MEASURING REGULARITY OF FINE UPPER LIMB MOVEMENTS WITH A HAPTIC PLATFORM FOR MOTOR LEARNING AND REHABILITATION

Robot-assisted systems for arm training are being increasingly used to target moderate-to-severe upper limb impairments in rehabilitation facilities, while hand fine motor skills are seldom being targeted by these machines. This manuscript describes and tests the feasibility of a system based on a haptic interface aimed to complement the efficacy of robotic training in the rehabilitation and motor learning associated with upper extremities movements. End-effector kinematics associated with different trajectory tasks performed by 11 healthy adults were used to extract measures of smoothness, under different testing conditions that included the presence or absence of visual and haptic feedback, the use of dominant vs. non dominant hand, different shapes (crosses and circles), and the verse with which movements were done. The normalized mean square jerk, extracted from the system together with specific speed parameters, was able to capture differences in regularity between the different shapes (MSJratio significantly higher when drawing crosses, p < 1.0 E-4), and that haptic feedback significantly influences this smoothness measure (MSJratio significantly higher when haptic feedback is present, p < 5.0 E-4). The proposed system may be used as a means to monitor the progress of movement regularity in robot-mediated therapy, and the results obtained experimentally highlight the influence of haptic feedback on the smoothness of finalized upper extremity fine movements

MEASURING REGULARITY OF FINE UPPER LIMB MOVEMENTS WITH A HAPTIC PLATFORM FOR MOTOR LEARNING AND REHABILITATION

Robot-assisted systems for arm training are being increasingly used to target moderate-to-severe upper limb impairments in rehabilitation facilities, while hand fine motor skills are seldom being targeted by these machines. This manuscript describes and tests the feasibility of a system based on a haptic interface aimed to complement the efficacy of robotic training in the rehabilitation and motor learning associated with upper extremities movements. End-effector kinematics associated with different trajectory tasks performed by 11 healthy adults were used to extract measures of smoothness, under different testing conditions that included the presence or absence of visual and haptic feedback, the use of dominant vs. non dominant hand, different shapes (crosses and circles), and the verse with which movements were done. The normalized mean square jerk, extracted from the system together with specific speed parameters, was able to capture differences in regularity between the different shapes (MSJratio significantly higher when drawing crosses, p < 1.0 E-4), and that haptic feedback significantly influences this smoothness measure (MSJratio significantly higher when haptic feedback is present, p < 5.0 E-4). The proposed system may be used as a means to monitor the progress of movement regularity in robot-mediated therapy, and the results obtained experimentally highlight the influence of haptic feedback on the smoothness of finalized upper extremity fine movements

Neuro-Mechanics of Recumbent Leg Cycling in Post-Acute Stroke Patients

Cycling training is strongly applied in post-stroke rehabilitation, but how its modular control is altered soon after stroke has been not analyzed yet. EMG signals from 9 leg muscles and pedal forces were measured bilaterally during recumbent pedaling in 16 post-acute stroke patients and 12 age-matched healthy controls. Patients were asked to walk over a GaitRite mat and standard gait parameters were computed. Four muscle synergies were extracted through nonnegative matrix factorization in healthy subjects and patients unaffected legs. Two to four synergies were identified in the affected sides and the number of synergies significantly correlated with the Motricity Index (Spearman’s coefficient = 0.521). The reduced coordination complexity resulted in a reduced biomechanical performance, with the two-module sub-group showing the lowest work production and mechanical effectiveness in the affected side. These patients also exhibited locomotor impairments (reduced gait speed, asymmetrical stance time, prolonged double support time). Significant correlations were found between cycling-based metrics and gait parameters, suggesting that neuro-mechanical quantities of pedaling can inform on walking dysfunctions. Our findings support the use of pedaling as a rehabilitation method and an assessment tool after stroke, mainly in the early phase, when patients can be unable to perform a safe and active gait training

Treatment of a rapidly expanding thoracoabdominal aortic aneurysm after endovascular repair of descending thoracic aortic aneurysm in an old patient.

Background: Aortic pathology progression and/or procedure related complications following endovascular repair should always be considered mostly in older patients. We herein describe a hybrid procedure for treatment of rapidly expanding thoracoabdominal aneurysm following endovascular treatment of a descending thoracic aortic aneurysm in an older patient. Case presentation: A 82-year-old man at 18 months after endovascular surgery for a contained rupture of descending thoracic aortic aneurysm revealed a type IV thoracoabdominal aneurysm with significant increase of the aortic diameters at superior mesenteric and renal artery levels. A hybrid approach consisting of preventive visceral vessel revascularization and endovascular repair of entire abdominal aorta was performed. Under general anaesthesia and by xyphopubic laparotomy, the infrarenal aneurysmatic aorta and common iliac arteries were replaced by a bifurcated woven prosthetic graf. From each of the prosthetic branches two reverse 14x7 mm bifurcated PTFE prosthetic grafts were anastomized to both renal arteries and to the celiac axis and superior mesenteric artery, respectively. Vessel ischemia was restricted to the time required for anastomosis. Three 10 cm Gore endovascular stent-grafts for a total length of 15 cm, were used. The overlapping of the stent-grafts was carried out from the bottom upwards, starting from the aorto-iliac prosthetic body up to the healthy segment of thoracic aorta, 40 mm from the previous stent-grafts. The patient was discharged on the 9th postoperative day. Conclusion: This technique offers the advantage of a less invasive treatment, reducing the risk of paraplegia, visceral ischaemia and pulmonary complications, mostly in older patients

