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

Functional Implications of Impaired Control of Submaximal Hip Flexion Following Stroke

Introduction: We quantified sub-maximal torque regulation during low to moderate intensity isometric hip flexion contractions in individuals with stroke and the associations with leg function. Methods: 10 participants with chronic stroke and 10 controls performed isometric hip flexion contractions at 5%, 10%, 15%, 20%, and 40% of maximal voluntary contraction (MVC) in paretic, non-paretic, and control legs. Results: Participants with stroke had larger torque fluctuations (coefficient of variation, CV), for both the paretic and non-paretic legs, than controls (Pr2 =0.45) and Berg Balance Score (r2=0.38). At 5% MVC, there were larger torque fluctuations in the contralateral leg during paretic contractions compared with the control leg. Conclusions: Impaired low-force regulation of paretic leg hip flexion can be functionally relevant and related to control versus strength deficits post stroke

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

Proceedings SIAMOC 2019

Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica, giunto quest'anno alla sua ventesima edizione, ritorna a Bologna, che già ospitò il terzo congresso nazionale nel 2002. Il legame tra Bologna e l'analisi del movimento è forte e radicato, e trova ampia linfa sia nel contesto accademico che nel ricco panorama di centri clinici d'eccellenza. Il congresso SIAMOC, come ogni anno, è l’occasione per tutti i professionisti dell’ambito clinico, metodologico ed industriale di incontrarsi, presentare le proprie ricerche e rimanere aggiornati sulle più recenti innovazioni nell’ambito dell’applicazione clinica dei metodi di analisi del movimento. Questo ha contribuito, in questi venti anni, a fare avanzare sensibilmente la ricerca italiana nel settore, conferendole un respiro ed un impatto internazionale, e a diffonderne l'applicazione clinica 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

Proceedings SIAMOC 2019

Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica, giunto quest'anno alla sua ventesima edizione, ritorna a Bologna, che già ospitò il terzo congresso nazionale nel 2002. Il legame tra Bologna e l'analisi del movimento è forte e radicato, e trova ampia linfa sia nel contesto accademico che nel ricco panorama di centri clinici d'eccellenza. Il congresso SIAMOC, come ogni anno, è l’occasione per tutti i professionisti dell’ambito clinico, metodologico ed industriale di incontrarsi, presentare le proprie ricerche e rimanere aggiornati sulle più recenti innovazioni nell’ambito dell’applicazione clinica dei metodi di analisi del movimento. Questo ha contribuito, in questi venti anni, a fare avanzare sensibilmente la ricerca italiana nel settore, conferendole un respiro ed un impatto internazionale, e a diffonderne l'applicazione clinica 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

