Analysis of knee strength measurements performed by a hand-held multicomponent dynamometer and optoelectronic system

The quantification of muscle weakness is useful to evaluate the health status and performance of patients and athletes. In this paper, we proposed a novel methodology to investigate and to quantify the effects induced by inaccuracy sources occurring when using a hand-held dynamometer (HHD) for knee strength measurements. The validation methodology is based on the comparison between the output of a one-component commercial HHD and the outputs of a six-component load cell, comparable in dimension and mass. An optoelectronic system was used to measure HHD positioning angles and displacements. The setup allowed to investigate the effects induced by: 1) the operator's ability to place and to hold still the HHD and 2) ignoring the transversal components of the force exchanged. The main finding was that the use of a single component HHD induced an overall inaccuracy of 5% in the strength measurements if the angular misplacements are kept within the values found in this paper (≤15°) and with a knee range of motion ≤22°. Extension trials were the most critical due to the higher force exerted, i.e., 249.4 ± 27.3 versus 146.4 ± 23.9 N of knee flexion. The most relevant source of inaccuracy was identified in the angular displacement on the horizontal plane

Upper body balance control strategy during continuous 3D postural perturbation in young adults

We explored how changes in vision and perturbation frequency impacted upright postural control in healthy adults exposed to continuous multiaxial support-surface perturbation. Ten subjects were asked to maintain equilibrium in standing stance with eyes open (EO) and eyes closed (EC) during sinusoidal 3D rotations at 0.25 (L) and 0.50 Hz (H). We measured upper-body kinematics – head, trunk, and pelvis – and analyzed differences in horizontal displacements and roll, pitch, and yaw sways. The presence of vision significantly decreased upper-body displacements in the horizontal plane, especially at the head level, while in EC the head was the most unstable segment. H trials produced a greater segment stabilization compared to L ones in EO and EC. Analysis of sways showed that in EO participants stabilized their posture by reducing the variability of trunk angles; in H trials a sway decrease for the examined segments was observed in the yaw plane and, for the pelvis only, in the pitch plane. Our results suggest that, during continuous multiaxial perturbations, visual information induced: (i) in L condition, a continuous reconfiguration of multi-body-segments orientation to follow the perturbation; (ii) in H condition, a compensation for the ongoing perturbation. These findings were not confirmed in EC where the same strategy – that is, the use of the pelvis as a reference frame for the body balance was adopted both in L and H

Robotic and clinical evaluation of upper limb motor performance in patients with Friedreich's Ataxia: an observational study

Background: Friedreich’s ataxia (FRDA) is the most common hereditary autosomal recessive form of ataxia. In this disease there is early manifestation of gait ataxia, and dysmetria of the arms and legs which causes impairment in daily activities that require fine manual dexterity. To date there is no cure for this disease. Some novel therapeutic approaches are ongoing in different steps of clinical trial. Development of sensitive outcome measures is crucial to prove therapeutic effectiveness. The aim of the study was to assess the reliability and sensitivity of quantitative and objective assessment of upper limb performance computed by means of the robotic device and to evaluate the correlation with clinical and functional markers of the disease severity. Methods: Here we assess upper limb performances by means of the InMotion Arm Robot, a robot designed for clinical neurological applications, in a cohort of 14 children and young adults affected by FRDA, matched for age and gender with 18 healthy subjects. We focused on the analysis of kinematics, accuracy, smoothness, and submovements of the upper limb while reaching movements were performed. The robotic evaluation of upper limb performance consisted of planar reaching movements performed with the robotic system. The motors of the robot were turned off, so that the device worked as a measurement tool. The status of the disease was scored using the Scale for the Assessment and Rating of Ataxia (SARA). Relationships between robotic indices and a range of clinical and disease characteristics were examined. Results: All our robotic indices were significantly different between the two cohorts except for two, and were highly and reliably discriminative between healthy and subjects with FRDA. In particular, subjects with FRDA exhibited slower movements as well as loss of accuracy and smoothness, which are typical of the disease. Duration of Movement, Normalized Jerk, and Number of Submovements were the best discriminative indices, as they were directly and easily measurable and correlated with the status of the disease, as measured by SARA. Conclusions: Our results suggest that outcome measures obtained by means of robotic devices can improve the sensitivity of clinical evaluations of patients’ dexterity and can accurately and efficiently quantify changes over time in clinical trials, particularly when functional scales appear to be no longer sensitive

