The Use of Functional Electrical Stimulation on the Upper Limb and Interscapular Muscles of Patients with Stroke for the Improvement of Reaching Movements: A Feasibility Study

Introduction: Reaching movements in stroke patients are characterized by decreased amplitudes at the shoulder and elbow joints and greater displacements of the trunk, compared to healthy subjects. The importance of an appropriate and specific contraction of the interscapular and upper limb (UL) muscles is crucial to achieving proper reaching movements. Functional electrical stimulation (FES) is used to activate the paretic muscles using short-duration electrical pulses. Objective: To evaluate whether the application of FES in the UL and interscapular muscles of stroke patients with motor impairments of the UL modifies patients’ reaching patterns, measured using instrumental movement analysis systems. Design: A cross-sectional study was carried out. Setting: The VICON Motion System® was used to conduct motion analysis. Participants: Twenty-one patients with chronic stroke. Intervention: The Compex® electric stimulator was used to provide muscle stimulation during two conditions: a placebo condition and a FES condition. Main outcome measures: We analyzed the joint kinematics (trunk, shoulder, and elbow) from the starting position until the affected hand reached the glass. Results: Participants receiving FES carried out the movement with less trunk flexion, while shoulder flexion elbow extension was increased, compared to placebo conditions. Conclusion: The application of FES to the UL and interscapular muscles of stroke patients with motor impairment of the UL has improved reaching movements.This research has been supported by Spanish Ministry of Science project HYPER PROJECT (CONSOLIDER-INGENIO 2010) Hybrid Neuroprosthetic and Neurorobotic Devices for Functional Compensation and Rehabilitation of Motor Disorders. HYPER-CSD2009-00067

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy

Biomechanics

Biomechanics is a vast discipline within the field of Biomedical Engineering. It explores the underlying mechanics of how biological and physiological systems move. It encompasses important clinical applications to address questions related to medicine using engineering mechanics principles. Biomechanics includes interdisciplinary concepts from engineers, physicians, therapists, biologists, physicists, and mathematicians. Through their collaborative efforts, biomechanics research is ever changing and expanding, explaining new mechanisms and principles for dynamic human systems. Biomechanics is used to describe how the human body moves, walks, and breathes, in addition to how it responds to injury and rehabilitation. Advanced biomechanical modeling methods, such as inverse dynamics, finite element analysis, and musculoskeletal modeling are used to simulate and investigate human situations in regard to movement and injury. Biomechanical technologies are progressing to answer contemporary medical questions. The future of biomechanics is dependent on interdisciplinary research efforts and the education of tomorrow’s scientists

Proceedings XXIII Congresso SIAMOC 2023

Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica (SIAMOC), giunto quest’anno alla sua ventitreesima edizione, approda nuovamente a Roma. Il congresso SIAMOC, come ogni anno, è l’occasione per tutti i professionisti che operano nell’ambito dell’analisi del movimento di incontrarsi, presentare i risultati delle proprie ricerche e rimanere aggiornati sulle più recenti innovazioni riguardanti le procedure e le tecnologie per l’analisi del movimento nella pratica clinica. Il congresso SIAMOC 2023 di Roma si propone l’obiettivo di fornire ulteriore impulso ad una già eccellente attività di ricerca italiana nel settore dell’analisi del movimento e di conferirle ulteriore respiro ed impatto internazionale. Oltre ai qualificanti temi tradizionali che riguardano la ricerca di base e applicata in ambito clinico e sportivo, il congresso SIAMOC 2023 intende approfondire ulteriori tematiche di particolare interesse scientifico e di impatto sulla società. Tra questi temi anche quello dell’inserimento lavorativo di persone affette da disabilità anche grazie alla diffusione esponenziale in ambito clinico-occupazionale delle tecnologie robotiche collaborative e quello della protesica innovativa a supporto delle persone con amputazione. Verrà infine affrontato il tema dei nuovi algoritmi di intelligenza artificiale per l’ottimizzazione della classificazione in tempo reale dei pattern motori nei vari campi di applicazione