Brain network involved in visual processing of movement stimuli used in upper limb robotic training: an fMRI study

Abstract Background The potential of robot-mediated therapy and virtual reality in neurorehabilitation is becoming of increasing importance. However, there is limited information, using neuroimaging, on the neural networks involved in training with these technologies. This study was intended to detect the brain network involved in the visual processing of movement during robotic training. The main aim was to investigate the existence of a common cerebral network able to assimilate biological (human upper limb) and non-biological (abstract object) movements, hence testing the suitability of the visual non-biological feedback provided by the InMotion2 Robot. Methods A visual functional Magnetic Resonance Imaging (fMRI) task was administered to 22 healthy subjects. The task required observation and retrieval of motor gestures and of the visual feedback used in robotic training. Functional activations of both biological and non-biological movements were examined to identify areas activated in both conditions, along with differential activity in upper limb vs. abstract object trials. Control of response was also tested by administering trials with congruent and incongruent reaching movements. Results The observation of upper limb and abstract object movements elicited similar patterns of activations according to a caudo-rostral pathway for the visual processing of movements (including specific areas of the occipital, temporal, parietal, and frontal lobes). Similarly, overlapping activations were found for the subsequent retrieval of the observed movement. Furthermore, activations of frontal cortical areas were associated with congruent trials more than with the incongruent ones. Conclusions This study identified the neural pathway associated with visual processing of movement stimuli used in upper limb robot-mediated training and investigated the brain’s ability to assimilate abstract object movements with human motor gestures. In both conditions, activations were elicited in cerebral areas involved in visual perception, sensory integration, recognition of movement, re-mapping on the somatosensory and motor cortex, storage in memory, and response control. Results from the congruent vs. incongruent trials revealed greater activity for the former condition than the latter in a network including cingulate cortex, right inferior and middle frontal gyrus that are involved in the go-signal and in decision control. Results on healthy subjects would suggest the appropriateness of an abstract visual feedback provided during motor training. The task contributes to highlight the potential of fMRI in improving the understanding of visual motor processes and may also be useful in detecting brain reorganisation during training.</p

Antonino Pio e Marco Aurelio. Maestro e allievo all’apice dell’Impero

Durante i ventitré anni (138-161 d.C.) del principato di Antonino Pio, l’impero romano raggiunge il suo punto più alto di sviluppo e unità. Antonino è assai lontano dal predecessore e padre adottivo, il “sorprendente, intemperante, inquietante e geniale Adriano”. Il nuovo imperatore ha lo stile semplice di un gentleman farmer di orientamento stoico: ama pescare, cacciare, passeggiare e conversare con gli amici; gusta i banchetti, gli istrioni e la letteratura. Eppure, senza muoversi mai da Roma e dall’Italia, sa reggere l’immenso territorio con saggezza, energia e tolleranza. Secondo il progetto di successione architettato da Adriano, il principato passa da Antonino al figlio adottivo prediletto, Marco Aurelio. A lui toccherà fronteggiare un mondo assediato dalle pestilenze, dai barbari e dalla nuova, incomprensibile, religione cristiana

Hepatotoxicity in Patients with Hepatocellular Carcinoma on Treatment with Immune Checkpoint Inhibitors

Risk factors for hepatic immune-related adverse events (HIRAEs) in patients with advanced/unresectable hepatocellular carcinoma (HCC) treated with immune checkpoint inhibitors (ICIs) are unclear. We investigated: (i) clinical and morpho-pathological predictors of HIRAEs in 27 pretreatment tumor specimens, including surrogate biomarkers of the HCC immune class (based on intratumoral tertiary lymphoid structures, and glutamine synthase, CD3, and CD79 expression); and (ii) the relationship between HIRAE onset and subsequent treatment outcomes. Fifty-eight patients were included—20 (34%) received ICIs alone, and 38 (66%) received ICIs plus targeted agents as first- or further-line treatment. After a median time of 0.9 months (range, 0.4–2.7), nine patients (15.5%) developed grade ≥ 3 hepatitis, which was significantly associated with higher baseline ALT levels (p = 0.037), and an infectious HCC etiology (p = 0.023). ICIs were safely resumed in six out of nine patients. Time to treatment failure (TTF) was not significantly different in patients developing grade ≥ 3 hepatitis vs. lower grades (3.25 vs. 3.91 months, respectively; p = 0.81). Biomarker surrogates for the HCC immune class were not detected in patients developing grade ≥ 3 hepatitis. Grade ≥ 3 hepatitis has a benign course that does not preclude safe ICI reintroduction, without any detrimental effect on TTF