LEONARDO BOCCUNI BIO

My mission: improving the efficacy of upper limb neurorehabilitation interventions

The past

I remember one of the very first neurological patients I treated, when as bachelor student I was doing an internship in a neurorehabilitation department in Italy. He had a severe acute hemiplegia involving both the right arm and leg, to the point he could barely activate any muscle at the beginning. We worked togethet very hard for months eventually recovering the ability to walk independently, but we couldn't achieve anything meaningful for his upper limb. I was very frustrated, so since the beginning I searched for alternative solutions to what I was already doing; I asked first to my supervisors, then looked in the literature, books, online resources. Despite some valuable recommendations, I couldn't really have an impact on the recovery of his arm functionality.

The positive side of this story though, is that I have never stopped searching for novel solutions since then. Initial failures have been like burning scars, which urged me to study, try, fail, try again, and eventually succeed. The last decade has been a long, beautiful path discovering my soul as researcher and innovator. I'm very grateful to the patients, colleagues, teachers and promotors that I have met along the journey so far.

The present

I believe to have finally developed a methodology for treating upper limb neurological disorders successfully. Being gounded on both research evidence and clinical experience, it could be summarized in three words:

• intensity

• variability

• personalization

When I'm working intensively with a patient I want to capitalize each minute we have available, in order to prime learning and neuroplastic changes. To this end, and also to motivate patient and avoid boredom, I constantly vary the exercise that we perform, so I could say that we never repeat the exact same task twice. Finally, all these efforts needs to be focused on improving specific deficits, and tailored to patient's expectations, beliefs and goals; we are not working on the patient, we are working WITH the patient towards shared objectives.

Besides therapeutic exercise, anything else that I apply. like functional electrical stimulation and hand splinting, are useful tools again towards an improvement of training intensity, variability, and personalized solutions.

The future

In the future I would like to develop innovative interventions in the following fields:

• Telerehabilitation (independent long term training)

• Neuromodulation (TMS, tDCS)

• Cardiovascular conditioning and its impact on fitness status and neuroplasticity

The reasons are that there is a limit to what we may achieve during the formal patient-therapist session. We need effective and economically sustainable interventions to further improve outcomes in the long term. In this perspective, I believe that developing training and technologies for telerehabilitation is a leading strategy.

Neuromodulation is an attractive methodology that I have been studying and learning since the beginning of my doctoral project; a field that is still evolving towards priming neuroplasticity before or during motor training, thus leveraging the impact of our interventions.

Overall health status is often compromised in neurological patients, to the point that indepency and quality of life is not a matter of motor function, but rather a consequence of severe deconditioning. In addition, there is seminal evidence that cardiovascular exercise after motor training may increase learning consolidation, particularly for high intensity training. I find this a very interesting a promising field.

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Personal facts

Besides my profession, here are three things that identifies me:

   1. Cooking

Typical for an italian, right? I love eating and cooking, expecially homemade filled pasta (tortellini, ravioli) and pizza. 

   2. Sport

Between the age 13-23 I have practiced rowing every day, reaching nice national and international results, one for all winning the World Coastal Rowing Championship in 2011. Now I am not rowing nor coaching anymore, but I still consider rowing as an intimate part my identity.

   3. Zodiac

I'm a capricorn, which according to Wikipedia (italian version) is described as follows:

People born under this sign have remarkable tenacity and ambition, thanks to which they can reach their goals successfully. Prudence, patience, reflection and self-control also belong to Capricorn. Those belonging to this sign also show a certain introversion and confidentiality and are characterized by an often evident pessimism and closure, which lead them to be often cold and distrustful of others. Like all earth signs, he can be very materialistic.

For the good and the bad, I think this is an impressively accurate description of me.