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Francesca Tinelli

Post-Doc in Cognitive Science, University of Florence


  • Email: francesca.tinelli (AT) inpe.unipi.it
  • Telephone:  +39 050 3153175

Research laboratories

  • CNR Institute of Neuroscience, Pisa
  • Department of Psychology, University of Florence
  • Stella Maris Foundation, Pisa, Italy

Current research and interests

  • Clinical Psychology



Tinelli, F., Gamucci, A., Battini, R. & Cioni, G. (2013). Congenital nystagmus in two infants born from mothers exposed to methadone during pregnancy,Ital J Pediatr, 1 (39), 40. PDF

BACKGROUND: Methadone is commonly prescribed as a substitute for illicit opioids. Use of methadone during pregnancy is associated with neonatal abstinence syndrome (NAS), reduced head circumference as well as a slight increase in neonatal mortality and morbidity. Less is known about the effects of methadone on the visual system.Cases: We report two Italian cases of nystagmus in infants born from mothers exposed to methadone during pregnancy. Ophthalmic or central disorders were excluded as a cause of nystagmus in both infants. The first case was followed at 3, 6 and 12 months while the second one was evaluated at 5 and 8 months. Both infants had normal neurological and cognitive development. Their first evaluation revealed different characteristics but both showed progressive improvement in ocular disorder, persistence of pendular horizontal nystagmus and nearly normal visual acuity. CONCLUSION: This report, the first description of Italian cases of nystagmus related to use of methadone during pregnancy, underlies the importance of a careful investigation of drug use in pregnancy in cases of unexplained congenital nystagmus.

Ricci, D. & Tinelli, F. (2013). Compromised approximate number system acuity in school-aged children born extremely preterm,Dev Med Child Neurol, PDF

De Rose, P., Albamonte, E., Lagana, V., Sivo, S., Pisoni, S., Gallini, F., et al. (2013). Perceptual-motor abilities in pre-school preterm children,Early Hum Dev, PDF

BACKGROUND: Several studies report a high percentage of premature infants presenting perceptual motor difficulties at school age. The new version of the Movement Assessment Battery for Children allows the assessment of perceptual-motor abilities in children from the age of 3years. AIMS: To evaluate early perceptual-motor abilities in prematurely born children below the age of 4years. STUDY DESIGN: The Movement Assessment Battery for Children 2nd edition was administered to 105 low-risk prematurely born children (<32weeks gestation) and in a control group of 105 term-born children matched for age and sex. All children were assessed between the age of 3years and 3years-11months. RESULTS: 63 children (60%) had total scores above the 15th percentile, 15 (14.3%) had scores between the 5th and the 15th percentile, and 13 (12.4%) below the 5th percentile. The remaining 14 children (13.3%) refused to perform or to complete the test. The difference between preterm and control group was significant for total scores, Manual Dexterity and Aiming and Catching scores. In the preterm group there was a correlation between age at testing, total scores and Aiming and Catching subscores. The Movement ABC-2 subscores were significantly lower in children born below 29weeks. CONCLUSION: Perceptual-motor difficulties can already be detected on the assessment performed before the age of 4years. Prematurely born children assessed between 3years and 3years-3months appeared to have more difficulties in performing the test than the older ones or their age matched term-born peers. These findings support the possibility of a delayed maturation in the younger age group.


Gori, M., Tinelli, F., Sandini, G., Cioni, G. & Burr, D. (2012). Impaired visual size-discrimination in children with movement disorders,Neuropsychologia, 8 (50), 1838-1843. PDF

Multisensory integration of spatial information occurs late in childhood, at around eight years (Gori, Del Viva, Sandini, & Burr, 2008). For younger children, the haptic system dominates size discrimination and vision dominates orientation discrimination: the dominance may reflect sensory calibration, and could have direct consequences on children born with specific sensory disabilities. Here we measure thresholds for visual discrimination of orientation and size in children with movement disorders of upper limbs. Visual orientation discrimination was very similar to the age-matched typical children, but visual size discrimination thresholds were far worse, in all eight individuals with early-onset movement disorder. This surprising and counterintuitive result is readily explained by the cross-sensory calibration hypothesis: when the haptic sense is unavailable for manipulation, it cannot be readily used to estimate size, and hence to calibrate the visual experience of size: visual discrimination is subsequently impaired. This complements a previous study showing that non-sighted children have reduced acuity for haptic orientation, but not haptic size, discriminations (Gori, Sandini, Martinoli, & Burr, 2010). Together these studies show that when either vision or haptic manipulation is impaired, the impairment also impacts on complementary sensory systems that are calibrated by that one.


