Motor patterns evaluation of people with neuromuscular disorders for biomechanical risk management and job integration/reintegration

Neurological diseases are now the most common pathological condition and the leading cause of disability, progressively worsening the quality of life of those affected. Because of their high prevalence, they are also a social issue, burdening both the national health service and the working environment. It is therefore crucial to be able to characterize altered motor patterns in order to develop appropriate rehabilitation treatments with the primary goal of restoring patients' daily lives and optimizing their working abilities. In this thesis, I present a collection of published scientific articles I co-authored as well as two in progress in which we looked for appropriate indices for characterizing motor patterns of people with neuromuscular disorders that could be used to plan rehabilitation and job accommodation programs. We used instrumentation for motion analysis and wearable inertial sensors to compute kinematic, kinetic and electromyographic indices. These indices proved to be a useful tool for not only developing and validating a clinical and ergonomic rehabilitation pathway, but also for designing more ergonomic prosthetic and orthotic devices and controlling collaborative robots

Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective

Prosthetic gait implies the use of compensatory motor strategies, including alterations in gait biomechanics and adaptations in the neural control mechanisms adopted by the central nervous system. Despite the constant technological advancements in prostheses design that led to a reduction in compensatory movements and an increased acceptance by the users, a deep comprehension of the numerous factors that influence prosthetic gait is still needed. The quantitative prosthetic gait analysis is an essential step in the development of new and ergonomic devices and to optimize the rehabilitation therapies. Nevertheless, the assessment of prosthetic gait is still carried out by a heterogeneous variety of methodologies, and this limits the comparison of results from different studies, complicating the definition of shared and well-accepted guidelines among clinicians, therapists, physicians, and engineers. This perspective article starts from the results of a project funded by the Italian Worker's Compensation Authority (INAIL) that led to the generation of an extended dataset of measurements involving kinematic, kinetic, and electrophysiological recordings in subjects with different types of amputation and prosthetic components. By encompassing different studies published along the project activities, we discuss the specific information that can be extracted by different kinds of measurements, and we here provide a methodological perspective related to multimodal prosthetic gait assessment, highlighting how, for designing improved prostheses and more effective therapies for patients, it is of critical importance to analyze movement neural control and its mechanical actuation as a whole, without limiting the focus to one specific aspect

health related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning

Objective: To evaluate the health-related quality of life in myotonic dystrophy type 1 and its relationships with clinical, genetic, neuropsychological and emotional factors. Design: Case-control study of a continuous series of patients with myotonic dystrophy type 1. Patients and methods: Twenty patients, and 20 age-, sex- and education-matched healthy controls underwent the MOS 36Item Short-Form Health Survey (SF-36), an extensive neuropsychological battery and emotional functioning tests. Results: Patients' SF-36 mean scores were lower than those of controls in all dimensions. The neuropsychological study showed a significant impairment in visuospatial and verba

sEMG and Postural Analysis for Biomechanical Risk Assessment in a Banknotes Printing Process

The purpose of this paper is to assess the biomechanical overload risk of some tasks that are typical of the printing industry, by means of surface electromyography and postural analysis software. In the first task of manual loading, muscle activation percentage duration of the Bicepses and Tricepses were similar for similar duty cycles. The Erector Spinae muscles had higher %MVC sustained for a greater percentage of the duty cycle. In the second task of aeration and transfer, Bicepses were activated for most of the duty cycle with a low %MVC between 0 and 5%. Differently, Triceps and Erector Spinae muscles had muscle activations with higher %MVC and higher percentage duration. In the third task, the muscular activity achieved the highest values in the Bicepses, while the activity of the Erector Spinae and Triceps muscles was less significant. Finally, in the fourth task, the compressive force values at the L5/S1 level found by 3DSSPP software ranged from 1072 N to 1863 N. Still at the L5/S1 level, shear forces ranged from 263 N to 310 N. In the observed conditions, the used methods found no significant biomechanical overload risk in the studied tasks. The %MVC values within the cycle were all below the threshold proposed by ACGIH. The force values at level L5/S1 estimated with 3DSSPP software were also less than the 3400 N threshold limit value proposed by NIOSH for compressive forces and less than the 700 N limit proposed for shear forces by Gallagher in his review. One of the observed activities at a faster working pace could increase the biomechanical risk. This is the case of the manual loading of the offset printing machine. In fact, the sheet board with the sheets to be loaded was positioned frontally to the printing machine loading area, thus forcing the operator to a 180° rotation. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG

