Training modalities in robot-mediated upper limb rehabilitation in stroke : A framework for classification based on a systematic review

© 2014 Basteris et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The work described in this manuscript was partially funded by the European project ‘SCRIPT’ Grant agreement no: 288698 (http://scriptproject.eu). SN has been hosted at University of Hertfordshire in a short-term scientific mission funded by the COST Action TD1006 European Network on Robotics for NeuroRehabilitationRobot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.Peer reviewedFinal Published versio

Kodaira-Spencer formality of products of complex manifolds

We shall say that a complex manifold $X$ is emph{Kodaira-Spencer formal} if its Kodaira-Spencer differential graded Lie algebra $A^{0,*}_X(Theta_X)$ is formal; if this happen, then the deformation theory of $X$ is completely determined by the graded Lie algebra $H^*(X,Theta_X)$ and the base space of the semiuniversal deformation is a quadratic singularity.. Determine when a complex manifold is Kodaira-Spencer formal is generally difficult and we actually know only a limited class of cases where this happen. Among such examples we have Riemann surfaces, projective spaces, holomorphic Poisson manifolds with surjective anchor map $H^*(X,Omega^1_X) o H^*(X,Theta_X)$ and every compact K"{a}hler manifold with trivial or torsion canonical bundle. In this short note we investigate the behavior of this property under finite products. Let $X,Y$ be compact complex manifolds; we prove that whenever $X$ and $Y$ are K"{a}hler, then $X imes Y$ is Kodaira-Spencer formal if and only if the same holds for $X$ and $Y$. A revisit of a classical example by Douady shows that the above result fails if the K"{a}hler assumption is droppe

Feasibility of a second iteration wrist and hand supported training system for self-administered training at home in chronic stroke

Telerehabilitation allows continued rehabilitation at home after discharge. The use of rehabilitation technology supporting wrist and hand movements within a motivational gaming environment could enable patients to train independently and ultimately serve as a way to increase the dosage of practice. This has been previously examined in the European SCRIPT project using a first prototype, showing potential feasibility, although several usability issues needed further attention. The current study examined feasibility and clinical changes of a second iteration training system, involving an updated wrist and hand supporting orthosis and larger variety of games with respect to the first iteration. Nine chronic stroke patients with impaired arm and hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility and arm and hand function were assessed before and after training. Median weekly training duration was 113 minutes. Participants accepted the six weeks of training (median Intrinsic Motivation Inventory = 4.4 points and median System Usability Scale = 73%). After training, significant improvements were found for the Fugl Meyer assessment, Action Research Arm Test and self-perceived amount of arm and hand use in daily life. These findings indicate that technology-supported arm and hand training can be a promising tool for self-administered practice at home after stroke.Final Accepted Versio

The Stabilized Poincare-Heisenberg algebra: a Clifford algebra viewpoint

The stabilized Poincare-Heisenberg algebra (SPHA) is the Lie algebra of quantum relativistic kinematics generated by fifteen generators. It is obtained from imposing stability conditions after attempting to combine the Lie algebras of quantum mechanics and relativity which by themselves are stable, however not when combined. In this paper we show how the sixteen dimensional Clifford algebra CL(1,3) can be used to generate the SPHA. The Clifford algebra path to the SPHA avoids the traditional stability considerations, relying instead on the fact that CL(1,3) is a semi-simple algebra and therefore stable. It is therefore conceptually easier and more straightforward to work with a Clifford algebra. The Clifford algebra path suggests the next evolutionary step toward a theory of physics at the interface of GR and QM might be to depart from working in space-time and instead to work in space-time-momentum.Comment: 14 page

Efficient indexing of necklaces and irreducible polynomials over finite fields

We study the problem of indexing irreducible polynomials over finite fields, and give the first efficient algorithm for this problem. Specifically, we show the existence of poly(n, log q)-size circuits that compute a bijection between {1, ... , |S|} and the set S of all irreducible, monic, univariate polynomials of degree n over a finite field F_q. This has applications in pseudorandomness, and answers an open question of Alon, Goldreich, H{\aa}stad and Peralta[AGHP]. Our approach uses a connection between irreducible polynomials and necklaces ( equivalence classes of strings under cyclic rotation). Along the way, we give the first efficient algorithm for indexing necklaces of a given length over a given alphabet, which may be of independent interest

Keratinocyte footprint assay discriminates antilaminin-332 pemphigoid from all other forms of pemphigoid diseases

Background Antilaminin-332 mucous membrane pemphigoid is a chronic severe pemphigoid disease characterized by autoantibodies to laminin-332. At present no commercial assay is available to demonstrate antilaminin-332 antibodies, and diagnosis relies on in-house techniques with limited sensitivities. Objectives In order to move, keratinocytes cultured in vitro secrete laminin-332 to attach to the culture dish. In that way, they leave behind a unique footprint trail of laminin-332. We aimed to develop a sensitive and specific laboratory assay to determine antilaminin-332 autoantibodies in patient serum based on binding of patient IgG to these unique footprints. Methods Normal human keratinocytes were grown on glass coverslips and incubated with patient or control serum for 1 h. The binding of IgG was then investigated by immunofluorescence. After validating the test for its ability to identify antilaminin-332 autoantibodies it was converted into a daily available test based on binding of IgG to dried coverslips that can be stored frozen. The staining patterns of sera from patients with antilaminin-332 pemphigoid were then compared with those of sera from patients with other autoimmune bullous diseases and normal human sera. Results IgG of all antilaminin-332 pemphigoid sera (n = 16) bound to laminin-332 footprints, while all normal human controls (n = 55) were negative. From the sera of patients with other diseases (n = 72) four sera tested positive. The footprint assay was also positive for sera that were negative by salt-split skin analysis, demonstrating that it is a very sensitive technique. Conclusions The keratinocyte footprint assay is a fast and specific assay to confirm or rule out the presence of antilaminin-332 autoantibodies. What's already known about this topic? Antilaminin-332 mucous membrane pemphigoid is a severe form of pemphigoid, and patients may have an increased risk of malignancies. The diagnosis of antilaminin-332 mucous membrane pemphigoid is complicated by the lack of specific commercial tests for antilaminin-332 antibodies and can be confirmed only in specialized laboratories. Keratinocytes in culture need laminin-332 for adhesion and migration and therefore deposit it on the bottom of the culture dish. What does this study add? The keratinocyte footprint assay detects antilaminin-332 autoantibodies in patient serum using the native laminin-332 produced by cultured keratinocytes. What is the translational message? The keratinocyte footprint assay is a fast and specific assay to confirm or rule out the presence of antilaminin-332 autoantibodies