Tinelli, T., Cicchini, G.M., Arrighi, R., Tosetti, M., Cioni, G.,  Morrone M. C. (2012). Blindsight in children with congenital and acquired cerebral lesions, Cortex (published online 10 August 2012) PDF

It has been shown that unconscious visual function can survive lesions to optical radiations and/or primary visual cortex (V1), a phenomenon termed “blindsight”. Studies on animal models (cat and monkey) show that the age when the lesion occurs determines the extent of residual visual capacities. Much less is known about the functional and underlying neuronal repercussions of early cortical damage in humans. We measured sensitivity to several visual tasks in four children with congenital unilateral brain lesions that severely affected optic radiations, and in another group of three children with similar lesions, acquired in childhood. In two of the congenital patients, we measured blood oxygenation level dependent (BOLD) activity in response to stimulation of each visual field quadrants. Results show clear evidence of residual unconscious processing of position, orientation and motion of visual stimuli displayed in the scotoma of congenitally lesioned children, but not in the children with acquired lesions. The calcarine cortical BOLD responses were abnormally elicited by stimulation of the ipsilateral visual field and in the scotoma region, demonstrating a profound neuronal reorganization. In conclusion, our data suggest that congenital lesions can trigger massive reorganization of the visual system to alleviate functional effects of early brain insults.


Tinelli, F., Guzzetta, A., Bertini, C., Ricci, D., Mercuri, E., Ladavas, E., et al. (2011). Greater Sparing of Visual Search Abilities in Children After Congenital Rather Than Acquired Focal Brain Damage,Neurorehabil Neural Repair, PDF

BACKGROUND: Visual search refers to the capacity of an individual to find a target among simultaneously presented distracters and is based on visual abilities such as a fast visual processing and an accurate control of ballistic eye movements (saccades) that guide the fovea to the target location. OBJECTIVE: In adults, visual field defects caused by brain damage are often associated with visual search disorders; in children, little is known about the effects of early brain lesions on visual search abilities. METHODS: To test the presence of visual search defects and to investigate the role of cortical plasticity after early brain lesions, 29 children with congenital or acquired cerebral lesions, with and without visual field defects, underwent a visual search test battery. RESULTS: The children with acquired lesions and visual field defects had longer reaction times (RTs) in the contralesional visual field compared with the ipsilesional, whereas those with congenital lesions and visual field defects did not have differences in RTs between the contralateral and ipsilateral visual fields and had a visual search pattern similar to children without a visual field defect. CONCLUSIONS: These findings support the hypothesis of more effective mechanisms of functional compensation and reorganization of the visual system in children with very early brain lesions, as opposed to those with later damage.


Ricci, D., Cesarini, L., Gallini, F., Serrao, F., Leone, D., Baranello, G., et al. (2010). Cortical visual function in preterm infants in the first year,J Pediatr, 4 (156), 550-555. PDF

OBJECTIVE: To assess visual function in low-risk preterm infants at 3, 5, and 12 months corrected age to determine whether the maturation of visual function in the first year is similar to that reported in term-born infants. STUDY DESIGN: Seventy-five low-risk infants (25.0-30.9 weeks gestation) underwent ophthalmological examinations and a battery of tests (fix and follow, visual fields, acuity, attention at distance, and fixation shift) designed to assess various aspects of visual function at 3, 5, and 12 months corrected age. RESULTS: The results were comparable with normative data from term-born infants in all tests but fixation shift, suggesting that maturation of most aspects of visual function is not significantly affected by preterm birth. In contrast, >25% of preterm infants failed the fixation shift test at 3 months, with a higher percentage of failing at 5 and 12 months. CONCLUSIONS: There is a specific profile of early visual behavior in low-risk preterm infants, with a high percentage of infants failing a test that specifically assesses visual attention and provides a measure of cortical processing.

