Publications (26)25.85 Total impact
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Conference Proceeding: Fatigue behaviour of artificial femoral stems: the role of Regulations and FE analysis
Terzo Congresso Gruppo Nazionale di Bioingegneria; 06/2012 -
Conference Proceeding: Evidence for telerehabilitation services from HTA Reports: a systematic review
Terzo Congresso Gruppo Nazionale di Bioingegneria; 06/2012 -
Article: Serum insulin-like growth factor-I (IGF-I) reference ranges for chemiluminescence assay in childhood and adolescence. Data from a population of in- and out-patients.
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ABSTRACT: Insulin-like growth factor I (IGF-I) measurement is widely used for the diagnosis of disorders of GH secretion and sensitivity, and for monitoring of both GH and IGF-I replacement therapies. However, the lack of appropriate reference values obtained from large and representative samples undermines its practical utility. To establish IGF-I reference values for a commonly used enzyme-labeled chemiluminescent immunometric assay in a large population of children aged 0 to 18 years. Cross-sectional analysis of serum IGF-I levels from samples collected in the two major Italian Children's Hospitals. IGF-I was measured using a solid-phase, enzyme-labeled chemiluminescent immunometric assay in 24403 children (50.6% girls) aged 0 to 18 years. Quantile regression coupled to multivariable fractional polynomials was used to produce age- and sex-specific reference values. Age- and sex-specific IGF-I reference values. Reference values for immunometric assay of IGF-I were produced in a large sample of children and adolescents. Prediction equations were provided to automatize their calculations.Growth hormone & IGF research: official journal of the Growth Hormone Research Society and the International IGF Research Society 05/2012; 22(3-4):134-8. · 2.35 Impact Factor -
Article: Responses to GHRH plus arginine test are more concordant with IGF-I circulating levels than responses to arginine and clonidine provocative tests.
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ABSTRACT: Although pharmacological GH stimulation tests are still considered the gold standard for GH deficiency (GHD) diagnosis, they are burdened by poor specificity. The majority of children diagnosed as having GHD show normal GH responses when re-tested at the end of growth, thus questioning the initial diagnosis. We evaluated the concordance between IGF-I levels and GH responses to provocative tests. We analyzed 105 GHRH plus arginine tests, 79 arginine tests, and 124 clonidine tests performed in 192 short children. IGF-I levels ≤-2SD score (SDS) were considered suggestive for high likelihood of GHD. The percentage of positive and negative results for each test was determined and compared with IGF-I levels, clinical follow-up and response to therapy. In children with IGF-I>-2SDS the arginine test showed a concordance rate of 6.9%, the clonidine test of 28.6%, and GHRH plus arginine test of 70%. In children with IGF-I≤-2SDS the concordance was 96.1%, 85.7%, and 46.4%, respectively. The overall concordance was 66.7% for GHRH plus arginine, 42.7% for clonidine, and 27.8% for arginine tests. Our results suggest that GHRH plus arginine test provides the best concordance with the assessment of IGF-I levels thus suggesting that the combination of the two procedures may significantly reduce the need of a second provocative test.Journal of endocrinological investigation 10/2011; 35(8):742-7. · 1.57 Impact Factor -
Article: Retinol-binding protein 4 in neonates born small for gestational age.
