Objective and automatic classification of Parkinson disease with Leap Motion controller

Background: The main objective of this paper is to develop and test the ability of the Leap Motion controller (LMC) to assess the motor dysfunction in patients with Parkinson disease (PwPD) based on the MDS-UPDRSIII exercises. Four exercises (thumb forefinger tapping, hand opening/closing, pronation/supination, postural tremor) were used to evaluate the characteristics described in MDS-UPDRSIII. Clinical ratings according to the MDS/UPDRS-section III items were used as target. For that purpose, 16 participants with PD and 12 healthy people were recruited in Ospedale Cisanello, Pisa, Italy. The participants performed standardized hand movements with camera-based marker. Time and frequency domain features related to velocity, angle, amplitude, and frequency were derived from the LMC data. Results: Different machine learning techniques were used to classify the PD and healthy subjects by comparing the subjective scale given by neurologists against the predicted diagnosis from the machine learning classifiers. Feature selection methods were used to choose the most significant features. Logistic regression (LR), naive Bayes (NB), and support vector machine (SVM) were trained with tenfold cross validation with selected features. The maximum obtained classification accuracy with LR was 70.37%; the average area under the ROC curve (AUC) was 0.831. The obtained classification accuracy with NB was 81.4%, with AUC of 0.811. The obtained classification accuracy with SVM was 74.07%, with AUC of 0.675. Conclusions: Results revealed that the system did not return clinically meaningful data for measuring postural tremor in PwPD. In addition, it showed limited potential to measure the forearm pronation/supination. In contrast, for finger tapping and hand opening/closing, the derived parameters showed statistical and clinical significance. Future studies should continue to validate the LMC as updated versions of the software are developed. The obtained results support the fact that most of the set of selected features contributed significantly to classify the PwPD and healthy subjects

A Force-Feedback Exoskeleton for Upper-Limb Rehabilitation in Virtual Reality

This paper presents the design and the clinical validation of an upper-limb force-feedback exoskeleton, the L-EXOS, for robotic-assisted rehabilitation in virtual reality (VR). The L-EXOS is a five degrees of freedom exoskeleton with a wearable structure and anthropomorphic workspace that can cover the full range of motion of human arm. A specific VR application focused on the reaching task was developed and evaluated on a group of eight post-stroke patients, to assess the efficacy of the system for the rehabilitation of upper limb. The evaluation showed a significant reduction of the performance error in the reaching task (paired t-test, p < 0.02

Percutaneous Venous Angioplasty in Patients With Multiple Sclerosis And Chronic Cerebrospinal Venous Insufficiency: A Randomized Wait List Control Study

Objectives: Venous percutaneous transluminal angioplasty (vPTA) in patients with multiple sclerosis (MS) and chronic cerebrospinal venous insufficiency (CCSVI) have shown contradictory results. Aim of the study is to evaluate the efficacy of the procedure in a randomized wait list control study. Materials: 66 adults with neurologist-confirmed diagnosis of MS and sonographic diagnosis of CCSVI were allocated in to vPTA-yes group (n=31) or vPTA-not group (n=35, control group). Venous PTA was performed immediately 15 days after randomization in PTA-yes group and 6 months later in the control group. Methods: Evoked potentials (EPs), clinical-functional measures (CFM) and upper limb kinematic measures (ULKM) were measured at baseline (T0) and six months after in both groups, just before the venous angioplasty in vPTA-not group (T1). Results: Comparing vPTA-yes and vPTA-not group, the CFM derived composite functional outcome showed 11(37%) versus 7(20%) improved, 1(3%) versus 3(8%) stable, 0 versus 7(20%) worsened and 19(61%) versus 18(51%) mixed patients (\u3c72=8.71, df=3, p=0.03). Unadjusted and adjusted (for baseline confounding variables) OR at 95% confident interval (95%CI) were respectively 1.93(1.3-2.8) P-value 0.0007 and 1.85(1.2-1.7) P-value 0.002. EPs and ULKM derived composite functional outcome showed no significant difference between the two groups. Conclusions: Venous angioplasty can positively impact a few CFM especially for the quality of life, but achieving disability improvement is unlikel

