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

Paraneoplastic epidermolysis bullosa acquisita associated with thyroid carcinoma

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Conservation status and historical relatedness of Italian cattle breeds

Abstract Background: In the last 50 years, the diversity of cattle breeds has experienced a severe contraction. However, in spite of the growing diffusion of cosmopolite specialized breeds, several local cattle breeds are still farmed in Italy. Genetic characterization of breeds represents an essential step to guide decisions in the management of farm animal genetic resources. The aim of this work was to provide a high-resolution representation of the genome-wide diversity and population structure of Italian local cattle breeds using a medium-density single nucleotide polymorphism (SNP) array. Results: After quality control filtering, the dataset included 31,013 SNPs for 800 samples from 32 breeds. Our results on the genetic diversity of these breeds agree largely with their recorded history. We observed a low level of genetic diversity, which together with the small size of the effective populations, confirmed that several breeds are threatened with extinction. According to the analysis of runs of homozygosity, evidence of recent inbreeding was strong in some local breeds, such as Garfagnina, Mucca Pisana and Pontremolese. Patterns of genetic differentiation, shared ancestry, admixture events, and the phylogenetic tree, all suggest the presence of gene flow, in particular among breeds that originate from the same geographical area, such as the Sicilian breeds. In spite of the complex admixture events that most Italian cattle breeds have experienced, they have preserved distinctive characteristics and can be clearly discriminated, which is probably due to differences in genetic origin, environment, genetic isolation and inbreeding. Conclusions: This study is the first exhaustive genome-wide analysis of the diversity of Italian cattle breeds. The results are of significant importance because they will help design and implement conservation strategies. Indeed, efforts to maintain genetic diversity in these breeds are needed. Improvement of systems to record and monitor inbreeding in these breeds may contribute to their in situ conservation and, in view of this, the availability of genomic data is a fundamental resource

Design and validation of novel methods for assessment of upper-limb spasticity through a powered elbow exoskeleton

Stroke is a neurological deficit attributed to an acute focal injury of the central nervous system (CNS) by a vascular cause, including cerebral infarction, intracerebral hemorrhage, and subarachnoid hemorrhage. Every year, in Italy, 200.000 people suffer a stroke, 80% of which represent new episodes, while the remaining 20% are relapses. Common symptoms observed in post-stroke patients include severe sensory and motor hemiparesis of the contralesional side of the body, loss of dexterity, and spasticity. Although many clinical scales are available to therapists to evaluate the rank of spasticity, their main limitation is the uncertainty and approximation due to the qualitative evaluation of the patient’s conditions. The purpose of this work is to propose a novel method for the assessment of elbow spasticity based on kinetic and kinematic data recorded by means of a powered elbow exoskeleton, namely NEEM (NEUROExos Elbow Module, available for use at the BioRobotics Institute, Scuola Superiore Sant’Anna), and surface electromyography data. A Graphical User Interface (GUI) was developed in LabVIEW© environment, which allows the therapist to customize the assessment program and perform passive and active flexion-extension movements with the exoskeleton at different speeds, while monitoring and recording the patient’s and robot parameters (i.e. electromyography signals, joint angle and joint torque). The assessment program was tested on 8 healthy subjects and a small group of patients. A MATLAB© code was compiled for the offline analysis of acquired data, in order to extract different parameters related to the patient’s muscles activation and degree of spasticity (i.e. Stretch Reflex Onset, EMG Burst Duration, joint stiffness and others). Results suggest that the proposed method can be potentially used in clinical applications to provide therapists with complementary, quantitative data on the joint spasticity. Further investigations will validate the robot measurements with the outcomes of clinical scales

Giant enchondroma recurrence of the proximal phalanx of the fifth finger: a case report

Enchondroma (EC) is a benign and cartilage-forming tumor that causes intramedullary lesions. Moreover, EC is the most common bone tumor in the phalanges and metacarpal bones of the hand, deforming the structure and causing pain and functional limitation. The management of this neoplasia is the surgical treatment and the approach that is well-accepted consists in the curettage followed by the void augmentation with biological or synthetic fillers. The results from surgery are usually good and the recurrence rate is low (2-15%). In this article we report a case of EC recurrence of the proximal phalanx of the fifth finger of the hand after curettage and grafting. The patient was treated with the amputation of the fifth ray according to the Tsuge technique, obtaining a satisfying clinical result

Sharing Augmented Reality between a Patient and a Clinician for Assessment and Rehabilitation in Daily Living Activities

In rehabilitation settings that exploit Mixed Reality, a clinician risks losing empathy with the patient by being immersed in different worlds, either real and/or virtual. While the patient perceives the rehabilitation stimuli in a mixed real–virtual world, the physician is only immersed in the real part. While in rehabilitation, this may cause the impossibility for the clinician to intervene, in skill assessment, this may cause difficulty in evaluation. To overcome the above limitation, we propose an innovative Augmented Reality (AR) framework for rehabilitation and skill assessment in clinical settings. Data acquired by a distributed sensor network are used to feed a “shared AR” environment so that both therapists and end-users can effectively operate/perceive it, taking into account the specific interface requirements for each user category: (1) for patients, simplicity, immersiveness, engagement and focus on the task; (2) for clinicians/therapists, contextualization and natural interaction with the whole set of data that is linked with the users’ performances in real-time. This framework has a strong potential in Occupational Therapy (OT) but also in physical, psychological, and neurological rehabilitation. Hybrid real and virtual environments may be quickly developed and personalized to match end users’ abilities and emotional and physiological states and evaluate nearly all relevant performances, thus augmenting the clinical eye of the therapist and the clinician-patient empathy. In this paper, we describe a practical exploitation of the proposed framework in OT: setting-up the table for eating. Both a therapist and a user wear Microsoft HoloLens 2. First, the therapist sets up the table with virtual furniture. Next, the user places the corresponding real objects (also in shape) to match them as closely as possible to the corresponding virtual ones. The therapist’s view is augmented during the test with motion, balance, and physiological estimated cues. Once the training is completed, he automatically perceives deviations in the position and attitude of each object and the elapsed time. We used a camera-based localization algorithm achieving a level of accuracy of 5 mm with a confidence level of 95% for position and 1° for rotation. The framework was designed and tested in collaboration with clinical experts of Villa Rosa rehabilitation hospital in Pergine (Italy), involving both a set of patients and healthy users to demonstrate the effectiveness of the designed architecture and the significance of the analyzed parameters between healthy users and patients