HAPP: a Haptic Portable Pad for Hand Disease Manual Treatment

Nowadays, especially with the Covid-19 pandemic, researchers are focusing their attention on the remote delivery of devices designed for rehabilitation purposes, allowing people to recover without the physical presence of a doctor. Manual therapy is a physical treatment that is used by therapists for the treatment of musculoskeletal pain and/or disabilities. The aim of this work is to present HAPP, a new haptic portable device, designed to help patients suffering of different patholohgies, as for instance the Complex Regional Pain Syndrome type-I disease, and more in general to investigate the effects of manual therapy for diseases of the carpus and metacarpus, by mimicking traditional mechanical and rhythmic stimuli characteristics of manual treatments. Its structure consists of a plate oriented by revolute-prismatic-spherical joints, with a rack-pinion mechanism that actuates the end-effector, stimulating the user's hand palm. We provide details about the device, such as the mechanical design, the mathematical model and a graphical user interface. Preliminary studies in order to evaluate the device force exerted at the user's palm were carried out

Design, Development, and Control of a Hand/Wrist Exoskeleton for Rehabilitation and Training

Robotic devices for rehabilitation and training is a promising and challenging research topic with a potentially huge social impact. The availability of tools for autonomously performing physiotherapy exercises increases their efficiency, provides supplementary information about results and progress, reduces physiotherapists' efforts and the need of their physical presence during exercise sessions, and encourages autonomy and independence in people with disabilities. Nevertheless, supportive technologies developed without the inputs and feedback of the end-user throughout the design process are less likely to be adopted for their intended purpose and use case. In this article, we propose a modular hand/wrist exoskeleton that actuates the wrist flexion/extension and adduction/abduction motions and hand fingers flexion/extension motions. It is designed to be wearable and easy to control and manage and can be used by the patient in collaboration with the physiotherapist or autonomously. A user-centered design perspective has been employed in all the design and development phases. This article introduces the main features of the device and presents some tests conducted with a user having limited hand and wrist mobility

MGlove-TS: A modular soft glove based on twisted string actuators and flexible structures

Advances in technology, design, and manufacturing processes are leading to noticeable improvements in rehabilitation management. In this paper, we introduce MGlove-TS, an actuated soft glove based on twisted string actuators (TSAs) developed to assist and support individuals with hand impairments limiting active movements and grasping force in their rehabilitation process and in daily living. The glove is designed to be lightweight, portable, easy to wear and use, comfortable for prolonged periods, with a little encumbrance, flexible and adaptable, and highly modular. The paper presents the main features of the proposed glove and a prototype actuating the thumb and index finger in flexion/extension and adduction/abduction movements. The actuated glove prototype has been evaluated through a series of tests, whose results showed its potential usefulness

The DressGripper: A Collaborative Gripper With Electromagnetic Fingertips for Dressing Assistance

This letter introduces a collaborative gripper designed for safe interactions during wearing operations. In a robotic system helping people to get dressed, two main goals have to be achieved: i) the gripper that potentially comes in contact with the person has to be intrinsically safe and ii) the gripper should be able to keep the cloth during dressing, e.g. while passing the arm inside the sleeve of a jacket. This letter proposes the DressGripper, a gripper that addresses these issues by combining a compliant and safe structure with an additional magnetic actuation at the fingertips. This combination enables a soft interaction with the robot while guaranteeing the necessary grasping tightness. Experiments with the proposed prototype demonstrate its applicability in robotic dressing assistance scenarios

Postoperative 3D conformal radiation therapy with dose-volume histogram assessment in non small-cell lung cancer