The cerebellum monitors errors and entrains executive networks

: Frontal midline θ (Fmθ) activity occurs in medial prefrontal cortices (mPFC), when expected and actual outcomes conflict. Cerebellar forward models could inform the mPFC about this mismatch. To verify this hypothesis we correlated the mPFC activation during a visuomotor tracking task (VM) with performance accuracy, in control and cerebellum-lesioned participants. Additionally, purely visual (V), motor (M) and a motor plus visual tasks (V&nbsp;+&nbsp;M) were performed. An Independent Component, with a mid-frontal topography scalp map and equivalent dipole location in the dorsal anterior cingulate cortex accounted for Fmθ. In control participants Fmθ power increased during VM, when the error level crossed a threshold, but not during V&nbsp;+&nbsp;M, M and V. This increase scaled with tracking error. Fmθ power failed to increase during VM in cerebellar participants, even at highest tracking errors. Thus, in control participants, activation of mPFC is induced when a continuous monitoring effort for online error detection is required. The presence of a threshold error for enhancing Fmθ, suggests the switch from an automatic to an executive tracking control, which recruits the mPFC. Given that the cerebellum stores forward models, the absence of Fmθ increases during tracking errors in cerebellar participants indicates that cerebellum is necessary for supplying the mPFC with prediction error-related information. This occurs when automatic control falters, and a deliberate correction mechanism needs to be triggered. Further studies are needed to verify if this alerting function also occurs in the context of the other cognitive and non-cognitive functions in which the cerebellum is involved

LA PAROLA È FEMMINA: IL VANTAGGIO LINGUISTICO DELLE DONNE DOPO UN ICTUS CEREBRALE

Si riportano gli effetti del genere sul recupero della capacità fasiche dopo ictu

VALUTAZIONE DELL’ASSETTO ORMONALE IN UN CAMPIONE DI PAZIENTI CON TRAUMA CRANIO-ENCEFALICO ED EMORRAGIA SUBARACNOIDEA: STUDIO RETROSPETTIVO.

si descrive una casistica di pazienti con grave cerebrolesione acquisita in cui è stato valutato l'assetto ormonale neuroipofisari

Randomized clinical trial on single zirconia crowns with feather-edge vs chamfer finish lines: Four-year results

The objective of this study was to evaluate the influence of two finish lines on the fracture resistance and periodontal response of porcelain zirconia crowns. Ethical committee approval was obtained, and 50 zirconia single crowns were placed in posterior regions. Abutments were randomly distributed into two groups: Group 1 (feather-edge preparation) and Group 2 (chamfer preparation). Patients were recalled after 1 month, 6 months, and 1, 2, 3, and 4 years. The function, esthetics, and marginal adaptation of the restorations were evaluated. Bleeding on probing (BoP) and distance of margins from the bone crest were recorded. Statistical analyses were performed for survival and success rates. Group 1 had an 80% success rate (21/25 crowns) and a 96% survival rate (24/25 crowns; 1 encountered irreparable fracture of ceramic layer); Group 2 had a 76% success rate (20/25 crowns) and a 100% survival rate (25/25 crowns). Chippings were noticed on 4 crowns in Group 1 (one crown replacement). Five chippings occurred in Group 2, without any replacement. There were no statistically significant differences between the two groups. BoP was found in 18 of the 25 crowns in Group 1 (72%) and in 12 of the 25 crowns in Group 2 (48%). A statistically significant correlation between BoP and the distance of the margin to the bone crest was found. It was concluded that: (1) clinical survival and success rates of the two preparation methods on crowns are not significantly different; (2) due to the statistically significant correlation between BoP and the distance of the margin to the bone crest, margins should be placed at least 3 mm from the bone crest; and (3) higher probability of BoP is expected in cases with feather-edge preparation

Spontaneous blinking behaviour in persistent vegetative and minimally conscious states: Relationships with evolution and outcome.

Abstract There is evidence that spontaneous blinking correlates with cognitive functions. This arises from the observation that blinking rate (BR) is modulated by arousal levels, basic cognitive processes (e.g., attention, information processing, memory, etc.) and more complex cognitive functions (e.g., reading, speaking, etc.). The aim of this work was to test the role of BR evaluation in the assessment of cognitive network functioning in awake patients with consciousness deficits. Thirteen patients were recruited for the study, and were assessed by the Glasgow coma scale (GCS) and Glasgow outcome scale (GOS) on admittance and discharge, respectively. A level of cognitive functioning scale (LCFS) score was assigned at every change in awareness or at least every 2 weeks. At the same time as the clinical tests, the BR was observed for a 5-min period. Ten healthy subjects, observed throughout three non-consecutive days, formed the control group. The BR underwent a different temporal behaviour in the two diagnostic categories. In the persistent vegetative state (PVS) group it remained stable throughout time and linked with the clinical conditions of the patients; whereas in the non-persistent vegetative state (NPVS) group it decreased over time as the cognitive conditions improved. Moreover, a strong inverse correlation was found between overall BR values and LCFS scores. We have concluded that the blinking behaviour changes manifested in PVS and NPVS patients reflect different evolution phases of a cholinergic-dopaminergic imbalance, and that a reduced BR characterizes the early stages of consciousness recovery