From AAL to ambient assisted rehabilitation: a research pilot protocol based on smart objects and biofeedback

AbstractThe progressive miniaturization of electronic devices and their exponential increase in processing, storage and transmission capabilities, represent key factors of the current digital transformation, also sustaining the great development of Ambient Assisted Living (AAL) and the Internet of Things. Although most of the investigations in the recent years focused on remote monitoring and diagnostics, rehabilitation too could be positively affected by the widespread integrated use of these devices. Smart Objects in particular may be among the enablers to new quantitative approaches. In this paper, we present a proof-of-concept and some preliminary results of an innovative pediatric rehabilitation protocol based on Smart Objects and biofeedback, which we administered to a sample of children with unilateral cerebral palsy. The novelty of the approach mainly consists in placing the sensing device into a common toy (a ball in our protocol) and using the information measured by the device to administer multimedia-enriched type of exercises, more engaging if compared to the usual rehabilitation activities used in clinical settings. We also introduce a couple of performance indexes, which could be helpful for a quantitative continuous evaluation of movements during the exercises. Even if the number of children involved and sessions performed are not suitable to assess any change in the subjects' abilities, nor to derive solid statistical inferences, the novel approach resulted very engaging and enjoyable by all the children participating in the study. Moreover, given the almost non-existent literature on the use of Smart Objects in pediatric rehabilitation, the few qualitative/quantitative results here reported may promote the scientific and clinical discussion regarding AAL solutions in a "Computer Assisted Rehabilitation" perspective, towards what can be defined "Pediatric Rehabilitation 2.0"

A narrative review of digital biomarkers in the management of major depressive disorder and treatment-resistant forms

IntroductionDepression is the leading cause of worldwide disability, until now only 3% of patients with major depressive disorder (MDD) experiences full recovery or remission. Different studies have tried to better understand MDD pathophysiology and its resistant forms (TRD), focusing on the identification of candidate biomarkers that would be able to reflect the patients’ state and the effects of therapy. Development of digital technologies can generate useful digital biomarkers in a real-world setting. This review aims to focus on the use of digital technologies measuring symptom severity and predicting treatment outcomes for individuals with mood disorders.MethodsTwo databases (PubMed and APA PsycINFO) were searched to retrieve papers published from January 1, 2013, to July 30, 2023, on the use of digital devices in persons with MDD. All papers had to meet specific inclusion criteria, which resulted in the inclusion of 12 articles.ResultsResearch on digital biomarkers confronts four core aspects: (I) predicting diagnostic status, (II) assessing symptom severity and progression, (III) identifying treatment response and (IV) monitoring real-word and ecological validity. Different wearable technologies have been applied to collect physiological, activity/sleep, or subjective data to explore their relationships with depression.DiscussionDepression’s stable rates and high relapse risk necessitate innovative approaches. Wearable devices hold promise for continuous monitoring and data collection in real world setting.ConclusionMore studies are needed to translate these digital biomarkers into actionable interventions to improve depression diagnosis, monitoring and management. Future challenges will be the applications of wearable devices routinely in personalized medicine

Drug Resistance: The Role of Exosomal miRNA in the Microenvironment of Hematopoietic Tumors

Extracellular vesicles (EVs), including exosomes, have an important role thanks to their ability to communicate and exchange information between tumor cells and the tumor microenvironment (TME), and have also been associated with communicating anti-cancer drug resistance (DR). The increase in proliferation of cancer cells alters oxygen levels, which causes hypoxia and results in a release of exosomes by the cancer cells. In this review, the results of studies examining the role of exosomal miRNA in DR, and their mechanism, are discussed in detail in hematological tumors: leukemia, lymphoma, and multiple myeloma. In conclusion, we underline the exosome’s function as a possible drug delivery vehicle by understanding its cargo. Engineered exosomes can be used to be more specific for personalized therapy