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ABSTRACT: Retinol-binding protein 4 (RBP4) is an adipocyte-derived 'signal' that may contribute to the pathogenesis of insulin resistance and Type 2 diabetes. The relationship of RBP4 with insulin resistance and metabolic risk in human beings has been the subject of several studies. Subjects born small for gestational age (SGA) are at risk of insulin resistance and Type 2 diabetes. Though RBP4 could represent an early marker of insulin resistance, to date, none have determined RBP4 in SGA children. Our aim was to measure RBP4 concentrations in cord blood of SGA newborns compared with those in children born with a birth weight appropriate for gestational age (AGA) and to determine whether serum RBP4 levels at birth correlate with insulin sensitivity markers. Sixty-four newborns, 17 born SGA (mean gestational age: 36.4+/-2.1 weeks), and 47 born AGA (mean gestational age: 37.0+/-3.6 weeks) were studied. The main outcome measures included anthropometry, lipid profile, insulin, homeostasis model assessment, quantitative insulin-sensitivity check index, adiponectin, and RBP4. RBP4 concentrations were significantly reduced in SGA newborns (p<0.002). No relationship was found between RBP4 and insulin sensitivity parameters. Stepwise regression analysis revealed that birth weight was the major predictor of RBP4 serum concentrations (p<0.001). RBP4 is reduced in SGA newborns, birth weight representing the major determinant of RBP4 concentrations, and is not related to insulin sensitivity. No significant difference in adiponectin levels and insulin sensitivity markers was found between SGA and AGA neonates.Journal of endocrinological investigation 04/2010; 33(4):218-21. · 1.57 Impact Factor -
Chapter: Satisfaction of patients and therapists with an upper limb tele-rehabilitation service
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ABSTRACT: Patient’s and operator’s satisfaction is one of the major requirements to be addressed in the implementation of a tele-rehabilitation service, to render it a valuable and effective means to administer remote rehabilitation treatment. This aspect was deeply investigated within the European Project HELLODOC (acronym for “HEaLthcare Service Linking Tele-rehabilitation to Disabled PeOple and Clinicians”; March 2005 - February 2007). The project focused on a home care upper limb tele-rehabilitation service delivered to a wide number - 81 patients in all - of neurological patients affected by traumatic brain injury (TBI), stroke (S) or multiple sclerosis (MS). The core of the service was the Portable Unit (PU) to be installed at patient’s home; the PU allows the execution of daily-like tasks and the measurement of some related kinetic and kinematic quantities. For evaluating general acceptability of the PU system a survey was delivered to patients and therapists, and a Visual Analogue Scale (VAS) was used to assess their satisfaction. The present study reports on main results of this activity. The analysis showed a general acceptability and satisfaction for both groups - patients and therapists - and some correlations were found among acceptability levels, pathologies and patient’s age. KeywordsTele-rehabilitation-patient’s satisfaction-upper-limb recovery01/2010: pages 176-179; -
Chapter: Pneumatic Test Device for the Accurate Assessment of Pressure Sensors
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ABSTRACT: Pressure sensors for plantar pressure measurement – either based on resistive or capacitive technology – should guarantee for high accuracy and reliability, since they are increasingly used both in scientific research tools in the field of biomechanics and in diagnostic tools in clinics. The above requirements not only entail a mandatory in-factory calibration, but also periodic in-the-field calibrations to verify the maintenance of an adequate quality level. The present study deals with the design, construction and validation of a valuable pneumatic calibration device suitable both for factory calibration – where each pressure sensor must be wholly characterized over the used pressure range – and for fast, easy in-the-field calibration - where sensor matrices must be tested in their final commercial assembly, and single pressure values are needed as well as force and center of pressure (COP) estimation. The described test device is based on a pneumatic circuit including an on-off valve and a proportional valve for the application of pressure in the range 0-700kPa under static and dynamic conditions over a small squared area, in the frequency range 0.5-1Hz. The test device is also equipped with a special tool to apply a known vertical force through 3 round supports of a graduated round table, to assess accuracy and precision of COP estimation. Correctness of table position is assured by an ad hoc positioning system. The pneumatic test device is relatively light, easily transportable, and adaptable to pressure sensors and platforms of different technology and size. KeywordsPressure sensors-biomechanics-test device-pneumatic circuit01/2010: pages 319-322; -
Article: The role of shear stress in the aetiology of diabetic neuropathic foot ulcers
Journal of Foot and Ankle Research 01/2008; I(suppl I). · 1.33 Impact Factor -
Conference Proceeding: Upper limb telerehabilitation with Home Care and Activity Desk (HCAD) system
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ABSTRACT: The main objective of this study was demonstrating the clinical effectiveness of the Home Care Activity Desk (HCAD) system in a home setting. The study was partly a randomized control trial study in which HCAD is compared to usual care. The patients using the HCAD system show during the month of treatment significant improvements on the individual tasks measured by the execution time. The overall results of the HCAD system concerning clinical effectiveness are positive. The HCAD system for chronic Stroke, TBI and MS patients is shown to be at least as effective as usual care.Virtual Rehabilitation, 2007; 10/2007 -
Article: Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism.
