[Show abstract][Hide abstract] ABSTRACT: Advances in technology are allowing for the production of several viable wearable robotic devices to assist with activities of daily living and with rehabilitation. One of the most pressing limitations to user satisfaction is the lack of consistency in motion between the user and the robotic device. The displacement between the robot and the body segment may not correspond because of differences in skin and tissue compliance, mechanical backlash, and/or incorrect fit.
Journal of NeuroEngineering and Rehabilitation 10/2014; 11(1):147. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Gait Analysis (GA) was demonstrated to change pre--surgical planning and improve gait outcomes in children with Cerebral Palsy. GA is often used also to assess walking capability of post--stroke subjects, although its influence in the clinical management of these patients has not yet been established.
European journal of physical and rehabilitation medicine. 09/2014;
[Show abstract][Hide abstract] ABSTRACT: The ability to walk independently is a primary goal for rehabilitation after stroke. Gait analysis provides a great amount of valuable information, while functional magnetic resonance imaging (fMRI) offers a powerful approach to define networks involved in motor control. The present study reports a new methodology based on both fMRI and gait analysis outcomes in order to investigate the ability of fMRI to reflect the phases of motor learning before/after electromyographic biofeedback treatment: the preliminary fMRI results of a post stroke subject's brain activation, during passive and active ankle dorsal/plantarflexion, before and after biofeedback (BFB) rehabilitation are reported and their correlation with gait analysis data investigated.
A control subject and a post-stroke patient with chronic hemiparesis were studied. Functional magnetic resonance images were acquired during a block-design protocol on both subjects while performing passive and active ankle dorsal/plantarflexion. fMRI and gait analysis were assessed on the patient before and after electromyographic biofeedback rehabilitation treatment during gait activities. Lower limb three-dimensional kinematics, kinetics and surface electromyography were evaluated. Correlation between fMRI and gait analysis categorical variables was assessed: agreement/disagreement was assigned to each variable if the value was in/outside the normative range (gait analysis), or for presence of normal/diffuse/no activation of motor area (fMRI).
Altered fMRI activity was found on the post-stroke patient before biofeedback rehabilitation with respect to the control one. Meanwhile the patient showed a diffuse, but more limited brain activation after treatment (less voxels). The post-stroke gait data showed a trend towards the normal range: speed, stride length, ankle power, and ankle positive work increased. Preliminary correlation analysis revealed that consistent changes were observed both for the fMRI data, and the gait analysis data after treatment (R > 0.89): this could be related to the possible effects BFB might have on the central as well as on the peripheral nervous system.
Our findings showed that this methodology allows evaluation of the relationship between alterations in gait and brain activation of a post-stroke patient. Such methodology, if applied on a larger sample subjects, could provide information about the specific motor area involved in a rehabilitation treatment.
Journal of NeuroEngineering and Rehabilitation 04/2014; 11(1):53. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Purpose: In accordance with the Task Oriented Approach, clinicians need assessment procedures providing information on the execution of multiple tasks. Instrumented task assessment can add information regarding sensory-motor strategies, difficult to assess purely by clinical observation. It has been shown that People with Multiple Sclerosis (PwMS) have difficulties in maintaining upright balance, but little is known about their ability to achieve a stable posture after the execution of tasks related to activities of daily living. The aim of the present study was to assess postural stabilization in a population of PwMS. Methods: Twenty Healthy Subjects (HS) and twenty PwMS were assessed in three tasks leading to a quiet erect posture: sit-to-stand, taking a step forward, bending forward. Antero-posterior ground reaction force was measured by a force platform and interpolated by a model providing information on the initial instability after task execution (Transitional_Sway), the time required to dissipate this initial instability (Stabilization_Time), and their stability in quiet upright posture (Static_Sway). Results: PwMS had statistically significant altered performance in comparison to HS: their instability after task execution (Transitional_Sway) was higher in bending and sit-to-stand (p < 0.05), their stabilization time (Stabilization_Time) was longer in bending and step forward (p < 0.05). Static_Sway was higher in all tasks (p < 0.05) indicating imbalance also in quiet upright posture. Implications for Rehabilitation PwMS experience balance disorders in the transition between movement and the upright posture. Transitional disorders are related to difficulties in the execution of the movement itself, or to difficulties in reducing body sway after the movement. Tailored rehabilitation program can be implement to reduce impairments during the movement itself promoting coordination between body segments during the movement, muscle strength, joint mobility, or in the following postural stabilization phase improving subject's perception of the position and movement of the centre of mass in upright position.