Alternative linear structures for classical and quantum systems

The possibility of deforming the (associative or Lie) product to obtain alternative descriptions for a given classical or quantum system has been considered in many papers. Here we discuss the possibility of obtaining some novel alternative descriptions by changing the linear structure instead. In particular we show how it is possible to construct alternative linear structures on the tangent bundle TQ of some classical configuration space Q that can be considered as "adapted" to the given dynamical system. This fact opens the possibility to use the Weyl scheme to quantize the system in different non equivalent ways, "evading", so to speak, the von Neumann uniqueness theorem.Comment: 32 pages, two figures, to be published in IJMP

Upper semi-continuity of the Royden-Kobayashi pseudo-norm, a counterexample for H\"olderian almost complex structures

If $X$ is an almost complex manifold, with an almost complex structure $J$ of class \CC^\alpha, for some $\alpha >0$, for every point $p\in X$ and every tangent vector $V$ at $p$, there exists a germ of $J$-holomorphic disc through $p$ with this prescribed tangent vector. This existence result goes back to Nijenhuis-Woolf. All the $J$ holomorphic curves are of class \CC^{1,\alpha} in this case. Then, exactly as for complex manifolds one can define the Royden-Kobayashi pseudo-norm of tangent vectors. The question arises whether this pseudo-norm is an upper semi-continuous function on the tangent bundle. For complex manifolds it is the crucial point in Royden's proof of the equivalence of the two standard definitions of the Kobayashi pseudo-metric. The upper semi-continuity of the Royden-Kobayashi pseudo-norm has been established by Kruglikov for structures that are smooth enough. In [I-R], it is shown that \CC^{1,\alpha} regularity of $J$ is enough. Here we show the following: Theorem. There exists an almost complex structure $J$ of class \CC^{1\over 2} on the unit bidisc \D^2\subset \C^2, such that the Royden-Kobayashi seudo-norm is not an upper semi-continuous function on the tangent bundle.Comment: 5 page

Are cognitive differences between immigrant and majority groups diminishing?

A review is given of scores on various cognitive measures, comparing groups of ethnic Dutch and non-Western immigrants using a large number of datasets. The research shows that there are large group differences in school results, work proficiency, and g for Turks, Moroccans, Surinamese, Netherlands Antilleans, and Indonesians from the Moluccans compared with ethnic Dutch. However, South-East Asians score higher, and persons with one immigrant and one ethnic Dutch parent score only slightly below the mean of the Dutch. When comparing first-generation disadvantaged immigrant groups with later generations the data show substantial improvements for g, a remarkable stability of educational differences for younger children, and a clear improvement in educational achievement at the end of primary school. Indirect data on intergenerational improvements in work proficiency appear suggestive of a trend of closing gaps. Some of the data reflect higher cognitive capacities over time, and this enhances integration of immigrants into Dutch society. Causes of group differences and improvements in mean level of g are discussed. Copyright © 2004 John Wiley & Sons, Ltd

Keratinocyte Binding Assay Identifies Anti-Desmosomal Pemphigus Antibodies Where Other Tests Are Negative

The serological diagnosis of pemphigus relies on the detection of IgG autoantibodies directed against the epithelial cell surface by indirect immunofluorescence (IIF) on monkey esophagus and against desmoglein 1 (Dsg1) and Dsg3 by ELISA. Although being highly sensitive and specific tools, discrepancies can occur. It is not uncommon that sera testing positive by ELISA give a negative result by IIF and vice versa. This brings diagnostic challenges wherein pemphigus has to be ascertained or ruled out, especially when no biopsy is available. We utilized the ability of anti-Dsg3 and anti-Dsg1 IgG to bind in specific desmosomal patterns to living cells to investigate these discrepancies between IIF and ELISA. Living cultured primary normal human keratinocytes were grown under differentiating conditions to induce adequate expression of Dsg1 and Dsg3, incubated with patient serum for 1 h, and then stained to visualize bound IgG. We investigated two different groups; sera from patients with a positive direct immunofluorescence (DIF) and inconsistent serological findings (n = 43) and sera with positive ELISA or IIF but with negative DIF (n = 60). As positive controls we used 50 sera from patients who fulfilled all diagnostics criteria, and 10 sera from normal human subjects served as negative controls. In the DIF positive group, IgG from 39 of the 43 sera bound to the cells in a desmosomal pattern while in the DIF negative group none of the 60 sera bound to the cells. This shows that for pemphigus patients, ELISA and IIF can be negative while anti-desmosomal antibodies are present and vice versa that ELISA and IIF can be positive in non-pemphigus cases. In absence of a biopsy for DIF, such findings may lead to misdiagnosis