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ABSTRACT: The aim of this study was to examine foot function in the presence of diabetes-induced alterations of the anatomical and biomechanical unit formed by the Achilles tendon, plantar fascia and metatarso-phalangeal joints. More specifically, we focused on the Windlass mechanism, the physiological mechanism which entails stiffening of the foot during propulsion. Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. The thickness of Achilles tendon and plantar fascia was measured by ultrasound. The main biomechanical parameters of foot-floor interaction during gait were acquired by means of dedicated platforms. The range of motion of the 1st metatarso-phalangeal joint was measured passively. The plantar fascia (PF) and Achilles tendon (AT) were significantly thickened in diabetic patients [control subjects: PF 2.0+/-0.5 mm, AT 4.0+/-0.5 mm; diabetic patients without neuropathy: PF 2.9+/-1.2 mm (P=0.002), AT 4.6+/-1.0 mm (P=0.016); diabetic patients with neuropathy: PF 3.0+/-0.8 mm (P<0.0001), AT 4.9+/-1.7 mm (P=0.026)]. Joint mobility was significantly reduced [control subjects: 100.0+/-10.0 degrees; diabetic patients without neuropathy: 54.0+/-29.4 degrees (P<0.0001); diabetic patients with neuropathy: 54.9+/-17.2 degrees (P<0.0001)]. Loading times and force integrals under the heel and the metatarsals increased [metatarsal loading time (% stance phase): control subjects 88.2+/-4.1%; diabetic patients without neuropathy 90.1+/-4.7% (P=0.146); diabetic patients with neuropathy 91.7+/-6.6% (P=0.048)]. Increased thickness of Achilles tendon and plantar fascia, more evident in the presence of neuropathy, may contribute to an overall increase of tensile force and to the occurrence of an early Windlass mechanism, maintained throughout the whole gait cycle. This might play a significant role in the overall alteration of the biomechanics of the foot-ankle complex.Diabetic Medicine 12/2005; 22(12):1713-9. · 2.90 Impact Factor -
Article: Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading?
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ABSTRACT: The diabetic foot often undergoes abnormal plantar pressures, changing in walking strategy, ulcerative processes. The present study focuses on the effects that diabetes-induced alterations of Achilles tendon, plantar fascia and first metatarso-phalangeal joint-both anatomical and functional-may have on foot loading. Sixty-one diabetic patients, with or without neuropathy, and 21 healthy volunteers were recruited. Thickness of Achilles tendon and plantar fascia was measured by ultrasound. Flexion-extension of the first metatarso-phalangeal joint was measured passively. Main biomechanic parameters of foot-floor interaction during gait were acquired and related to the above measurements. Plantar fascia and Achilles tendon were significantly (P<0.05) thicker in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 2.0 mm (0.5), 2.9 mm (1.2) and 3.0 mm (0.8) for plantar fascia, respectively, and 4.0 mm (0.5), 4.6 mm (1.0) and 4.9 mm (1.7) for Achilles tendon, respectively. Flexion-extension of the first metatarso-phalangeal joint was significantly (P<0.05) smaller in diabetics than in controls; mean values (SD) for controls, diabetics without and with neuropathy were 100.0 degrees (10.0), 54.0 degrees (29.4) and 54.9 degrees (17.2), respectively. The increase in the vertical force under the metatarsals was strongly related (R=0.83, explained variance=70.1%) to the changes in the three above parameters. Thickening of plantar fascia and Achilles tendon in diabetics, more evident in the presence of neuropathy, concurs to develop a rigid foot, which poorly absorbs shock during landing (performs the physiological impact force absorption during landing). More generally, an overall alteration of the foot-ankle complex motion likely occurs throughout the whole gait cycle, which partly explains the abnormal loading under the forefoot.Clinical Biomechanics 06/2005; 20(5):532-9. · 2.07 Impact Factor -
Article: New instrumental set for the assessment of the hand functionality.
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ABSTRACT: Hand motor deficits have been widely investigated, and several devices have been proposed for the selective and accurate study of specific hand motor tasks. Most studies have focused on the four, long fingers. The thumb function, although extremely important for the performance of most daily activities involving the hand, has scarcely been documented. A set of general-purpose, instrumental measuring devices has been designed and constructed at the authors' laboratory to measure and monitor the force each finger exerts separately, under isometric conditions, during pressing tasks. More generally, it is meant for the functional evaluation of the normal hand in different postures, but it also provides reliable measurements of the injured or deformed hand. The instrumental set is suitable for both biomechanical research and clinical applications. Effectively integrated with a visual feedback tool, it could be exploited in delivering and monitoring custom-designed rehabilitation programmes. The characteristics of the force transducers (range 0-100 N) were: inter-axis crosstalk < 4%; non-linearity < +/- 0.4% f.s.; hysteresis < 0.3% f.s.; overall accuracy +/- 1% f.s. The overall measurement system resolution was better than 0.1 N, and the keys response to the mechanical shock (acquired at 10 kHz) showed a resonance frequency of about 1 kHz. It was observed that the thumb contributed more than 30% of the overall pressing force.Medical & Biological Engineering & Computing 09/2003; 41(5):513-5. · 1.88 Impact Factor -
Article: Measurement device for ankle joint kinematic and dynamic characterisation.
