Il Tecnico di Neurofisiopatologia in ambito neuroriabilitativo e di ricerca scientifica: studio osservazionale di impiego sul territorio nazionale italiano.
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Abstract
Introduzione
La figura professionale del Tecnico di Neurofisiopatologia (TNFP) è da sempre correlata all’ambito diagnostico. Tuttavia il numero di tecnici occupati nella ricerca scientifica, o in campo neuroriabilitativo, sta aumentando. Sono infatti sempre più diffuse diverse metodiche di stimolazione cerebrale utilizzate per la neuroriabilitazione ed eseguibili dal TNFP (Stimolazione Magnetica Transcranica ripetitiva, repetitive Transcranial Magnetic Stimulation – rTMS; Stimolazione a Corrente Diretta transcranica, transcranial Direct Current Stimulation - tDCS). Inoltre, differenti tecniche di registrazione dei dati funzionali (Magnetoencefalografia – MEG; Elettroencefalogramma ad Alta Densità; High Density Electroencephalogram - HD-EEG; Interfaccia Cervello-Computer, Brain Computer Interface - BCI) effettuabili dal tecnico consentono l’inserimento di questa figura professionale nel settore della ricerca scientifica.
Obiettivo
Lo studio si propone di conoscere lo stato attuale di impiego dei TNFP Italiani, in ambito neuroriabilitativo e di ricerca scientifica.
Materiali e metodi
É stato somministrato un questionario, distribuito su tutto il territorio nazionale tramite e-mail e canali social da parte delle commissioni d’albo dei Tecnici di Neurofisiopatologia (Ordini TSRM PSTRP) e dall’Associazione Italiana dei Tecnici di Neurofisiopatologia (AITN).
Risultati
Dei 91 partecipanti allo studio, 49 TNFP svolgono attività in ambito neuroriabilitativo e/o di ricerca scientifica. Il maggior numero dei partecipanti, 19 su 49 (39%) è impiegato in strutture pubbliche; la tipologia di contratto più frequente è l’assunzione a tempo indeterminato (32 tecnici su 49). Alla domanda relativa alla formazione fornita durante il corso di studi, per l’impiego in tali ambiti, 13 tecnici su 49 hanno dichiarato di non aver ricevuto una preparazione adeguata, 21 di aver avuto una formazione limitata, 10 hanno definito sufficienti le basi fornite, 5 hanno risposto di essere stati adeguatamente preparati durante la Laurea triennale.
Conclusioni
Una maggior formazione legata alla neuroriabilitazione e alla metodologia di ricerca potrebbe incrementare le competenze dei TNFP e di conseguenza aumentare gli sbocchi lavorativi in tali settori.
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References
[2] Gazzetta Ufficiale LEGGE 10 agosto 2000, n. 251. Disciplina delle professioni sanitarie infermieristiche, tecniche, della riabilitazione, della prevenzione nonche' della professione ostetrica. 2000.
[3] Bhattacharya, A., Mrudula, K., Sreepada, S., Sathyaprabha, T., Pal, P., Chen, R., & Udupa, K. (2022). An Over-view of Noninvasive Brain Stimulation: Basic Principles and Clinical Applications. Canadian Journal of Neurologi-cal Sciences, 49(4), 479-492. doi:10.1017/cjn.2021.158
[4] https://www.tsrm-pstrp.org/wp-content/uploads/2023/08/Evoluzione-profili-professionali-Documento-di-posizionamento-TSRM-e-PSTRP-finale.pdf (Accessed August 21, 2023).
[5] Barker AT, Jalinous R, Freeston IL. Non-invasive magnetic stimulation of human motor cortex. Lancet. 1985;11(1):1106–1107.
[6] Ruohonen J, Karhu J. Navigated transcranial magnetic stimulation. Neurophysiol Clin. 2010;40(1):7–17.
