. Slow-oscillatory transcranial direct current stimulation (sotDCS) h...

Magnetoencephalography (MEG) is a non-invasive neurophysiological technique used to study the cerebral cortex. Currently, MEG is mainly used clinically to localize epileptic foci and eloquent brain areas in order to avoid damage during neurosurgery. MEG might, however, also be of help in monitoring stroke recovery and rehabilitation. This review fo...

Balance impairment is a frequent and undertreated manifestation in ankylosing spondylitis, leading to increased risk of falls and lower quality of life. Our aim was to assess supervised training and home-based rehabilitation efficacy on balance improvement in ankylosing spondylitis subjects on biologic agents. This was a single-blinded, quasi-rando...

Hemodilution during cardiopulmonary bypass (CPB) is widely used to decrease transfusion and improve microcirculation but has drawbacks, such as diminished hemoblogin levels. Among others, reduced brain oxygenation accounts for neurological adverse outcomes after CPB. The aim of the present study was to ascertain if and how continuous electroencepha...

Rehabilitation programs, to be efficiently tailored, need clear prognostic markers. In acute stroke, neurophysiological measures, such as motor evoked potentials (MEPs), have been proposed, although with discordant results. The aim of this study was to identify a reliable neurophysiological measure of recovery in acute poststroke individuals by com...

Electrophysiological and hemodynamic data can be integrated to accurately and precisely identify the generators of abnormal electrical activity in drug-resistant focal epilepsy. Arterial Spin Labeling (ASL), a magnetic resonance imaging (MRI) technique for quantitative noninvasive measurement of cerebral blood flow (CBF), can provide a direct measu...

Rehabilitation programs, to be efficiently tailored, need clear prognostic markers. In acute stroke, neurophysiological measures, such as motor evoked potentials (MEPs), have been proposed, although with discordant results. The aim of this study was to identify a reliable neurophysiological measure of recovery in acute post-stroke individuals by co...

Sleep and deprivation of it are known methods to increase the yield of epileptic abnormalities. Whereas neurophysiological mechanisms underlying discharges increase were suggested, less is known of the topographical distribution patterns in wake and sleep. We compared interictal epileptic discharges (IEDs) scalp distribution using 256-channels EEG...

Temporal lobe epilepsy (TLE) is often associated with memory deficits. Given the putative role for sleep spindles memory consolidation, spindle generators skewed toward the affected lobe in TLE subjects may be a neurophysiological marker of defective memory. Slow-oscillatory transcranial direct current stimulation (sotDCS) during slow waves sleep (...

Interictal epileptiform discharges (IEDs) constitute a perturbation of ongoing cerebral rhythms, usually more frequent during sleep. The aim of the study was to determine whether sleep influences the spread of IEDs over the scalp and whether their distribution depends on vigilance-related modifications in cortical interactions. Wake and sleep 256-c...

Gamma knife radiosurgery (GK-RS) is a technique applied in selected cases of mesial-temporal epilepsy, although still limited to centres with adequate instrumentation and expertise. Here, we report a case of radio surgery targeted with the aid of electrical source imaging that localizes the cortical area generating the scalp epileptic discharges. T...