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Fiori L, Castiglia SF, Chini G, Draicchio F, Sacco F, Serrao M, Tatarelli A, Varrecchia T, Ranavolo A. The Lower Limb Muscle Co-Activation Map during Human Locomotion: From Slow Walking to Running. Bioengineering (Basel) 2024; 11:288. [PMID: 38534562 DOI: 10.3390/bioengineering11030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
The central nervous system (CNS) controls movements and regulates joint stiffness with muscle co-activation, but until now, few studies have examined muscle pairs during running. This study aims to investigate differences in lower limb muscle coactivation during gait at different speeds, from walking to running. Nineteen healthy runners walked and ran at speeds ranging from 0.8 km/h to 9.3 km/h. Twelve lower limb muscles' co-activation was calculated using the time-varying multi-muscle co-activation function (TMCf) with global, flexor-extension, and rostro-caudal approaches. Spatiotemporal and kinematic parameters were also measured. We found that TMCf, spatiotemporal, and kinematic parameters were significantly affected by gait speed for all approaches. Significant differences were observed in the main parameters of each co-activation approach and in the spatiotemporal and kinematic parameters at the transition between walking and running. In particular, significant differences were observed in the global co-activation (CIglob, main effect F(1,17) = 641.04, p < 0.001; at the transition p < 0.001), the stride length (main effect F(1,17) = 253.03, p < 0.001; at the transition p < 0.001), the stride frequency (main effect F(1,17) = 714.22, p < 0.001; at the transition p < 0.001) and the Center of Mass displacement in the vertical (CoMy, main effect F(1,17) = 426.2, p < 0.001; at the transition p < 0.001) and medial-lateral (CoMz, main effect F(1,17) = 120.29 p < 0.001; at the transition p < 0.001) directions. Regarding the correlation analysis, the CoMy was positively correlated with a higher CIglob (r = 0.88, p < 0.001) and negatively correlated with Full Width at Half Maximum (FWHMglob, r = -0.83, p < 0.001), whereas the CoMz was positively correlated with the global Center of Activity (CoAglob, r = 0.97, p < 0.001). Positive and negative strong correlations were found between global co-activation parameters and center of mass displacements, as well as some spatiotemporal parameters, regardless of gait speed. Our findings suggest that walking and running have different co-activation patterns and kinematic characteristics, with the whole-limb stiffness exerted more synchronously and stably during running. The co-activation indexes and kinematic parameters could be the result of global co-activation, which is a sensory-control integration process used by the CNS to deal with more demanding and potentially unstable tasks like running.
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Affiliation(s)
- Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
- Behavioral Neuroscience PhD Program, Department of Physiology and Pharmacology, Sapienza University, Viale dell'Università 30, 00185 Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Floriana Sacco
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
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Ranavolo A, Ajoudani A, Chini G, Lorenzini M, Varrecchia T. Adaptive Lifting Index ( aLI) for Real-Time Instrumental Biomechanical Risk Assessment: Concepts, Mathematics, and First Experimental Results. Sensors (Basel) 2024; 24:1474. [PMID: 38475017 DOI: 10.3390/s24051474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/16/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
When performing lifting tasks at work, the Lifting Index (LI) is widely used to prevent work-related low-back disorders, but it presents criticalities pertaining to measurement accuracy and precision. Wearable sensor networks, such as sensorized insoles and inertial measurement units, could improve biomechanical risk assessment by enabling the computation of an adaptive LI (aLI) that changes over time in relation to the actual method of carrying out lifting. This study aims to illustrate the concepts and mathematics underlying aLI computation and compare aLI calculations in real-time using wearable sensors and force platforms with the LI estimated with the standard method used by ergonomists and occupational health and safety technicians. To reach this aim, 10 participants performed six lifting tasks under two risk conditions. The results show us that the aLI value rapidly converges towards the reference value in all tasks, suggesting a promising use of adaptive algorithms and instrumental tools for biomechanical risk assessment.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy
| | - Arash Ajoudani
- HRI2 Laboratory, Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy
| | - Marta Lorenzini
- HRI2 Laboratory, Istituto Italiano di Tecnologia, 16163 Genova, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy
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Ranavolo A, Ajoudani A, Bonnet V, De Nunzio AM, Draicchio F, Sartori M, Serrao M. Editorial: Job integration/reintegration of people with neuromuscular disorders in the epoch of "industry 4.0". Front Neurol 2024; 15:1371430. [PMID: 38456151 PMCID: PMC10919900 DOI: 10.3389/fneur.2024.1371430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Arash Ajoudani
- HRI2 Laboratory, Italian Institute of Technology (IIT), Genova, Italy