Background: Despite many randomized trials, the indication of postoperative radiation therapy (PORT) in non small cell lung cancer (NSCLC) is controversial. Involved-field conformal (3D) RT has never been studied prospectively. In this study, we aim to assess the outcome of patients treated with involved-field 3D PORT with or without chemotherapy in locally advanced NSCLC. Materials and Methods: From 1990 to 2006, data from 75 consecutive patients treated with curative surgery and PORT for NSCLC were retrospectively analyzed. Male to female ratio was 57/18, and median age was 58 years (38−76). There were 5 patients with stage I, 22 with stage II, and 48 with stage III disease. Pneumonectomy or lobectomy was realized in 24 and 51 patients, respectively. Mediastinal lymphadenectomy was performed in all patients. PORT indications were positive margins and/or positive mediastinal lymph nodes. Cisplatinbased chemotherapy was given in 15 patients. All patients had 3D conformal planning. Median RT dose was 60 Gy using at least 6-MV photons in 6 weeks, and CTV included bronchial stump and only positive nodal areas. Dose-volume histograms (DVH) assessing the pulmonary volume receiving 20 Gy (V20 Gy) were used in all patients. Results: Compliance to PORT was 100%. In a median follow-up period of 55 months, 26 (35%) patients are alive without disease. Median overall survival time was 24 months, with survival rate of 35% at 5 years. The 5-year locoregional control and distant disease-free rates were 80% and 57%, respectively. Patients treated with pneumonectomy and those treated with at least 60-Gy PORT had better outcome. Grade 3 or more CTC v3.0 toxicity was observed only in 4 (5%) patients. No lethal toxicity was observed. Conclusions: We conclude that involved-field 3D conformal 60-Gy PORT tailored with DVH V20 Gy assessment improves locoregional control without increasing lethal toxicity. Prospective studies using the abovementioned criteria are warranted

Feasibility and efficacy of accelerated weekly concomitant boost postoperative radiation therapy combined with concomitant chemotherapy in patients with locally advanced head and neck cancer.

BACKGROUND: The aim of this study was to assess feasibility and efficacy of weekly concomitant boost accelerated postoperative radiation therapy (PORT) with concomitant chemotherapy (CT) in patients with locally advanced head and neck cancer (LAHNC). METHODS AND MATERIALS: Conformal or intensity-modulated 66-Gy RT was performed in 5.5 weeks in 40 patients. Cisplatin was given at days 1, 22, and 43. Median follow-up was 36 months. RESULTS AND DISCUSSION: Grade 3 mucositis, dysphagia, and erythema was observed in ten (25%), nine (23%), and six (13%) patients, respectively. Grade 3 or more anemia was observed in two (6%) patients, and leukopenia in five (13%) patients. No grade 3 or 4 thrombocytopenia was observed. Grade 3 nephrotoxicity was observed in one patient (3%). No treatment-related mortality was observed. Grade 2 or more xerostomia and edema were observed in ten (25%) and one (3%) patient, respectively. Locoregional relapse occurred in eight patients, and seven patients developed distant metastases. Median time to locoregional relapse was 6 months. Three-year overall, disease-free survival, and locoregional control rates were 63%, 62%, and 81%, respectively. Multivariate analysis revealed that the only prognostic factor was nodal status. CONCLUSION: Reducing overall treatment time using accelerated PORT/CT by weekly concomitant boost (six fractions per week) combined with concomitant cisplatin CT is easily feasible with acceptable morbidity

Decrease in hemoglobin levels following surgery influences the outcome in head and neck cancer patients treated with accelerated postoperative radiotherapy.

AIM: To assess the influence of hemoglobin (Hb) levels in locally advanced head and neck cancer (LAHNC) patients treated with surgery and postoperative radiotherapy (PORT). MATERIAL AND METHODS: Pre- and postoperative Hb levels were collected in 79 patients treated with surgery followed by accelerated PORT for LAHNC. Median follow-up was 52 months (range 12-95 months). RESULTS AND DISCUSSION: Four-year overall survival (OS) rate was 51%. Neither pre- nor postoperative Hb level (<120 or 130 g/l in women or men, respectively) influenced the outcome. However, when Hb decrease between pre- and postoperative Hb values was taken into account, 4-year OS was significantly higher in patients with Hb difference less than 38 g/l (quartile value) compared with those with Hb decrease 38 g/l or more (61% versus 16%, P = 0.008). CONCLUSION: Decrease in Hb level by more than 38 g/l after surgery secondary to blood loss influences the outcome when postoperative RT is indicated