Digital Telemedicine in improving health, social, and economic outcomes in patients with functional motor disorders

This thesis analyses the use of digital telemedicine in improving clinical, social, and economic outcomes for patients with Functional Motor Disorders (FMD). This field is increasingly interesting, given the diagnostic complexity and the need for customized and continuous rehabilitation treatments for such patients. FMDs are characterized by motor symptoms resulting from abnormal functioning of brain networks rather than structural damage. These patients are complex due to most motor and non-motor symptoms combined. Due to this, the patient population is not understood and studied, and only in recent years have researchers shown interest in FMDs. An important tool in evaluating and executing diagnosis is gait analysis, which revealed significant differences in spatiotemporal parameters between patients with FMD, Parkinson's, and healthy controls. A distinct element differentiating FMD from other neurological diseases and healthy subjects is the dual-task paradigm, which proved useful in diagnosing FMD and improving understanding of higher-level motor control. FMDs improve, or don’t get worse, their performance with distraction. Moreover, immersive virtual reality (VR) has been shown to improve postural control and motor performance in patients with FMD, acting on attention, beliefs, and sense of agency. Thanks to substantial technological development, VR could be implemented in telemedicine systems, facilitating home monitoring, active patient involvement, and remote rehabilitation. Another limitation of this patient population is the limited healthcare system specialized in FMD and the limited expert personnel for rehabilitation treatment. Wearable devices could enable monitoring of patients’ daily life activities and performance, such as gait parameters and physical activity, providing useful data for diagnosis and treatment. So, the focus is on remote rehabilitation (especially digital telerehabilitation) and gait analysis through wearable technologies and virtual reality. This thesis consisted of three main parts, corresponding to the commitment of three PhD years. In the first phase, through a literature review, an analysis of technologies used in unsupervised settings for patients with neurological disorders was computed. One notable result was that no studies on FMD and wearable sensors in an ecological setting existed. In the second phase, attention was placed on researching possible gait parameters as biomarkers for FMD. Based on previous results obtained by the research team on balance and gait analysis, an innovative protocol was developed and implemented. This protocol combined wearable sensors and immersive Virtual Reality to analyze motor behavior and gait attitude during single tasks and cognitive and visual-fixation dual tasks in real and virtual environments. The literature suggests that gait performance in dual-task conditions improves gait control. In the third phase, a randomized clinical trial on two parallel FMD groups (with and without wearable sensors) was conducted to compare motor and non-motor outcomes and quality of life in home settings. Moreover, a collaboration with a company (daVi Digital Medicine) was maintained for three years to develop innovative devices, such as the Aureha sensorised t-shirt, for upper limb telerehabilitation. In conclusion, digital telemedicine and telerehabilitation (supported by virtual reality and wearable technologies) represent a significant step in managing functional motor disorders and offering new opportunities for early diagnosis, personalized rehabilitation, and improvement of patient's quality of life. However, challenges remain related to integrating these technologies into clinical practice and the standardization of protocols. Further studies are needed to consolidate the results and expand the applicability of these innovative solutions.