Physical activity levels in individuals after stroke

L'augmentation du niveau d'activité physique, définie comme tout mouvement corporel volontaire nécessitant une dépense d'énergie, pourrait améliorer la fonction et la santé des personnes après un accident vasculaire cérébral (AVC). L’objectif général était d’analyser le niveau d’évidences des interventions visant à augmenter le niveau d'activité physique après un AVC et de comparer l’effets d’interventions. La première étude a proposé un protocole pour une revue systématique (PROSPERO 2016: CRD42016037750) des effets d’interventions sur les niveaux d'activité physique après un AVC. La deuxième étude a consisté en une revue systématique d'essais contrôlés randomisés qui ont examiné les interventions utilisées pour augmenter les niveaux d'activité physique après un AVC. Dix-huit études ont été incluses (bons scores PEDro et très bas scores GRADE). Dans sept études, les groupes expérimentaux (aérobique seulement, résistance et entraînement à domicile; conseils, aérobie, résistance et entraînement à domicile; stimulation électrique; entraînement aux tâches fonctionnelles; thérapie assistée par robot; rétroaction basée sur accéléromètre; et encouragement à réaliser de l’activité physique) ont montré une amélioration de l'activité physique. Cependant, le petit nombre d'études et l'hétérogénéité des interventions, des mesures de résultats et des résultats ont limité les conclusions. La troisième étude a décrit un protocole d'un essai contrôlé randomisé (ClinicalTrials.gov: NCT02798237) visant à déterminer l'efficacité de l'entraînement aérobique sur l'amélioration du niveau d'activité physique et du temps consacré aux activités à faible dépense énergétique après un AVC. La quatrième étude a comparé les effets de deux interventions (essai contrôlé randomisé) de marche sur le niveau d'activité physique, le temps consacré aux activités à faible consommation d'énergie, la condition cardiorespiratoire, la dépression, l’endurance, la mobilité, la participation et la qualité de vie. Vingt-deux adultes vivant dans la communauté après un AVC chronique ont été randomisé en deux groupes. Les participants du groupe expérimental ont suivi un entraînement aérobique sur tapis roulant de 40 minutes à 60-80% de sa fréquence cardiaque de réserve, trois jours/semaine pendant 12 semaines. Les participants du groupe contrôle ont reçu la même intervention mais en limitant l’effort à 40% de la fréquence cardiaque de réserve. Il n'y a pas eu de changements significatifs sur le niveau d'activité physique ou le temps consacré aux activités à faible consommation d'énergie. Seuls les participants du groupe expérimental ont amélioré leur qualité de vie améliorée (13 points; IC95%: 3,5-23 points). Les deux groupes ont amélioré la dépression (2,2 points; IC95%: 0,01-4,3 points), leur endurance (31-55 m; IC95%: 3,8-107 m) et leur mobilité (0,12 m/s; IC95% : 0,02-0,2 m/s). Il n'y a pas eu d'autres changements significatifs. Les résultats de cette thèse ont permis de démontrer l’insuffisance d’évidences pour recommander des interventions visant à augmenter les niveaux d'activité physique des individus après un AVC. Aussi, ils nous ont amené à conclure que d’autres études sont requises pour clarifier les avantages de l'entraînement aérobique sur l'activité physique et le temps consacré aux activités à faible consommation d'énergie.The increase of physical activity levels, defined as any voluntary bodily movement that requires energy expenditure, might improve function and health in individuals after stroke. The general objective of this thesis was to analyze the current level of evidence about interventions to increase physical activity level after stroke and to develop an experimental study that could provide evidence that could help clinical practice. The first study had the objective to describe a protocol for the development of a systematic review (PROSPERO 2016: CRD42016037750) about the effects of interventions on physical activity levels after stroke. The objective of second study was to develop a systematic review of randomized controlled trials that examined which interventions have been employed for increasing physical activity levels after stroke. Eighteen studies were included (good PEDro and very low GRADE-scores). In seven studies, the experimental groups (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation; functional-task training; robot-assisted therapy; accelerometer-based feedback, and physical activity encouragement) showed significant increases in physical activity. However, the small number of studies and the heterogeneity in the interventions, outcome measures, and results limit the conclusions. The third study had the objective to describe the protocol of a randomized controlled trial (ClinicalTrials.gov: NCT02798237) aimed to investigate if aerobic training is effective on improving physical