Competence to Consent to Sexual Activity in Bipolar Disorder and Schizophrenic Spectrum Disorders

Little is known about the ability of persons with severe mental disorders to give consent to sexual activity. A possible reason for this shortcoming is the absence of specific criteria and tools to measure sexual consent in psychiatric clinical settings. We developed a clinician oriented semi-structured interview, the Sexual Consent Assessment Scale (SCAS), and investigated sexual consent capacity in a sample of hospitalized patients with bipolar disorder (n = 54, M (age) = 38.1 years, 48% males) and schizophrenic spectrum disorders (n = 31, M (age) = 38.4 years, 29% males). The SCAS items were derived from the criteria proposed by Kennedy and Niederbuhl (Am J Ment Retard, 106:503-510, 2001). The full scale and a shorter scale comprising 10 items (SCAS-10) achieved good initial validity. Patients with schizophrenic spectrum disorders had worse sexual consent capacity than patients with bipolar disorder. This difference was unexpectedly independent from patients' symptomatology, as measured by the Brief Psychiatric Rating Scale. Conversely, poor cognitive functioning measured by the Raven's Standard Progressive matrices was associated with reduced capacity to give sexual consent in both groups. Subjects in the schizophrenic spectrum disorders group were more frequently judged incapable in basic knowledge of birth control methods and in domains underlying metacognitive abilities. Principal component analysis revealed two SCAS-10 interpretable factors: "appropriateness-recognition" and "consequences-metacognition." Our study suggests that patients with severe psychiatric disorders, especially those with cognitive dysfunction, might be at risk of incapacity to give valid sexual consent

A woman lost in the cemetery: A case of time-limited amnesia

A 43-year-old woman one day experienced a dissociative fugue which she could not recall. She was married, nulliparous, with no history of dissociative disorder or other psychiatric disorders. She had been sexually abused during late childhood-early adolescence. She was examined thoroughly from both psychiatric and medical standpoints to exclude organic causes for her condition. Magnetic Resonance Imaging showed only some non-specific abnormalities. On personality tests, a histrionic structure of personality emerged, with obsessive and narcissistic traits accompanied by rigidity and anxiety, dysphoria and high risk for depression; some impairment was found in executive function tests. Final diagnosis was one of dissociative fugue. In fact, organic traits were not sufficient to establish a diagnosis of Transient Global Amnesia. © 2010 Psychology Press

Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation

The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device

Open-Lip Schizencephaly Associated With Bipolar Disorder in a Young Man Exposed in Utero to the Chernobyl Disaster

[No abstract available

Neurocognition, psychopathology, and subjective disturbances in schizophrenia: a comparison between short-term and remitted patients

Patients with schizophrenia present deficits in multiple domains of cognition. The purposes of this study were to examine the extent of the relationship between psychopathologic symptoms, cognitive function, and subjective disturbances in a group of patients affected by schizophrenia spectrum disorders and to compare short-term with remitted patients. Seventy-nine patients meeting DSM-IV criteria for schizophrenia, schizophreniform disorder, and schizoaffective disorder were assessed through the PANS,the Frankfurt Complaint Questionnaire, and a neuropsychologic battery exploring the 7 Measurement and Treatment Research to improve Cognition in Schizophrenia cognitive domains (speed of processing, attention/vigilance, working memory, verbal learning, visual learning, reasoning and problem solving, and social cognition) plus executive control. Neuropsychologic and psychopathologic variables were compared and correlated. Treatment groups did not differ in neuropsychologic and psychopathologic measures. The cognitive factor of the PANS correlated with worse performance on cognitive tasks and with higher scores on the FCQ 24 in the short-term, remitted, and combined groups. Subjective disturbances correlated with impaired executive control, reasoning and problem solving, and social cognition but not during the short-term phase. Both “objective” and subjective psychopathology are intertwined with cognitive function, suggesting some common underlying neural bases. The condition of being in a short-term or a remitted phase of the illness influences this interrelationship, regardless of the type of antipsychotic medication taken