| | - Vincent Bonnet
- LAAS-CNRS, Université Paul Sabatier, CNRS, Toulouse, France
| | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - National Institute for Insurance Against Accidents at Work, Rome, Italy
| | - Massimo Sartori
- Department of Biomechanical Engineering, University of Twente, Enschede, Netherlands
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
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Castiglia SF, Trabassi D, Conte C, Gioiosa V, Sebastianelli G, Abagnale C, Ranavolo A, Di Lorenzo C, Coppola G, Casali C, Serrao M. Local Dynamic Stability of Trunk During Gait is Responsive to Rehabilitation in Subjects with Primary Degenerative Cerebellar Ataxia. Cerebellum 2024:10.1007/s12311-024-01663-4. [PMID: 38279000 DOI: 10.1007/s12311-024-01663-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
This study aimed to assess the responsiveness to the rehabilitation of three trunk acceleration-derived gait indexes, namely the harmonic ratio (HR), the short-term longest Lyapunov's exponent (sLLE), and the step-to-step coefficient of variation (CV), in a sample of subjects with primary degenerative cerebellar ataxia (swCA), and investigate the correlations between their improvements (∆), clinical characteristics, and spatio-temporal and kinematic gait features. The trunk acceleration patterns in the antero-posterior (AP), medio-lateral (ML), and vertical (V) directions during gait of 21 swCA were recorded using a magneto-inertial measurement unit placed at the lower back before (T0) and after (T1) a period of inpatient rehabilitation. For comparison, a sample of 21 age- and gait speed-matched healthy subjects (HSmatched) was also included. At T1, sLLE in the AP (sLLEAP) and ML (sLLEML) directions significantly improved with moderate to large effect sizes, as well as SARA scores, stride length, and pelvic rotation. sLLEML and pelvic rotation also approached the HSmatched values at T1, suggesting a normalization of the parameter. HRs and CV did not significantly modify after rehabilitation. ∆sLLEML correlated with ∆ of the gait subscore of the SARA scale (SARAGAIT) and ∆stride length and ∆sLLEAP correlated with ∆pelvic rotation and ∆SARAGAIT. The minimal clinically important differences for sLLEML and sLLEAP were ≥ 36.16% and ≥ 28.19%, respectively, as the minimal score reflects a clinical improvement in SARA scores. When using inertial measurement units, sLLEAP and sLLEML can be considered responsive outcome measures for assessing the effectiveness of rehabilitation on trunk stability during walking in swCA.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy.
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.
| | - Dante Trabassi
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Carmela Conte
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Valeria Gioiosa
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Chiara Abagnale
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Alberto Ranavolo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso Della Repubblica 79, 04100, Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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Varrecchia T, Chini G, Tarbouriech S, Navarro B, Cherubini A, Draicchio F, Ranavolo A. The assistance of BAZAR robot promotes improved upper limb motor coordination in workers performing an actual use-case manual material handling. Ergonomics 2023; 66:1950-1967. [PMID: 36688620 DOI: 10.1080/00140139.2023.2172213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/14/2023] [Indexed: 06/17/2023]
Abstract
This study aims at evaluating upper limb muscle coordination and activation in workers performing an actual use-case manual material handling (MMH). The study relies on the comparison of the workers' muscular activity while they perform the task, with and without the help of a dual-arm cobot (BAZAR). Eleven participants performed the task and the flexors and extensors muscles of the shoulder, elbow, wrist, and trunk joints were recorded using bipolar electromyography. The results showed that, when the particular MMH was carried out with BAZAR, both upper limb and trunk muscular co-activation and activation were decreased. Therefore, technologies that enable human-robot collaboration (HRC), which share a workspace with employees, relieve employees of external loads and enhance the effectiveness and calibre of task completion. Additionally, these technologies improve the worker's coordination, lessen the physical effort required to interact with the robot, and have a favourable impact on his or her physiological motor strategy. Practitioner summary: Upper limb and trunk muscle co-activation and activation is reduced when a specific manual material handling was performed with a cobot than without it. By improving coordination, reducing physical effort, and changing motor strategy, cobots could be proposed as an ergonomic intervention to lower workers' biomechanical risk in industry.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | | | | | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
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6
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Varrecchia T, Ranavolo A, Chini G, De Nunzio AM, Draicchio F, Martinez-Valdes E, Falla D, Conforto S. High-density surface electromyography allows to identify risk conditions and people with and without low back pain during fatiguing frequency-dependent lifting activities. J Electromyogr Kinesiol 2023; 73:102839. [PMID: 37948840 DOI: 10.1016/j.jelekin.2023.102839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