activity levels and time spent in low-energy expenditure activities after stroke. The fourth study, a randomized controlled trial, aimed to investigate if aerobic training would improve physical activity levels and time spent in low-energy expenditure activities (primary outcomes), and cardiorespiratory fitness, depression, endurance, mobility, participation and quality of life (secondary outcomes) after stroke. Twenty-two community-dwelling adults with chronic stroke were randomized in two groups. The experimental group performed aerobic treadmill training at 60-80% of their heart rate reserve. The control group performed overground walking below 40% of heart rate reserve. Both groups received 40 minutes of intervention three days per week over 12-weeks. There were no significant changes on physical activity levels and time spent in low-energy expenditure activities. Compared to the controls, the experimental group showed increased quality of life (13 points; 95%CI: 3.5 to 23 points). Both groups improved depression (2.2 points; 95%CI: 0.01 to 4.3 points), endurance (31-55 m; 95%CI: 3.8 to 107 m), and mobility (0.12 m/s; 95%CI: 0.02 to 0.2 m/s). There were no other significant changes. The results of this thesis showed that the limited evidence currently available is insufficient to make a recommendation about interventions to increase physical activity levels of individuals after stroke. Further studies are needed to clarify the benefits of aerobic training on physical activity and time spent in low-energy expenditure activities.O aumento do nível de atividade física, definido como qualquer movimento corporal voluntário que requer gasto energético, pode melhorar a função e a saúde dos indivíduos após o acidente vascular encefálico (AVE). O objetivo geral dessa tese foi analisar o estado atual das evidências sobre intervenções com o objetivo de aumentar o nível de atividade física pós-AVE e desenvolver um estudo experimental que forneça evidências que possam auxiliar a prática clínica. O primeiro estudo teve como objetivo descrever um protocolo de uma revisão sistemática (PROSPERO 2016: CRD42016037750) sobre os efeitos de intervenções no nível de atividade física pós-AVE. O objetivo do segundo estudo foi realizar uma revisão sistemática de ensaios clínicos randomizados que examinaram quais intervenções foram empregadas para aumentar o nível de atividade física pós-AVE. Dezoito estudos foram incluídos (escores PEDro bons e GRADE muito baixo). Em sete estudos, os grupos experimentais (fortalecimento, exercícios aeróbios e domiciliares; aconselhamento, fortalecimento, exercícios aeróbios e domiciliares; estimulação elétrica; treino específico da tarefa; terapia robótica; feedback baseado em acelerômetro; e encorajamento à atividade física) mostraram aumento do nível de atividade física. Entretanto, o número limitado de estudos e a heterogeneidade das intervenções, dos desfechos mensurados e dos resultados limitam as conclusões. O terceiro estudo teve como objetivo descrever o protocolo de um ensaio clínico randomizado (ClinicalTrials.gov: NCT02798237) para investigar a eficácia do treinamento aeróbio na melhora do nível de atividade física e do tempo gasto em atividades de baixo consumo energético pós-AVE. O quarto estudo, um ensaio clínico randomizado, teve como objetivo investigar se o treinamento aeróbio melhora o nível de atividade física e o tempo gasto em atividades de baixo consumo energético (desfechos primários), a aptidão cardiorrespiratória, a depressão, a capacidade de caminhada, a mobilidade, a participação e a qualidade de vida (desfechos secundários) pós-AVE. Vinte e dois adultos residentes na comunidade pós-AVE crônico foram randomizados em dois grupos. O grupo experimental realizou treinamento aeróbio em esteira a 60-80% da frequência cardíaca de reserva. O grupo controle realizou caminhada no solo com intensidade inferior a 40% da frequência cardíaca de reserva. Ambos os grupos receberam 40 minutos de intervenção três dias por semana durante 12 semanas. Não houve diferença estatisticamente significativa no nível de atividade física e no tempo gasto em atividades de baixo consumo energético. Comparado ao grupo controle, o grupo experimental apresentou aumento da qualidade de vida (13 pontos; IC95%: 3,5-23 pontos). Ambos os grupos melhoraram a depressão (2,2 pontos; IC95%: 0,01-4,3 pontos), a capacidade de caminhada (31-55 m; IC95%: 3,8-107m) e a mobilidade (0,12 m/s; IC95%: 0,02-0,2 m/s). Não houve outras alterações significativas. Os resultados desta tese mostram que a evidência limitada disponível atualmente é insuficiente para fazer uma recomendação sobre intervenções para aumentar o nível de atividade física dos indivíduos pós-AVE. Ensaios clínicos futuros são necessários para determinar os benefícios do treinamento aeróbio no nível de atividade física e no tempo gasto em atividades de baixo consumo energético