Disability and Rehabilitation 03/2014; · 1.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot-Marie-Tooth disease (CMT) type 1A. For this purpose Ground Reaction Force (GRF) was measured by means of a piezoelectric force platform during the Sit-To-Stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Center of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects.
The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Yinf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres.
Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.
[Show abstract][Hide abstract] ABSTRACT: Advanced rehabilitation strategies of the upper limb in stroke patients focus on the recovery of the most important daily activities. In this study we analyzed quantitatively and qualitatively the motor strategies employed by stroke patients when reaching and drinking from a glass. We enrolled 6 hemiparetic poststroke patients and 6 healthy subjects. Motion analysis of the task proposed (reaching for the glass, bringing it to the mouth, and putting it back on the table) with the affected limb was performed. Clinical assessment using the Fugl-Meyer Assessment for Upper Extremity was also included. During the reaching for the glass the patients showed a reduced arm elongation and trunk axial rotation due to motor deficit. For this reason, as observed, they carried out compensatory strategies which included trunk forward displacement and head movements. These preliminary data should be considered to address rehabilitation treatment. Moreover, the kinematic analysis protocol developed might represent an outcome measure of upper limb rehabilitation processes.
BioMed Research International 01/2014; 2014:636123. · 2.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: When people simultaneously draw lines with one hand and circles with the other hand, both trajectories tend to assume an oval shape, showing that hand motor programs interact (the so-called "bimanual coupling effect"). The aim of the present study was to investigate how motor parameters (drawing trajectories) and the related brain activity vary during bimanual movements both in real execution and in motor imagery tasks. In the 'Real' modality, subjects performed right hand movements (lines) and, simultaneously, Congruent (lines) or Non-congruent (circles) left hand movements. In the 'Imagery' modality, subjects performed only right hand movements (lines) and, simultaneously, imagined Congruent (lines) or Non-congruent (circles) left hand movements. Behavioral results showed similar interference of both the real and the imagined circles on the actually executed lines, suggesting that the coupling effect also pertains to motor imagery. Neuroimaging results showed that a prefrontal-parietal network, mostly involving the pre-supplementary motor area (pre-SMA) and the posterior parietal cortex (PPC), was significantly more active in Non-congruent than in Congruent conditions, irrespective of task (Real or Imagery). The data also confirmed specific roles of the right superior parietal lobe (SPL) in mediating spatial interference, and of the left PPC in motor imagery. Collectively, these findings suggest that real and imagined non-congruent movements activate common circuits related to the intentional and predictive operation generating bimanual coupling, in which the pre-SMA and the PPC play a crucial role.
[Show abstract][Hide abstract] ABSTRACT: Movements with both hands are essential to our everyday life, and it has been shown that performing asymmetric bimanual movements produces an interference effect between hands. There have been many studies-using varying methods-investigating the development of bimanual movements that show that this skill continues to evolve during childhood and adolescence. In the current study we used a spatial bimanual task to delineate the development of bimanual movements not only during different stages of childhood but also during late stages of adulthood. Furthermore, we used the same task as a window to observe the involvement of motor imagery through the same age groups. For this study we recruited participants from 4 different age groups and asked them to perform congruent and noncongruent bimanual movements in a Real condition, where participants moved both hands, and in an Imagery condition, where they had to imagine 1 hand's movements while actually using the other hand. Our results showed that, with actual movement execution, the interference between motor programs of the 2 hands is higher in children (6-10 years old) than in younger adults (20-30 years old), while it tends to increase again in the elderly adults (60-80 years old). Interestingly, in the Imagery condition, the interference was present only among 10-year-old and 20- to 30-year-old participants, suggesting that motor imagery, not yet developed in young children and compromised by age in the elderly subjects, did not modulate motor performance in these last 2 groups. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
[Show abstract][Hide abstract] ABSTRACT: In a previous study we identified 3 different gait patterns in a group of children with CMT1A disease: Normal-like (NL), Foot-drop (FD), Foot-drop and Push-off Deficit (FD&POD). Goal of the present study was to perform a follow-up evaluation of the same group of patients to analyze possible changes of gait features in relation to disease progression or specific therapy.