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ABSTRACT: The paper describes a measurement device for obtaining the kinematic characterisation and isometric loading of ankle joints under different working conditions. Non-invasive, in vivo experiments can be conducted with this experimental apparatus, the potential of which could be usefully exploited in basic biomedical research, prosthesis design, clinical applications, sports medicine and rehabilitation. The device determines the 3D movement of the foot with respect to the shank and evaluates the torques and moments around the three articular axes in relation to any desired angular position of the ankle complex. When integrated with superficial electromyographic techniques and electrical stimulation, it allows the assessment of the functionality of the lower leg in both mechanical and myo-electrical terms. The paper reports the main mechanical and electronic features of the device (high linearity; maximum moment ranges +/- 300 Nm for flexion-extension, +/- 35 Nm for both pronation-supination and internal-external rotation; angular ranges: +/- 100 degrees of dorsi-plantar flexion, +/- 50 degrees of internal-external rotation and prono-supination; linear ranges: +/- 25 mm along each axis). Results from a healthy volunteer, under voluntary or stimulated conditions, helped in testing its operatability, reliability, robustness, repeatability and effectiveness. Preliminary simplified protocols have been also applied to 20 healthy volunteers, and the main results were 80.8 +/- 11.9 degrees of internalexternal rotation, 46.2 +/- 9.1 degrees of prono-supination and 74.6 +/- 13.1 degrees of flexion-extension. Torques and moments were normalised with respect to a body mass index of 30. The maximum plantar flexion moment (57.5 + 21.3 Nm) was measured with the foot at 150 of dorsal flexion; the maximum dorsal flexion moment (50.2 + 20.3 Nm) was measured with the foot at 150 of plantar flexion.Medical & Biological Engineering & Computing 08/2003; 41(4):486-93. · 1.88 Impact Factor -
Article: Pattern of abnormal tangential forces in the diabetic neuropathic foot.
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ABSTRACT: The role of tangential stress in neuropathic foot ulceration is yet unknown. The aim of this study was to investigate the tangential forces developed during gait by the whole foot and by selected subareas of it, namely the heel, the metatarsals and the hallux. 61 diabetic patients have been evaluated: 27 without neuropathy, 19 with neuropathy and 15 with previous neuropathic ulcer. The patients were compared with 21 healthy volunteers. A piezo-dynamometric platform was used to measure the three components of the ground reaction force under the total foot and the selected subareas. A significant reduction was observed for the forward peak and the backward peak of the anteroposterior ground reaction force component measured under the whole foot. Patients with previous neuropathic ulcer showed a significant increase of the mediolateral stress under the metatarsals. Tangential stress is altered in diabetic neuropathic patients; the increased mediolateral component suggests that tangential stress could have a role in the high risk of recurrence observed in patients with previous ulceration. To assess the effectiveness of a non-invasive methodology for the estimation and the monitoring of significant alterations of the tangential stress with the increase of neuropathy.Clinical Biomechanics 07/2001; 16(5):446-54. · 2.07 Impact Factor -
Article: Integrated pressure-force-kinematics measuring system for the characterisation of plantar foot loading during locomotion.
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ABSTRACT: Plantar pressure, ground reaction force and body-segment kinematics measurements are largely used in gait analysis to characterise normal and abnormal function of the human foot. The combination of all these data together provides a more exhaustive, detailed and accurate view of foot loading during activities than traditional measurement systems alone do. A prototype system is presented that integrates a pressure platform, a force platform and a 3D anatomical tracking system to acquire combined information about foot function and loading. A stereophotogrammetric system and an anatomically based protocol for foot segment kinematics is included in a previously devised piezo-dynamometric system that combines pressure and force measurements. Experimental validation tests are carried out to check for both spatial and time synchronisation. Misalignment of the three systems is found to be within 6.0, 5.0 and 1.5 mm for the stereophotogrammetric system, force platform and pressure platform, respectively. The combination of position and pressure data allows for a more accurate selection of plantar foot subareas on the footprint. Measurements are also taken on five healthy volunteers during level walking to verify the feasibility of the overall experimental protocol. Four main subareas are defined and identified, and the relevant vertical and shear force data are computed. The integrated system is effective when there is a need for loading measurements in specific plantar foot subareas. This is attractive both in clinical assessment and in biomechanics research.Medical & Biological Engineering & Computing 04/2000; 38(2):156-63. · 1.88 Impact Factor -
Article: Spatial-temporal parameters of gait: reference data and a statistical method for normality assessment.