Clinical Decision Support Systems with Game-based Environments, Monitoring Symptoms of Parkinson’s Disease with Exergames

Parkinson’s Disease (PD) is a malady caused by progressive neuronal degeneration, deriving in several physical and cognitive symptoms that worsen with time. Like many other chronic diseases, it requires constant monitoring to perform medication and therapeutic adjustments. This is due to the significant variability in PD symptomatology and progress between patients. At the moment, this monitoring requires substantial participation from caregivers and numerous clinic visits. Personal diaries and questionnaires are used as data sources for medication and therapeutic adjustments. The subjectivity in these data sources leads to suboptimal clinical decisions. Therefore, more objective data sources are required to better monitor the progress of individual PD patients. A potential contribution towards more objective monitoring of PD is clinical decision support systems. These systems employ sensors and classification techniques to provide caregivers with objective information for their decision-making. This leads to more objective assessments of patient improvement or deterioration, resulting in better adjusted medication and therapeutic plans. Hereby, the need to encourage patients to actively and regularly provide data for remote monitoring remains a significant challenge. To address this challenge, the goal of this thesis is to combine clinical decision support systems with game-based environments. More specifically, serious games in the form of exergames, active video games that involve physical exercise, shall be used to deliver objective data for PD monitoring and therapy. Exergames increase engagement while combining physical and cognitive tasks. This combination, known as dual-tasking, has been proven to improve rehabilitation outcomes in PD: recent randomized clinical trials on exergame-based rehabilitation in PD show improvements in clinical outcomes that are equal or superior to those of traditional rehabilitation. In this thesis, we present an exergame-based clinical decision support system model to monitor symptoms of PD. This model provides both objective information on PD symptoms and an engaging environment for the patients. The model is elaborated, prototypically implemented and validated in the context of two of the most prominent symptoms of PD: (1) balance and gait, as well as (2) hand tremor and slowness of movement (bradykinesia). While balance and gait affections increase the risk of falling, hand tremors and bradykinesia affect hand dexterity. We employ Wii Balance Boards and Leap Motion sensors, and digitalize aspects of current clinical standards used to assess PD symptoms. In addition, we present two dual-tasking exergames: PDDanceCity for balance and gait, and PDPuzzleTable for tremor and bradykinesia. We evaluate the capability of our system for assessing the risk of falling and the severity of tremor in comparison with clinical standards. We also explore the statistical significance and effect size of the data we collect from PD patients and healthy controls. We demonstrate that the presented approach can predict an increased risk of falling and estimate tremor severity. Also, the target population shows a good acceptance of PDDanceCity and PDPuzzleTable. In summary, our results indicate a clear feasibility to implement this system for PD. Nevertheless, long-term randomized clinical trials are required to evaluate the potential of PDDanceCity and PDPuzzleTable for physical and cognitive rehabilitation effects

Body sensor networks: smart monitoring solutions after reconstructive surgery

Advances in reconstructive surgery are providing treatment options in the face of major trauma and cancer. Body Sensor Networks (BSN) have the potential to offer smart solutions to a range of clinical challenges. The aim of this thesis was to review the current state of the art devices, then develop and apply bespoke technologies developed by the Hamlyn Centre BSN engineering team supported by the EPSRC ESPRIT programme to deliver post-operative monitoring options for patients undergoing reconstructive surgery. A wireless optical sensor was developed to provide a continuous monitoring solution for free tissue transplants (free flaps). By recording backscattered light from 2 different source wavelengths, we were able to estimate the oxygenation of the superficial microvasculature. In a custom-made upper limb pressure cuff model, forearm deoxygenation measured by our sensor and gold standard equipment showed strong correlations, with incremental reductions in response to increased cuff inflation durations. Such a device might allow early detection of flap failure, optimising the likelihood of flap salvage. An ear-worn activity recognition sensor was utilised to provide a platform capable of facilitating objective assessment of functional mobility. This work evolved from an initial feasibility study in a knee replacement cohort, to a larger clinical trial designed to establish a novel mobility score in patients recovering from open tibial fractures (OTF). The Hamlyn Mobility Score (HMS) assesses mobility over 3 activities of daily living: walking, stair climbing, and standing from a chair. Sensor-derived parameters including variation in both temporal and force aspects of gait were validated to measure differences in performance in line with fracture severity, which also matched questionnaire-based assessments. Monitoring the OTF cohort over 12 months with the HMS allowed functional recovery to be profiled in great detail. Further, a novel finding of continued improvements in walking quality after a plateau in walking quantity was demonstrated objectively. The methods described in this thesis provide an opportunity to revamp the recovery paradigm through continuous, objective patient monitoring along with self-directed, personalised rehabilitation strategies, which has the potential to improve both the quality and cost-effectiveness of reconstructive surgery services.Open Acces