Nineteen children with CMT1A were evaluated clinically (CMT-Examination Score and Overall Neuropathy Limitation Scale) and through gait analysis 18.2+/-1.5 months after a baseline evaluation. Meanwhile, 3 of them had foot surgery.
Fifteen out of the 16 non-operated patients significantly changed at least one of the two parameters associated to primary signs (FD and/or POD). Eleven participants worsened at least one parameter and 9 improved one parameter. CMTES significantly worsened for the group of non-operated patients. However, there was no change in CMTES score in 4 patients and in ONLS score in 11. At subgroup level, participants originally belonging to NL group showed a trend towards a foot-drop deficit (-15%, ns); FD and FD&POD subgroups did not change their primary signs, although significant changes were identified individually. All 3 patients operated have improved push-off and proximal joint patterns during walking. Clinical scores did not change within any sub-group.
Subtle changes occurring in 1.5 year in gait features of CMT1A children can be instrumentally identified. Such changes show a large inter-subject variability, with some patients even improving their walking pattern. There is anecdotal evidence that foot surgery may improve the push-off phase of gait.
Journal of NeuroEngineering and Rehabilitation 07/2013; 10(1):65. · 2.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the present study we explored the effect of prismatic adaptation (PA) applied to the upper right limb on the walking trajectory of a neglect patient with more severe neglect in far than in near space. The patient was asked to bisect a line fixed to the floor by walking across it before and after four sessions of PA distributed over a time frame of 67 days. Gait path was analyzed by means of an optoelectronic motion analysis system. The walking tra-jectory improved following PA and the result was maintained at follow-up, 15 months after treatment. The improvement was greater for the predicted bisection error (estimated on the basis of the trajectory extrapolated from the first walking step) than for the observed bisection error (measured at line bisection). These results show that PA may act on high level spatial representation of gait trajectory rather than on lower level sensory-motor gait components and suggest that PA may have a long-lasting rehabilitative effect on neglect patients showing a deviated walking trajectory.
Frontiers in Human Neuroscience 07/2013; · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In anosognosia for hemiplegia, patients may claim having performed willed actions with the paralyzed limb despite unambiguous evidence to the contrary. Does this false belief of having moved reflect the functioning of the same mechanisms that govern normal motor performance? Here, we examined whether anosognosics show the same temporal constraints known to exist during bimanual movements in healthy subjects. In these paradigms, when participants simultaneously reach for two targets of different difficulties, the motor programs of one hand affect the execution of the other. In detail, the movement time of the hand going to an easy target (i.e., near and large), while the other is going to a difficult target (i.e., far and small), is slowed with respect to unimanual movements (temporal coupling effect). One right-brain-damaged patient with left hemiplegia and anosognosia, six right-brain-damaged patients with left hemiplegia without anosognosia, and twenty healthy subjects were administered such a bimanual task. We recorded the movement times for easy and difficult targets, both in unimanual (one target) and bimanual (two targets) conditions. We found that, as healthy subjects, the anosognosic patient showed coupling effect. In bimanual asymmetric conditions (when one hand went to the easy target and the other went to the difficult target), the movement time of the non-paralyzed hand going to the easy target was slowed by the 'pretended' movement of the paralyzed hand going to the difficult target. This effect was not present in patients without anosognosia. We concluded that in anosognosic patients, the illusory movements of the paralyzed hand impose to the non-paralyzed hand the same motor constraints that emerge during the actual movements. Our data also support the view that coupling relies on central operations (i.e., activation of intention/programming system), rather than on online information from the periphery.
[Show abstract][Hide abstract] ABSTRACT: Can we fully incorporate into our body schema the body parts of others, altering our sense of ownership ? And, to what extent, given the tight link between body and motor representations, does an altered sense of body-ownership affect motor awareness  and the sense of agency [3,4]? The new study we report here demonstrates that a body part of one individual can become so deeply embedded in another's sensory-motor circuits as to have objective effects on the latter's motor execution. Indeed, we found, in right-brain-damaged hemiplegic patients who identified another person's hand as belonging to themselves, significant interference effects of the alien hand movements on the actual movements of their own intact hand.
Current biology: CB 01/2013; 23(2):R57-8. · 10.99 Impact Factor