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ABSTRACT: Spatial and temporal parameters of gait are of recognised clinical relevance in the assessment of motor pathologies, because they normally occur in established combinations which can be altered by pathologies. The data collected from 596 healthy subjects have been used to establish relationships among these parameters and a procedure to estimate deviation from normality based on the comparison between measured values and values estimated by exploiting these relationships. The applied multiple linear regression method (MLRM) was preliminarily validated by comparing its outputs with those of corresponding equations found in the literature, and by applying it to a control group of 12 healthy subjects.Gait & Posture 11/1999; 10(2):171-81. · 2.12 Impact Factor -
Article: Alteration of spatial-temporal parameters of gait in Chronic Fatigue Syndrome patients.
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ABSTRACT: Chronic Fatigue Syndrome (CFS) has been widely studied and a lot of information is available in the literature regarding the immunological, virological, neuroendocrinal and psychiatric aspects of the disease, but its aetiology is still poorly understood. Great attention has also been paid to the alteration of the muscular function caused by CFS. The aim of the present work was to study CFS patients' gait in order to find out objective measures which can better characterize the pathology. Spatial and temporal parameters of gait were collected from a group of 12 CFS informed volunteers by using the typical instrumentation of movement analysis, and raw data were statistically elaborated. Comparisons with reference data from a population of healthy subjects revealed significant abnormalities in the symmetry indices of the bilateral parameters and in the linear relationships among parameters, and between these parameters and the physical characteristics of the patients. Interestingly, the abnormalities were present as from the beginning of the gait, which indicates that they are unlikely to be caused by the rapid increasing fatigue. This strengthens the hypothesis of a direct involvement of the central nervous system (CNS) in the onset of the disease.Journal of the Neurological Sciences 01/1998; 154(1):18-25. · 2.35 Impact Factor -
Article: Piezo-dynamometric platform for a more complete analysis of foot-to-floor interaction
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ABSTRACT: A compound instrument was constructed by superimposing a dedicated pressure platform on a commercial force platform. This instrument simultaneously estimates the ground reaction force resultants (vertical and shear forces, free moment and location of the center of pressure), pressure distribution throughout the foot-floor contact area, the trajectory of the center of pressure superimposed on the contact area (footprint). On the basis of the readings provided by the force plate the authors calibrated pressure sensors more accurately. They could therefore accurately estimate the vertical local components of the ground reaction. This information and the measured shear force resultants were essential for computing the shear forces acting on elementary areas corresponding to the active surface of each pressure sensor. This, in turn, allowed the authors to estimate the vertical and shear force resultants and free moment for subareas of the foot. This is a feature peculiar to this compound instrument, and for its effective exploitation the authors have implemented a few methods for the reliable identification of the subareas of interest. Two application instances are hereby reportedIEEE Transactions on Rehabilitation Engineering 01/1998; -
Article: Multistep pressure platform as a stand-alone system for gait assessment.
Medical & Biological Engineering & Computing 08/1996; 34(4):299-304. · 1.88 Impact Factor -
Article: A device for the measurement of malleoli diastasis.
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ABSTRACT: Assessment of the degree of laxity of the distal tibio-fibular joint ligaments is of great importance in the treatment of some ankle pathologies resulting from traumas and when evaluating the effectiveness of re-constructive operations. This can be done by measuring the variation in the intermalleolar distance while loading and flexing the joint in a known way. So far, only X-ray techniques have been applied for this purpose, but they are invasive and do not allow for analysis under dynamic conditions. We have developed a wearable strain gauge device to be positioned directly over the malleoli for measurement of the intermalleolar distance variation. It has been tested on healthy and injured subjects, in both static and dynamic conditions. Data obtained in the static tests are in agreement with those found in literature. Dynamic analysis allowed for correlation of malleoli diastasis (MD) with the different phases of gait and different injured states.Technology and health care: official journal of the European Society for Engineering and Medicine 04/1996; 3(4):241-9.
Top co-authors
Top Journals
Institutions
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2012
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Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico
Milano, Lombardy, Italy
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2010–2011
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University of Rome Tor Vergata
Roma, Latium, Italy
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1996–2010
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Istituto Superiore di Sanità
- Department of Technology and Health
Roma, Latium, Italy
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1998
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Università degli Studi G. d'Annunzio Chieti e Pescara
Chieti, Abruzzo, Italy
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