[7] Jannati A, Oberman LM, Rotenberg A, Pascual-Leone A. Assessing the mechanisms of brain plasticity by transcra-nial magnetic stimulation. Neuropsychopharmacology. 2023 Jan;48(1):191-208.
[8] Cohen SL, Bikson M, Badran BW, George MS. A visual and narrative timeline of US FDA miletones for Transcranial Magnetic Stimulation (TMS) devices, Brain Stimul. 2022; 15 (1): 73-75.
[9] Repetitive Transcranial Magnetic Stimulation (rTMS) Systems - Class II Special Controls Guidance for Industry and FDA Staff. 2011. Avaiable at https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/repetitive-transcranial-magnetic-stimulation-rtms-systems-class-ii-special-controls-guidance (last access 13 April 2023).
[10] FDA permits marketing of transcranial magnetic stimulation for treatment of obsessive compulsive disorder. 2018. Avaiable at https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-transcranial-magnetic-stimulation-treatment-obsessive-compulsive-disorder (last access 13 April 2023).
[11] Somaa FA, de Graaf TA, Sack AT Transcranial Magnetic Stimulation in the Treatment of Neurological Diseases. .Front Neurol. 2022;13:793253.
[12] Pateraki G, Anargyros K, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Ziogka P, Sgantzos M, Folia V, Peristeri E, Dardiotis E.J. Therapeutic application of rTMS in neurodegenerative and movement disorders: A review. Elec-tromyogr Kinesiol. 2022 Feb;62:102622.
[13] Marder KG, Barbour T, Ferber S, Idowu O, Itzkoff A Psychiatric Applications of Repetitive Transcranial Magnetic Stimu-lation. Focus (Am Psychiatr Publ). 2022 Jan;20(1):8-18.
[14] Calabrò RS, Billeri L, Manuli A, Iacono A, Naro A.J. Applications of transcranial magnetic stimulation in migraine: evi-dence from a scoping review. Integr Neurosci. 2022 Jun 7;21(4):110.
[15] Paulus W Outlasting excitability shifts induced by direct current stimulation of the human brain. Suppl Clin Neurophysiol. 2004;57:708-14.
[16] Nitsche MA, Fricke K, Henschke U, Schlitterlau A, Liebetanz D, Lang N, Henning S, Tergau F, Paulus W. Pharmacological modula-tion of cortical excitability shifts induced byb transcranial direct current stimulation in humans. .J Physiol. 2003 Nov 15;553(Pt 1):293-301.
[17] Fried PJ, Santarnecchi E, Antal A, Bartres-Faz D, Bestmann S, Carpenter LL, Celnik P, Edwards D, Farzan F, Fecteau S, George MS, He B, Kim YH, Leocani L, Lisanby SH, Loo C, Luber B, Nitsche MA, Paulus W, Rossi S, Rossini PM, Rothwell J, Sack AT, Thut G, Ugawa Y, Ziemann U, Hallett M, Pascual-Leone A. Training in the practice of noninvasive brain stimulation: Recommendations from an IFCN committee. Clin Neurophysiol. 2021 Mar;132(3):819-837. doi: 10.1016/j.clinph.2020.11.018. Epub 2020 Dec 3.
[18] Rich TL, Gillick BT. Electrode Placement in Transcranial Direct Current Stimulation- How Reliable Is the Determination of C3/C4? Brain Sci. 2019 Mar 22;9(3):69. doi: 10.3390/brainsci9030069.
[19] Lantz G, Grave de Peralta R, Spinelli L, Seeck M, Michel C.M, Epileptic source localization with high density EEG: how many electrodes are needed?, Clinical Neurophysiology, Volume 114, Issue 1, 2003, Pages 63-69, ISSN 1388-2457
[20] Holmes MD, Brown M, Tucker DM, Saneto RP, Miller KJ, Wig GS, et al. Localization of extra temporal seizure with non-invasive dense-array EEC. Pediatr Neurosurg. 2008;44:474–9.