Guzzetta, A., D'Acunto, G., Rose, S., Tinelli, F., Boyd, R. & Cioni, G. (2010). Plasticity of the visual system after early brain damage,Dev Med Child Neurol, 10 (52), 891-900. PDF

The aim of this review is to discuss the existing evidence supporting different processes of visual brain plasticity after early damage, as opposed to damage that occurs during adulthood. There is initial evidence that some of the neuroplastic mechanisms adopted by the brain after early damage to the visual system are unavailable at a later stage. These are, for example, the ability to differentiate functional tissue within a larger dysplastic cortex during its formation, or to develop new thalamo-cortical connections able to bypass the lesion and reach their cortical destination in the occipital cortex. The young brain also uses the same mechanisms available at later stages of development but in a more efficient way. For example, in people with visual field defects of central origin, the anatomical expansion of the extrastriatal visual network is greater after an early lesion than after a later one, which results in more efficient mechanisms of visual exploration of the blind field. A similar mechanism is likely to support some of the differences found in people with blindsight, the phenomenon of unconscious visual perception in the blind field. In particular, compared with people with late lesions, those with early brain damage appear to have stronger subjective awareness of stimuli hitting the blind visual field, reported as a conscious feeling that something is present in the visual field. Expanding our knowledge of these mechanisms could help the development of early therapeutic interventions aimed at supporting and enhancing visual reorganization at a time of greatest potential brain plasticity.

Filippi, L., Cavallaro, G., Fiorini, P., Daniotti, M., Benedetti, V., Cristofori, G., et al. (2010). Study protocol: safety and efficacy of propranolol in newborns with Retinopathy of Prematurity (PROP-ROP): ISRCTN18523491,BMC Pediatr, (10), 83. PDF

BACKGROUND: Despite new therapeutic approaches have improved the prognosis of newborns with retinopathy of prematurity (ROP), an unfavourable structural and functional outcome still remains high. There is high pressure to develop new drugs to prevent and treat ROP. There is increasing enthusiasm for anti-VEGF drugs, but angiogenic inhibitors selective for abnormal blood vessels would be considered as an optimal treatment.In an animal experimental model of proliferative retinopathy, we have recently demonstrated that the pharmacological blockade of beta-adrenoreceptors improves retinal neovascularization and blood retinal barrier breakdown consequent to hypoxia. The purpose of this study is to evaluate the propranolol administration in preterm newborns suffering from a precocious phase of ROP in terms of safety and efficacy in counteracting the progression of retinopathy. METHODS/DESIGN: Preterm newborns (gestational age at birth lower than 32 weeks) with stage 2 ROP (zone II-III without plus) will be randomized, according to their gestational age, to receive propranolol added to standard treatment (treatment adopted by the ETROP Cooperative Group) or standard treatment alone. Propranolol will be administered until retinal vascularization will be completely developed, but not more than 90 days. Forty-four participants will be recruited into the study. To evaluate the safety of propranolol administration, cardiac and respiratory parameters will be continuously monitored. Blood samplings will be performed to check renal, liver and metabolic balance. To evaluate the efficacy of propranolol, the progression of the disease, the number of laser treatments or vitrectomies, the incidence of retinal detachment or blindness, will be evaluated by serial ophthalmologic examinations. Visual function will be evaluated by means of behavioural standardized tests. DISCUSSION: This pilot study is the first research that explores the possible therapeutic role of beta blockers in ROP. The objective of this research is highly ambitious: to find a treatment simple, inexpensive, well tolerated and with few adverse effects, able to counteract one of the major complications of the prematurity. Any favourable results of this research could open new perspectives and original scenarios about the treatment or the prevention of this and other proliferative retinopathies. TRIAL REGISTRATION: Current Controlled Trials ISRCTN18523491; ClinicalTrials.gov Identifier NCT01079715; EudraCT Number 2010-018737-21.