Neurological Assessment of Infants with Cerebral Arterial Ischaemic Stroke

ABSTRACT Arterial Ischaemic Stroke (AIS) occurs in approximately 0.25% of full term infants and around 1% of preterm infants. Up to 60% of perinatal strokes results in neurological deficits, with hemiplegic cerebral palsy (HCP) being a frequent adverse motor outcome. This is a lifelong condition that affects the daily living and the quality of life of these children and their families and often it is diagnosed only after the first year of life or even later, when significant asymmetries in upper extremity function and motor skill development are obvious. This is in contrast to adults who have a stroke who are identified with hemiparesis days not years after the brain injury. Motor outcomes in neonates with stroke are largely dependent on the location of the injury. The most common presenting feature of neonatal term infants with AIS is seizure and other common presentations include encephalopathy, apnea, tone abnormalities as well as persistent respiratory and feeding difficulties. Physical disability can range from minimal (e.g. weakness in one hand without discernible effects on activities of daily living) to profound (e.g. permanently restricted to a wheelchair and unable to eat or speak independently requiring 24h care). Today’s neuroimaging techniques such as ultrasound, computed tomography and magnetic resonance imaging, provide the possibility to identify brain lesions that may cause hemiplegia. Together with the classical neurological examination, these tools give us the possibility to perform prospective studies of the neurological development of these infants. What is still missing is a method that could help us for an early diagnosis of future neurological disabilities. There is actually no proof that early intervention could prevent the development of cerebral palsy in these infants, but it could help prevent secondary defects such as contractures and other forms of immobility, improving their future life. Many studies have confirmed that Prechtl’s Method of Qualitative Assessment of General Movements of infants is one of the most powerful predictive tools that we have. The General Movements Assessment (GMA) is a non-intrusive, reliable, quick and cost-effective method of functional assessment of the young nervous system developed by Heinz Prechtl and his colleagues of the Department of Developmental Neurology in Groningen (The Netherlands). This assessment is based on the observation of video-recordings showing the child during his spontaneous motility, with nobody neither touching nor stimulating him. By observation we could be able to distinguish between normal and abnormal general movements. Normal General Movements are gross movements involving the whole body; they may last from a few second to several minutes or longer. What is particular about them is the variable sequence of arm, leg, neck and trunk movements. They wax and wane in intensity, force and speed and they also have a gradual beginning and end. The majority of sequences of extension and flection movements of arms and legs is complex, with superimposed rotations and frequent slight changes in the direction of the movement. These additional components make the movement fluent and elegant and create the impression of complexity and variability. Abnormal General Movements are movements lacking complexity, variability and fluency. They could be poor in their quality, or cramped synchronised or even chaotic. These features can be related to some neurological deficits, which can range from cerebral palsy to mild neurological disabilities. Previous studies highlighted the important predictive power of Fidgety movements, which emerge around 6-9 weeks of post-term age. Fidgety movements are small movements of moderate speed and variable acceleration of neck, trunk and limbs, in all directions, continual in the awake infant, except during focused attention, fussing and crying. They may be seen as early as 6 weeks but usually occur around 9 weeks and are present until 20 weeks or even a few weeks longer, at which time intentional, goal directed, and antigravity movements occur and start to dominate. The absence of fidgety movements is highly predictive for later neurological impairments, particularly for cerebral palsy, both the spastic and dyskinetic forms. General movements can be observed also in fetuses as young as nine weeks postmenstrual age (age of the fetus or infant calculated from the date of the mother’s last period), that is why this method can be of a real support for an early diagnosis. In our study we tried to use this method on a population of 22 full-term infants, 6 were healthy infants, while 16 have been diagnosed with perinatal arterial ischaemic stroke. The aim of this study was to confirm the predictive value of the qualitative assessment of spontaneous motor activity, together with the evaluation of the Motor Repertoire and the assessment of asymmetries in various body parts. We wanted to analyse to what extent the long-term neurological outcome of infants diagnosed with neonatal stroke is related to their motor performance at age 3 to 5 months; to confirm the predictive power of the quality of fidgety movements and the significant correlation between asymmetry of segmental movements and the presence of later hemiplegia in infants with neonatal stroke; to find a correlation between severe neurological outcome and asymmetry in hand movements, kicking, trunk bending and foot-foot contact and to confirm or reject the theory of the silent period that would prevent an early diagnosis of unilateral CP

Mirror (a)symmetry? Visuo-proprioceptive interactions in individuals with spastic hemiparetic cerebral palsy