Automated displacement measurements on historical canvases

Abstract Background In this paper we describe a configurable system based on laser displacement sensors for the contactless acquisition of 3D and 2D shapes of near-planar objects such as the paintings. Methods The system is based on two single-point laser triangulation sensors, a planar robot and a suite of software for driving the sensors, acquiring and post-processing the collected data. As a demonstration of the developed system we monitored three artifacts with the different aims to monitor the elastic properties of the artworks and the effectiveness of support frames in compensating the micro-climate fluctuations: the "Annunciazione" Antonello da Messina, the "Paliotto di San Domenico", and the "Portiera Oddi-Montesperelli". Results In the "Annunciazione" case, the canvas response to tensioning trials was analyzed. The collected data permitted to quantify a maximum displacement of 0.9 and 1.5 mm for the tensioning tests at 1 and 2 mm, respectively. In the "Portiera" case, the displacement difference between the left and right canvas sides was (1.0 ± 0.13)%, due to the inherent anisotropy of the material and by the structure of the artifact. In the "Paliotto" case, instead, minor displacement variations of the gilt leather due to the environment were observed, due to the analysis conducted prior of the restoration. Conclusions The overall obtained results demonstrated that the system is able to provide useful data for the art conservation field, with a max inaccuracy less than 100 μm

Quantification of Age-Related Differences in Reaching and Circle-Drawing using a Robotic Rehabilitation Device

Background: Although robotic therapy is at the forefront of upper limb rehabilitation, there is limited information about the importance of selecting age-matched subjects to evaluate recovery of arm movement during rehabilitation

Inter-laboratory and inter-operator reproducibility in gait analysis measurements in pediatric subjects

The intra-subject, the inter-operator, and the inter-laboratory variabilities are the main sources of uncertainties in gait analysis, and their effects have been partially described in the literature for adult populations. This study aimed to extend the repeatability and reproducibility analysis to a pediatric population, accounting for the effects induced by the intra-subject variations, the measurement setup, the marker set configuration, and the involved operators in placing markers and EMG electrodes. We evaluated kinematic, kinetic and EMG outputs collected from gait analyses performed on two healthy children in two laboratories, by two operators, and with two marker placement protocols. The two involved centers previously defined a common acquisition procedure based on their routine pipelines. The similarity of kinematic, kinetic, and EMG curves were evaluated by means of the coefficients of the Linear Fit Method, and the Mean Absolute Variability with and without the offset among curves. The inter-operator variability was found to be the main contribution to the overall reproducibility of kinematic and kinetic gait data. On the contrary, the main contribution to the variability of the EMG signals was the intra-subject repeatability that is due to the physiological stride to stride muscle activation variability

Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20–44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991–1993; n56,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998–2000; n518,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007–2010; n510,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19–1.59) from 1998–2000 to 2007–2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhiniti

Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants

Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed. To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age. The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research

Years of life that could be saved from prevention of hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) causes premature death and loss of life expectancy worldwide. Its primary and secondary prevention can result in a significant number of years of life saved. AIM: To assess how many years of life are lost after HCC diagnosis. METHODS: Data from 5346 patients with first HCC diagnosis were used to estimate lifespan and number of years of life lost after tumour onset, using a semi-parametric extrapolation having as reference an age-, sex- and year-of-onset-matched population derived from national life tables. RESULTS: Between 1986 and 2014, HCC lead to an average of 11.5 years-of-life lost for each patient. The youngest age-quartile group (18-61 years) had the highest number of years-of-life lost, representing approximately 41% of the overall benefit obtainable from prevention. Advancements in HCC management have progressively reduced the number of years-of-life lost from 12.6 years in 1986-1999, to 10.7 in 2000-2006 and 7.4 years in 2007-2014. Currently, an HCC diagnosis when a single tumour <2 cm results in 3.7 years-of-life lost while the diagnosis when a single tumour 65 2 cm or 2/3 nodules still within the Milan criteria, results in 5.0 years-of-life lost, representing the loss of only approximately 5.5% and 7.2%, respectively, of the entire lifespan from birth. CONCLUSIONS: Hepatocellular carcinoma occurrence results in the loss of a considerable number of years-of-life, especially for younger patients. In recent years, the increased possibility of effectively treating this tumour has improved life expectancy, thus reducing years-of-life lost