A Service Robot for Navigation Assistance and Physical Rehabilitation of Seniors

The population of the advanced countries is ageing, with the direct consequence that an increasing number of people will have to live with sensitive, cognitive and physical disabilities. People with impaired physical ability are not confident to move alone, especially in crowded environment and for long journeys, highly reducing the quality of their life. We propose a new generation of robotic walking assistants whose mechanical and electronic components are conceived to optimize the collaboration between the robot and its users. We will apply these general ideas to investigate the interaction between older adults and a robotic walker, named FriWalk, exploiting it either as a navigational or as a rehabilitation aid. For the use of the FriWalk as a navigation assistance, the system guides the user securing high levels of safety, a perfect compliance with the social rules and non-intrusive interaction between human and machine. To this purpose, we developed several guidance systems ranging from completely passive strategies to active solutions exploiting either the rear or the front motors mounted on the robot. The common strategy at the basis of all the algorithms is that the responsibility of the locomotion belongs always to the user, both to increase the mobility of elder users and to enhance their perception of control over the robot. This way the robot intervenes only whenever it is strictly necessary not to mitigate the user safety. Moreover, the robotic walker has been endowed with a tablet and graphical user interface (GUI) which provides the user with the visual indications about the path to follow. Since the FriWalk was developed to suit the needs of users with different deficits, we conducted extensive human-robot interaction (HRI) experiments with elders, complemented with direct interviews of the participants. As concerns the use of the FriWalk as a rehabilitation aid, force sensing to estimate the torques applied by the user and change the user perceived inertia can be exploited by doctors to let the user feel the device heavier or lighter. Moreover, thanks to a new generation of sensors, the device can be exploited in a clinical context to track the performance of the users' rehabilitation exercises, in order to assist nurses and doctors during the hospitalization of older adults

Post-operative acute urinary retention after greenlight laser. Analysis of risk factors from a multicentric database

Purpose: Greenlight laser is a mini-invasive technique used to treat Benign Prostatic Obstruction (BPO). Some of the advantages of GreenLight photoselective vaporization (PVP) are shorter catheterization time and hospital stay compared to TURP. Post-operative acute urinary retention (pAUR) leads to patients' discomfort, prolonged hospital stay and increased health care costs. We analyzed risk factors for urinary retention after GreenLight laser PVP. Materials and methods: In a multicenter experience, we retrospectively analyzed the onset of early and late post-operative acute urinary retention in patients undergoing standard or anatomical PVP. The pre-, intra- and post-operative characteristics were compared betweene patients who started to void and the patients who developed post-operative urinary retention. Results: The study included 434 patients suitable for the study. Post-operative acute urinary retention occurred in 39 (9%). Patients with a lower prostate volume (P < .001), an adenoma volume lower than 40 mL (P < .001), and lower lasing time (P = .013) had a higher probability to develop pAUR at the univariate analysis. The multivariate logistic regression confirmed that lower lasing time (95% CI: 0.86-0.99, OR = 0.93, P = .046) and adenoma volume (95% CI: 0.89-0.98, OR = 0.94, P = .006) are correlated to pAUR. Furthermore IPSS ≥ 19 (95% CI: 1.19- 10.75, OR = 2.27, P = .023) and treatment with 5-ARI (95% CI: 1.05-15.03, OR = 3.98, P = .042) are risk factors for pAUR. Conclusion: In our series, post-operative acute urinary retention was related to low adenoma volume and lasing time, pre-operative IPSS ≥ 19 and 5-ARI intake. These data should be considered in deciding the best timing for urethral catheters removal

Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

OBJECTIVE: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. METHODS: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 ((125)I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. (125)I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. RESULTS: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. CONCLUSION: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. ADVANCES IN KNOWLEDGE: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome

Assistive robotic walker parameter identification for estimation of human thrust without force sensors

In this paper we propose a parameter identification procedure for the wheel-motor dynamic of a robotic walker, i.e. a commercial trolley for elderly people endowed with cognitive, sensing and guidance capabilities. The objective of the wheel-motor dynamic model is to generate a suitable time reference to be used in an estimation algorithm. The ultimate goal of the estimation algorithm is to retrieve the thrust, i.e.Torque and force, that the older adult user of the robotic walker applies to the platform. These quantities are of paramount importance in order to adopt intelligent and comfortable walker guidance algorithms. The novelty of this approach is the avoidance of additional costly sensors that are usually used to solve such a problem. Experimental results are reported to show the effectiveness of the proposed approach