The work presented in this thesis aimed to get more insight into the previously reported positive effects of mirror visual feedback in children with spastic hemiparetic cerebral palsy (SHCP) and into visuo-proprioceptive interactions in children and adolescents with SHCP during goal-directed matching tasks. Individuals with SHCP have unilateral motor impairments that hamper them in accurate movement performance. In conjunction with the motor problems, these individuals experience sensory problems. The first study in this thesis (chapter two) found that mirror visual feedback of the impaired arm in SHCP led to significantly higher levels of neuromuscular activity than mirror visual feedback of the less-impaired arm. This indicates that the mirror-effect was not just caused by the illusory perception of symmetry between two limbs, and confirmed that the beneficial effect is dependent on mirror visual feedback of the less-impaired arm. In chapter three and four it was demonstrated that the ability of children with SCHP to match one (matching) hand with the position of the other (reference) hand, without visual information, is deteriorated when compared to typically developing children. However, if visual information of the static reference arm was available to the participants, the matching accuracy of the matching hand was significantly higher. Mirror visual feedback of the reference arm, generated by placing a mirror in between the arms in the sagittal plane, created the illusion that both hands were already at the endpoint. However, this did not impact upon the matching accuracy of the matching arm and resulted in similar error scores as regular feedback of the reference arm. Chapter five showed that moving the less-impaired arm in synchrony with the impaired arm resulted in higher matching accuracy than moving the impaired arm alone. Moreover, mirror visual feedback of the less-impaired arm improved matching accuracy for a subset of the participants. The effects of a short practice of a bimanual matching task with (mirror) visual feedback of the less-impaired arm on matching accuracy of the impaired arm was studied in chapter six. The results showed a higher matching accuracy of the impaired arm after the practice period. However, the role of the mirror is still inconclusive in this respect. From this it can be concluded that for individuals with SHCP practice of a matching movement can induce a transfer from visual to proprioceptive control of movement. Taken together, the work in this thesis showed that the deficit in position sense of the impaired arm in individuals with SHCP can be modified by visual feedback of the less-impaired arm. Although the role of mirror visual feedback is still inconclusive, it seems that motor learning can induce a transfer from visual to proprioceptive control of movement, which can have implications for therapy

Assessment of an automatic prosthetic elbow control strategy using residual limb motion for transhumeral amputated individuals with socket or osseointegrated prostheses

International audienceMost transhumeral amputated individuals deplore the lack of functionality of their prosthesis due to control-related limitations. Commercialized prosthetic elbows are controlled via myoelectric signals, yielding complex control schemes when users have to control an entire prosthetic limb. Limited control yields the development of compensatory strategies. An alternative control strategy associates residual limb motions to automatize the prosthetic elbow motion using a model of physiological shoulder/elbow synergies. Preliminary studies have shown that elbow motion could be predicted from residual limb kinematic measurements, but results with transhumeral amputated individuals were lacking. This study focuses on the experimental assessment of automatic prosthetic elbow control during a reaching task, compared to conventional myoelectric control, with six transhumeral amputated individuals, among whom, three had an osseointegrated device. Part of the recruited participants had an osseointegrated prosthetic device. The task was achieved within physiological precision errors with both control modes. Automatic elbow control reduced trunk compensations, and restored a physiologically-like shoulder/elbow movement synchronization. However, the kinematic assessment showed that amputation and prosthesis wear modifies the shoulder movements in comparison with physiological shoulder kinematics. Overall, participants described the automatic elbow control strategy as intuitive, and this work highlights the interest of automatized prosthetic elbow motion

Proceedings XXII Congresso SIAMOC 2022

Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica dà l’occasione a tutti i professionisti, dell’ambito clinico e ingegneristico, di incontrarsi, presentare le proprie ricerche e rimanere aggiornati sulle più recenti innovazioni nell’ambito dell’applicazione clinica dei metodi di analisi del movimento, al fine di promuoverne lo studio e le applicazioni cliniche per migliorare la valutazione dei disordini motori, aumentare l’efficacia dei trattamenti attraverso l’analisi quantitativa dei dati e una più focalizzata pianificazione dei trattamenti, ed inoltre per quantificare i risultati delle terapie correnti

Mirror (a)symmetry?: Visuo-proprioceptive interactions in individuals with Spastic Hemiparetic Cerebral Palsy

Savelsbergh, G.J.P. [Promotor]Ledebt, A. [Copromotor]Deconinck, F.J.A. [Copromotor