Robotic Rehabilitation and Multimodal Instrumented Assessment of Post-stroke Elbow Motor Functions—A Randomized Controlled Trial Protocol

Background: The reliable assessment, attribution, and alleviation of upper-limb joint stiffness are essential clinical objectives in the early rehabilitation from stroke and other neurological disorders, to prevent the progression of neuromuscular pathology and enable proactive physiotherapy toward functional recovery. However, the current clinical evaluation and treatment of this stiffness (and underlying muscle spasticity) are severely limited by their dependence on subjective evaluation and manual limb mobilization, thus rendering the evaluation imprecise and the treatment insufficiently tailored to the specific pathologies and residual capabilities of individual patients. Methods: To address these needs, the proposed clinical trial will employ the NEUROExos Elbow Module (NEEM), an active robotic exoskeleton, for the passive mobilization and active training of elbow flexion and extension in 60 sub-acute and chronic stroke patients with motor impairments (hemiparesis and/or spasticity) of the right arm. The study protocol is a randomized controlled trial consisting of a 4-week functional rehabilitation program, with both clinical and robotically instrumented assessments to be conducted at baseline and post-treatment. The primary outcome measures will be a set of standard clinical scales for upper limb spasticity and motor function assessment, including the Modified Ashworth Scale and Fugl-Meyer Index, to confirm the safety and evaluate the efficacy of robotic rehabilitation in reducing elbow stiffness and improving function. Secondary outcomes will include biomechanical, muscular activity, and motor performance parameters extracted from instrumented assessments using the NEEM along with synchronous EMG recordings. The study protocol has been registered on clinicaltrials.gov with registration trial number NCT04484571. Conclusions: This randomized controlled trial aims to validate an innovative instrumented methodology for clinical spasticity assessment and functional rehabilitation, relying on the precision and accuracy of an elbow exoskeleton combined with EMG recordings and the expertise of a physiotherapist, thus complementing and maximizing the benefits of both practices

Survey of transfemoral amputee experience and priorities for the user-centered design of powered robotic transfemoral prostheses

BACKGROUND: Transfemoral amputees experience a complex host of physical, psychological, and social challenges, compounded by the functional limitations of current transfemoral prostheses. However, the specific relationships between human factors and prosthesis design and performance characteristics have not yet been adequately investigated. The present study aims to address this knowledge gap. METHODS: A comprehensive single-cohort survey of 114 unilateral transfemoral amputees addressed a broad range of demographic and clinical characteristics, functional autonomy, satisfaction and attitudes towards their current prostheses, and design priorities for an ideal transfemoral prosthesis, including the possibility of active assistance from a robotic knee unit. The survey was custom-developed based on several standard questionnaires used to assess motor abilities and autonomy in activities of daily living, prosthesis satisfaction, and quality of life in lower-limb amputees. Survey data were analyzed to compare the experience (including autonomy and satisfaction) and design priorities of users of transfemoral prostheses with versus without microprocessor-controlled knee units (MPKs and NMPKs, respectively), with a subsequent analyses of cross-category correlation, principal component analysis (PCA), cost-sensitivity segmentation, and unsupervised K-means clustering applied within the most cost-sensitive participants, to identify functional groupings of users with respect to their design priorities. RESULTS: The cohort featured predominantly younger (< 50 years) traumatic male amputees with respect to the general transfemoral amputee population, with pronounced differences in age distribution and amputation etiology (traumatic vs. non-traumatic) between MPK and NMPK groups. These differences were further reflected in user experience, with MPK users reporting significantly greater overall functional autonomy, satisfaction, and sense of prosthesis ownership than those with NMPKs, in conjunction with a decreased incidence of instability and falls. Across all participants, the leading functional priorities for an ideal transfemoral prosthesis were overall stability, adaptability to variable walking velocity, and lifestyle-related functionality, while the highest-prioritized general characteristics were reliability, comfort, and weight, with highly variable prioritization of cost according to reimbursement status. PCA and user clustering analyses revealed the possibility for functionally relevant groupings of prosthesis features and users, based on their differential prioritization of these features—with implications towards prosthesis design tradeoffs. CONCLUSIONS: This study’s findings support the understanding that when appropriately prescribed according to patient characteristics and needs in the context of a proactive rehabilitation program, advanced transfemoral prostheses promote patient mobility, autonomy, and overall health. Survey data indicate overall stability, modularity, and versatility as key design priorities for the continued development of transfemoral prosthesis technology. Finally, observed associations between prosthesis type, user experience, and attitudes concerning prosthesis ownership suggest both that prosthesis characteristics influence device acceptance and functional outcomes, and that psychosocial factors should be specifically and proactively addressed during the rehabilitation process. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12984-021-00944-x

Cosy objects: instant products for the reorganization of spaces and function.