Guzzetta, A., Tinelli, F., Del Viva, M. M., Bancale, A., Arrighi, R., Pascale, R. R., et al. (2009). Motion perception in preterm children: role of prematurity and brain damage,Neuroreport, 15 (20), 1339-1343. PDF

We tested 26 school-aged children born preterm at a gestational age below 34 weeks, 13 with and 13 without periventricular brain damage, with four different visual stimuli assessing perception of pure global motion (optic flow), with some form information (segregated translational motion) and form-defined static stimuli. Results were compared with a group of age-matched healthy term-born controls. Preterm children with brain damage showed significantly lower sensitivities relative to full-term controls in all four tests, whereas those without brain damage were significantly worse than controls only for the pure motion stimuli. Furthermore, when form information was embedded in the stimulus, preterm children with brain lesions scored significantly worse than those without lesions. These results suggest that in preterm children dorsal stream-related functions are impaired irrespective of the presence of brain damage, whereas deficits of the ventral stream are more related to the presence of periventricular brain damage.


Morrone, M. C., Guzzetta, A., Tinelli, F., Tosetti, M., Del Viva, M., Montanaro, D., et al. (2008). Inversion of perceived direction of motion caused by spatial undersampling in two children with periventricular leukomalacia,J Cogn Neurosci, 6 (20), 1094-1106. PDF

We report here two cases of two young diplegic patients with cystic periventricular leukomalacia who systematically, and with high sensitivity, perceive translational motion of a random-dot display in the opposite direction. The apparent inversion was specific for translation motion: Rotation and expansion motion were perceived correctly, with normal sensitivity. It was also specific for random-dot patterns, not occurring with gratings. For the one patient that we were able to test extensively, contrast sensitivity for static stimuli was normal, but was very low for direction discrimination at high spatial frequencies and all temporal frequencies. His optokinetic nystagmus movements were normal but he was unable to track a single translating target, indicating a perceptual origin of the tracking deficit. The severe deficit for motion perception was also evident in the seminatural situation of a driving simulation video game. The perceptual deficit for translational motion was reinforced by functional magnetic resonance imaging studies. Translational motion elicited no response in the MT complex, although it did produce a strong response in many visual areas when contrasted with blank stimuli. However, radial and rotational motion produced a normal pattern of activation in a subregion of the MT complex. These data reinforce the existent evidence for independent cortical processing for translational, and circular or radial flow motion, and further suggest that the two systems have different vulnerability and plasticity to prenatal damage. They also highlight the complexity of visual motion perception, and how the delicate balance of neural activity can lead to paradoxical effects such as consistent misperception of the direction of motion. We advance a possible explanation of a reduced spatial sampling of the motion stimuli and report a simple model that simulates well the experimental results.

Guzzetta, F., Cioni, G., Mercuri, E., Fazzi, E., Biagioni, E., Veggiotti, P., et al. (2008). Neurodevelopmental evolution of West syndrome: a 2-year prospective study,Eur J Paediatr Neurol, 5 (12), 387-397. PDF

OBJECTIVE: The aim of this study was to evaluate the epileptic and developmental evolution in infants with West syndrome. METHODS: A prospective study of 21 infants was performed, with a follow-up at 2 years. Serial assessment included long-term EEG monitoring, visual and auditory evaluation and assessment of neurodevelopment. RESULTS: Neurosensory and developmental impairments at the spasm onset were transitory in seven cases, including four cryptogenic forms. In all other cases, there was a progressive worsening in neurosensory and developmental impairments. The epileptic evolution was generally better: in 11 of the 16 infants without seizures at outcome, spasms had already disappeared by 2 months after disease onset. Statistic analysis of results showed a correlation between neurosensory impairment and development throughout the whole follow-up. In addition, visual function at T1 resulted significant predictor of developmental outcome. Among the epileptic features, disorganization of slow sleep was an unfavorable prognostic factor. CONCLUSION: Some forms of West syndrome are confirmed to have a benign evolution: among them there are not only cryptogenic cases but also symptomatic ones without significant neurodevelopmental impairment. Abnormalities of sleep organization, expression of the pervasive epileptic disorder, seem to play a role in determining a developmental deterioration. Neurosensory impairment since the onset of the disease could be a relevant cause of the developmental disorder.

