Positive effects of robotic exoskeleton training of upper limb reaching movements after stroke

This study, conducted in a group of nine chronic patients with right-side hemiparesis after stroke, investigated the effects of a robotic-assisted rehabilitation training with an upper limb robotic exoskeleton for the restoration of motor function in spatial reaching movements. The robotic assisted rehabilitation training was administered for a period of 6 weeks including reaching and spatial antigravity movements. To assess the carry-over of the observed improvements in movement during training into improved function, a kinesiologic assessment of the effects of the training was performed by means of motion and dynamic electromyographic analysis of reaching movements performed before and after training. The same kinesiologic measurements were performed in a healthy control group of seven volunteers, to determine a benchmark for the experimental observations in the patients’ group. Moreover degree of functional impairment at the enrolment and discharge was measured by clinical evaluation with upper limb Fugl-Meyer Assessment scale (FMA, 0–66 points), Modified Ashworth scale (MA, 0–60 pts) and active ranges of motion. The robot aided training induced, independently by time of stroke, statistical significant improvements of kinesiologic (movement time, smoothness of motion) and clinical (4.6 ± 4.2 increase in FMA, 3.2 ± 2.1 decrease in MA) parameters, as a result of the increased active ranges of motion and improved cocontraction index for shoulder extension/flexion. Kinesiologic parameters correlated significantly with clinical assessment values, and their changes after the training were affected by the direction of motion (inward vs. outward movement) and position of target to be reached (ipsilateral, central and contralateral peripersonal space). These changes can be explained as a result of the motor recovery induced by the robotic training, in terms of regained ability to execute single joint movements and of improved interjoint coordination of elbow and shoulder joints

Quantitative EEG analysis in minimally conscious state patients during postural changes

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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

Fast cyclical movements of the forearm: a method to compute a novel preprogramming index

Evaluating the ability of movement preprogramming in elderly and in Parkinsonian subjects is known to be important for clinical diagnosis and for rehabilitation purposes. Employing cyclical two-target reaching tasks (Fitt’s tasks) a new cinematic analysis of forearm movements is performed [1]. We extract a new Index of Preprogramming (IP) which relates to the standardization of cinematic patterns. Another index (R2) quantifies nonlinearities [2] that on-line control introduces in the patterns due to corrective strokes. Present indexes can be employed together with known preprogramming indexes based on counts of corrective strokes [3] and they allow for a more accurate evaluation of the motor control strategies used by the subject

Blink-related broad-band EEG oscillations at rest, precuneus and consciousness

Si descrivono le modificazioni EEg correlate all'ammiccamento spontane

Automatic segmentation of REM sleep into three substages

Objectives: The research aimed to introduce and test an automatic method for segmentation of REM sleep into three substages, respectively characterized by: enhancement of rapid eye movements; selective enhancement of slow eye movements (SEMs); reduction in the amount of eye movements. This objective was suggested by two kinds of data reported in the literature: distinction between phasic and tonic REM sleep, and remarkable presence of SEMs during REM sleep. Methods: The following signals were recorded: 19 EEG traces, submental EMG, and two EOGs (E1-A2 and E2-A2).The automatic analysis was performed on the EOG signals recorded during the REM periods that were identified by visual scoring. Themethod applied,which was derived from a previous method for the recognition of NREM microstructure, allowed identifying and characterizing events that consisted in transient amplitude increases in either a slower (0.2–0.6Hz) or a faster (1–3Hz) component of the EOG. Segmentation was obtained by means of simple queries to a database containing the features of the events. Results: The segmentation procedure made it possible to calculate nine parameters for each REM period: the duration percentages of the three substages, and the amplitude, mean frequency, and frequency variance of the two components. Conclusions: A quantitative description of the oscillating properties of REM sleep can suggest hypotheses about currently debated ssues, regarding the thalamocortical intrinsic loop active during REM sleep, the REM sleep behaviour disorder, the reduction of vulnerability during REM sleep, the mechanisms of sleep regulation, and the complex process of sleep building

Structuring cortical bistability in sleeping DOC parallels the recovery of consciousness

Last years the study of consciousness in both healthy people and DOC patients focused on the emerging properties of complex bidirectional thalamo-cortical connections; hence the study of sleep could be an optimal window to study thalamo-cortical circuits involved in consciousness and to verify the role of thalamo-cortical connectivity in the recovery of consciousness. Here, we aim at studying the EEG of a sample of patients with DOC in different recordings along the recovery of consciousness (VS, MCS and Exit From Minimally Conscious State, EMCS) to see how it changes in the different levels of consciousness

The relation between EMG activity and kinematic parameters strongly supports a role of the action tremor in parkinsonian bradykinesia

The kinematics characteristics of an upper arm extension of large amplitude (90°) performed in the horizontal plane and the simultaneous activity of the shoulder muscles were recorded in 12 parkinsonian patients and in six normal control subjects. The movement, triggered by an acoustic "go" signal, was preceded by an isometric adduction. Within the whole population of individuals (n = 18) a strong, positive correlation was observed between the root mean square value of agonist EMG activity, evaluated during the acceleration phase of the movement, and both peak velocity and acceleration. In six patients tremor bursts at the frequency of 8-14 Hz (action tremor) were observed during the movement phase in the anterior, middle, and posterior deltoid: all these patients showed low root mean square values and were bradykinetic with respect to the control subjects. The remaining six patients did not show this action tremor during the movement phase. All but one had an agonist activation of normal duration and amplitude, showed high root mean square values, and performed well in the range of control subjects. We conclude that the inability to suppress the activity of pathological oscillator(s) responsible for the action tremor plays a fundamental role in the bradykinesia associated with Parkinson's disease

The relation between EMG activity and kinematic parameters strongly supports a role of the action tremor in parkinsonian bradykinesia. Movement Disorders, 16(1): 47-57, 2001.

7noAbstract The kinematics characteristics of an upper arm extension of large amplitude (90°) performed in the horizontal plane and the simultaneous activity of the shoulder muscles were recorded in 12 parkinsonian patients and in six normal control subjects. The movement, triggered by an acoustic "go" signal, was preceded by an isometric adduction. Within the whole population of individuals (n = 18) a strong, positive correlation was observed between the root mean square value of agonist EMG activity, evaluated during the acceleration phase of the movement, and both peak velocity and acceleration. In six patients tremor bursts at the frequency of 8-14 Hz (action tremor) were observed during the movement phase in the anterior, middle, and posterior deltoid: all these patients showed low root mean square values and were bradykinetic with respect to the control subjects. The remaining six patients did not show this action tremor during the movement phase. All but one had an agonist activation of normal duration and amplitude, showed high root mean square values, and performed well in the range of control subjects. We conclude that the inability to suppress the activity of pathological oscillator(s) responsible for the action tremor plays a fundamental role in the bradykinesia associated with Parkinson's disease.reservedmixedCARBONCINI, M.C; MANZONI, D; STRAMBI, S; BONUCCELLI, U; PAVESE, N; ANDRE, P; ROSSI, BCarboncini, M. C; Manzoni, D; Strambi, S; Bonuccelli, U; Pavese, N; Andre, Paolo; Rossi, B