The DECA project, coordinated by Agnes Rebaglio and undertaken in partnership with the Municipality of Milan and the Farsi Prossimo consortium, has placed at the centre of the design the operational requirements of second level hospitality centres for refugees. In this context we have carried out a workshop experience for the development and provision of a series of ‘cosy’ products, so called because they seek to improve the process of inclusion for guests in the welcome centers. Second-level hospitality must deal with several key issues that include: the management of time, the gender issue, the cultural differences and the attendant need for a neutral space, the sensitive state of emergency, the mix between public and private sphere. Given the current urgency, the conditions for the guests of the centre and the need for viable answers in a very short time, the project has sought appropriate solutions for the immediate term by drawing on ready-made items. Thanks to the collaboration of IKEA, materials and objects in the catalogue have provided the raw material for the project

The role of psychological well-being in multiple sclerosis rehabilitation

BACKGROUND: In patients affected by multiple sclerosis (MS) the disabilities increase during the progression of the disease, with a negative impact on quality of life. Rehabilitation improves motor performances, but remains unclear the role of psychological variables on motor recovery. AIM: The aim of this study was to investigate the role of the psychological well-being during a rehabilitation care in MS patients with moderate to severe disability. DESIGN: Longitudinal study. SETTING: Outpatients in a Neurorehabilitation Unit of Pisa and Ferrara University Hospital. POPULATION: 93 subjects affected by MS with moderate to severe degree of impairment were recruited (43 male, 50 female; mean age 53±11.19 years). In relation to the Expanded Disability Status Scale (EDSS) score the sample was divided in two group: Group 1 with moderate impairment (EDSS 4-5.5) and Group 2 with severe impairment (EDSS 6-7). METHODS: Psychological and functional status was assessed before and after a motor rehabilitative treatment, appropriate to their clinical needs. Parameters collected were: Short Form 36, Patient Health Questionnaire, Fatigue Severity Scale, 6-minute walking test and 10-meter walking test. RESULTS: Mood disorders, low quality of life (QoL) and high perceived fatigue are characteristic symptoms in our sample. Results do not show a direct correlation with motor impairment. Mood improves in both groups, while walking endurance and speed ability recovers only in Group 1, on the contrary QoL improves only in Group 2. Regression analysis show that in Group 1 a better QoL predicts a higher motor recovery, whereas in Group 2 the improvement of walking endurance influences the subjective well-being at the discharge. CONCLUSIONS: Subjective well-being is related with the perception of the new condition of life. In less impaired patients psychological status can influence the liability toward rehabilitation treatment, while in more impaired patients motor recovery affect well-being. Therefore, the psychological counselling should be provided during the rehabilitation treatment in order to achieve a successful patients' care. CLINICAL REHABILITATION IMPACT: Our approach contributes to bring out the role of subjective factors on motor rehabilitation outcome and the functional recovery effect on the psychological well-being. The knowledge of subjective needs related to disability degree should be used to customize an appropriate care in MS patients

Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement

A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings pointed out the necessity of applying a stratification based on lesion location when investigating interhemispheric balance in stroke. Here, we tested whether cortical involvement could imply differences in band-specific activity and brain symmetry in post stroke patients with cortico-subcortical and subcortical strokes. We explored brain activity related to lesion location through EEG power analysis and quantitative Electroencephalography (qEEG) measures. Thirty stroke patients in the subacute phase and 10 neurologically intact age-matched right-handed subjects were enrolled. Stroke patients were equally subdivided in two groups based on lesion location: cortico-subcortical (CS, mean age +/- SD: 72.21 +/- 10.97 years; time since stroke +/- SD: 31.14 +/- 11.73 days) and subcortical (S, mean age +/- SD: 68.92 +/- 10.001 years; time since stroke +/- SD: 26.93 +/- 13.08 days) group. We assessed patients' neurological status by means of National Institutes of Health Stroke Scale (NIHSS). High density EEG at rest was recorded and power spectral analysis in Delta (1-4 Hz) and Alpha (8-14 Hz) bands was performed. qEEG metrics as pairwise derived Brain Symmetry Index (pdBSI) and Delta/Alpha Ratio (DAR) were computed and correlated with NIHSS score. S showed a lower Delta power in the Unaffected Hemisphere (UH) compared to Affected Hemisphere (AH; z = -1.98, p < 0.05) and a higher Alpha power compared to CS (z = -2.18, p < 0.05). pdBSI was negatively correlated with NIHSS (R = -0.59, p < 0.05). CS showed a higher value and symmetrical distribution of Delta band activity (z = -2.37, p < 0.05), confirmed also by a higher DAR value compared to S (z = -2.48, p < 0.05). Patients with cortico-subcortical and subcortical lesions show different brain symmetry in the subacute phase. Interestingly, in subcortical stroke patient brain activity is related with the clinical function. qEEG measures can be explicative of brain activity related to lesion location and they could allow precise definition of diagnostic-therapeutic algorithms in stroke patients

Functional status and quality of life of stroke survivors undergoing rehabilitation programmes in a hospital setting

BACKGROUND: While the positive effects of rehabilitation on physical functioning are well documented in stroke literature, more controversial results arise from the evaluation of the impact on quality of life.OBJECTIVE: The aim of the present study is to examine the associations among functional status and different measures of quality of life in a sample of inpatients undergoing rehabilitation programmes, and to consider the role of psychological distress, coping strategies and social support.METHODS: Twenty-nine stroke survivors were evaluated at the admission to a hospital-based Rehabilitation Unit and just before discharge. Questionnaires for the evaluation of functional status, health-related QoL, individualised QoL, psychological distress, coping strategies and social support were administered to them.RESULTS: While functional status improves significantly after treatment, individualised evaluations of QoL seem to be less affected. Adaptive coping strategies and social support showed significant correlations with positive outcomes on specific QoL domains, whereas psychological distress was associated with negative outcomes.CONCLUSIONS: The data from the present study support the evidence that different measures of QoL and functional status are not strongly associated one another, and that psychological distress, coping strategies and social support can be significantly related to specific outcome measures