Tinelli, F., Pei, F., Guzzetta, A., Bancale, A., Mazzotti, S., Baldassi, S., et al. (2008). The assessment of visual acuity in children with periventricular damage: a comparison of behavioural and electrophysiological techniques,Vision Res, 10 (48), 1233-1241. PDF

It has been controversial whether electrophysiology offers better precision than behavioural techniques in measuring visual acuity in children with brain damage. We investigated the concordance between sweep VEPs and Acuity Cards (AC) in 29 children with periventricular leukomalacia (PVL), the most common type of brain damage in preterm infants. An overall good correlation was shown but with relatively better behavioural acuity values. VEP/AC ratio was significantly correlated to corpus callosum posterior thinning. We propose that this result reflects the efficacy of the compensatory mechanisms following early brain damage which may differentially affect the two methods.


Caputo, R., Tinelli, F., Bancale, A., Campa, L., Frosini, R., Guzzetta, A., et al. (2007). Motor coordination in children with congenital strabismus: effects of late surgery,Eur J Paediatr Neurol, 5 (11), 285-291. PDF

BACKGROUND: Strabismus is one of the most common visual disorders in infancy. While there is a great attention on the effects of the timing of surgery as to the development of binocular vision, little is known about the possible influence of congenital strabismus on perceptual-motor and more generally, on neuromotor development. AIMS: Aim of this study was to investigate perceptual-motor and motor coordination abilities of 19 children with essential congenital esotropia who underwent a late surgery (after 4 years), compared to 23 age-matched controls. METHODS: Children were tested using the Movement Assessment Battery for Children (Movement ABC) that were performed both 1-week before surgery (T1) and about 3 months (+/-2 weeks) after surgery (T2). RESULTS AND CONCLUSIONS: At T1, abnormal or borderline results were found in more than half of the children with strabismus, as opposed to only about 17% of the controls. At T2 none of the children showed abnormal Movement ABC total scores and there was no difference in global scores between the study and the control group. The two groups also did not show any significant difference in individual items of the movement ABC with the exception of those assessing ball skills. Our results suggest that surgical correction of strabismus, even when performed after the 4th year of life, appears to be effective in improving perceptual-motor and motor function.


Baranello, G., Rando, T., Bancale, A., D'Acunto, M. G., Epifanio, R., Frisone, M. F., et al. (2006). Auditory attention at the onset of West syndrome: correlation with EEG patterns and visual function,Brain Dev, 5 (28), 293-299. PDF

At the onset of West syndrome a specific impairment of visual function has been clearly demonstrated, while other aspects of sensorial development, and in particular of the auditory function, have been less studied. The aim of this study was to evaluate auditory function and orienting responses at the onset of West syndrome, and to relate the results with EEG patterns, visual function and neurodevelopmental competence. A prospective multicentric study was performed on 25 successively enrolled infants with West syndrome; all the patients underwent a full clinical assessment, including MRI and video-EEG, visual function and auditory orienting responses (AORs) as well as Griffiths' developmental scales. The whole assessment performed at the onset of spasms (T0) was repeated after two months (T1). AORs resulted significantly impaired both at T0 and T1. At the onset of spasms a highly significant relationship of auditory attention with visual function and neurodevelopmental competence was shown in both cryptogenic and symptomatic forms, but it was no longer present after two months. Our results may suggest a possible pervasive effect of the epileptic disorder on sensory processing, associated to a deficit of neurodevelopment. Although we failed to show a significant correlation between auditory orienting responses and EEG patterns, some evidence seems to support at least partially an influence of the epileptic disorder per se on the genesis of the sensorial impairment. A longer follow up and a larger cohort will be useful for a better clarification of these findings.

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