[21] Yamazaki M, Tucker DM, Terrill M, Fujimoto A, Yamamoto T. Dense array EEG source estimation in neocortical epilepsy. Front Neurol. 2013;4:42.http://dx.doi.org/10.3389/fneur.2013.00042. eCollection 2013 Erratum in: Front Neurol 2013, 4, 132.
[22] Storti FS, Galazzo IB, Del Felice A, Pizzini FB, Arcaro C, Farmaggio E, et al. Combining ESI, ASL, and PET for quantitative assess-ment of drug-resistant focal epilepsy. Neuroimage. 2013Epub ahead of print.
[23] Mégevand P, Spinelli L, Genetti M, Brodbeck V, Momkian S, Schaller K, et al. Electrical source imaging of interictal activity accu-rately localizes the seizure onset zone. J Neurol Neurosurg Psychiatry. 2014;85:38–43.
[24] Michel CM, Murray MM, Lantz G, Gonzalez S, Spinelli L, Peralta R. EEG source imaging. Clin Neurophysiol. 2004 a;115:2195–222.
[25] Brodbeck V, Spinelli L, Lascano AM, Pollo C, Schaller K, Vargas MI, et al. Electrical source imaging for presurgical focus localiza-tion in epilepsy patients with normal MRI. Epilepsia. 2010;51:583–91.
[26] Zumsteg D, Friedman A, Wennberg RA, Wieser HG. Source localization of mesial temporal interictal epileptiform discharges: correlation with intracranial foramen ovale electrode recordings. Clin Neurophysiol. 2005;116(12):2810–8.
[27] Lantz G, Grave de Peralta Menendez R, Gonzalez Andino S, Michel CM. Noninvasive localization of electromagnetic epileptic ac-tivity. II. Demonstration of sublobar accuracy in patients with simultaneous surface and depth recordings. Brain Topogr. 2001;14(2):139–47.
[28] Brodbeck V, Lascano AM, Spinelli L, Seeck M, Michel CM. Accuracy of EEC source imaging of epileptic spikes in patients with large brain lesions. Clin Neurophysiol. 2009;120(4):679–85.
[29] Buril J, Burilova P, Pokorna A, Balaz M, Use of High-Density EEH in patients with Parkinson disease treated with deep brain stimulation, Biomedical Papers, 2020, 164(4):366-370| DOI:10.5507/bp.2020.042.
[30] Seeber M, Scherer R, Wagner J, Solis-Escalante T, Müller-Putz GR. High and low gamma EEG oscillations in central sensorimotor areas are conversely modulated during the human gait cycle. Neuroimage. 2015 May 15;112:318-326. doi: 10.1016/j.neuroimage.2015.03.045. Epub 2015 Mar 24.
[31] Pisarenco I, Caporro M, Prosperetti C, Manconi M, High-density electroencephalography as an innovative tool to explore sleep physiology and sleep related disorders, International Journal of Psychophysiology, Volume 92, Issue 1, 2014, Pages 8-15, ISSN 0167-8760, https://doi.org/10.1016/j.ijpsycho.2014.01.002.
[32] Mason KM, Ebersole SM, Fujiwara H, Lowe JP, Bowyer SM. What you need to know to become a MEG technologist. Neurodiagn J. 2013 Sep;53(3):191-206. doi: 10.1080/21646821.2013.11079906.
[33] Bagić AI, Barkley GL, Rose DF, Ebersole JS; ACMEGS Clinical Practice Guideline Committee. American Clinical Magnetoenceph-alography Society Clinical Practice Guideline 4: qualifications of MEG-EEG personnel. J Clin Neurophysiol. 2011 Aug;28(4):364-5. doi: 10.1097/WNO.0b013e3181cde4dc.
[34] Hegazy M, Gavvala J. Magnetoencephalography in clinical practice. Arq Neuropsiquiatr. 2022 May;80(5):523-529. doi: 10.1590/0004-282X-ANP-2021-0083.