Low back pain (LBP) is a leading cause of disability in the workplace, often caused by manually lifting of heavy loads. Instrumental-based assessment tools are used to quantitatively assess the biomechanical risk of lifting activities. This study aims to verify that, during the execution of fatiguing frequency-dependent lifting, high-density surface electromyography (HDsEMG) allows the discrimination of healthy controls (HC) versus people with LBP and biomechanical risk levels. Fifteen HC and eight people with LBP performed three lifting tasks with a progressively increasing lifting index, each lasting 15 min. Erector spinae (ES) activity was recorded using HDsEMG and amplitude parameters were calculated to characterize the spatial distribution of muscle activity. LBP group showed a less ES activity than HC (lower root mean square across the grid and of the activation region) and an involvement of the same muscular area across the task (lower coefficient of variation of the center of gravity of muscle activity). The results indicate the usefulness of HDsEMG parameters to classify risk levels for both HC and LBP groups and to determine differences between them. The findings suggest that the use of HDsEMG could expand the capabilities of existing instrumental-based tools for biomechanical risk classification during lifting activities.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy.
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy.
| | - Alessandro Marco De Nunzio
- LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, Differdange 4671, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange 4671, Luxembourg.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00078 Rome, Italy.
| | - Eduardo Martinez-Valdes
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B152TT, United Kingdom.
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston B152TT, United Kingdom.
| | - Silvia Conforto
- Department of Industrial, Electronic and Mechanical Engineering, Roma Tre University, Via Vito Volterra 62, Roma, Lazio, Italy.
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Cherubini A, Navarro B, Passama R, Tarbouriech S, Elprama SA, Jacobs A, Niehaus S, Wischniewski S, Tönis FJ, Siahaya PL, Chini G, Varrecchia T, Ranavolo A. Interdisciplinary evaluation of a robot physically collaborating with workers. PLoS One 2023; 18:e0291410. [PMID: 37819889 PMCID: PMC10566690 DOI: 10.1371/journal.pone.0291410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Collaborative Robots-CoBots-are emerging as a promising technological aid for workers. To date, most CoBots merely share their workspace or collaborate without contact, with their human partners. We claim that robots would be much more beneficial if they physically collaborated with the worker, on high payload tasks. To move high payloads, while remaining safe, the robot should use two or more lightweight arms. In this work, we address the following question: to what extent can robots help workers in physical human-robot collaboration tasks? To find an answer, we have gathered an interdisciplinary group, spanning from an industrial end user to cognitive ergonomists, and including biomechanicians and roboticists. We drew inspiration from an industrial process realized repetitively by workers of the SME HANKAMP (Netherlands). Eleven participants replicated the process, without and with the help of a robot. During the task, we monitored the participants' biomechanical activity. After the task, the participants completed a survey with usability and acceptability measures; seven workers of the SME completed the same survey. The results of our research are the following. First, by applying-for the first time in collaborative robotics-Potvin's method, we show that the robot substantially reduces the participants' muscular effort. Second: we design and present an unprecedented method for measuring the robot reliability and reproducibility in collaborative scenarios. Third: by correlating the worker's effort with the power measured by the robot, we show that the two agents act in energetic synergy. Fourth: the participant's increasing level of experience with robots shifts his/her focus from the robot's overall functionality towards finer expectations. Last but not least: workers and participants are willing to work with the robot and think it is useful.
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Affiliation(s)
| | | | | | | | | | - An Jacobs
- IMEC-SMIT-Vrije Universiteit Brussel, Brussels, Belgium
| | - Susanne Niehaus
- Federal Institute of Occupational Safety and Health, Dortmund, Germany
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Refai MIM, Sridar S, Govaerts R, Chini G, Varrecchia T, Del Ferraro S, Falcone T, De Bock S, Molinaro V, Elprama SA, Jacobs A, Ranavolo A, De Pauw K, van der Kooij H, Sartori M. Does a Soft Actuated Back Exosuit Influence Multimodal Physiological Measurements and User Perception During an Industry Inspired Task? IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941262 DOI: 10.1109/icorr58425.2023.10304777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Back support soft exosuits are promising solutions to reduce risk of musculoskeletal injuries at workplaces resulting from physically demanding and repetitive lifting tasks. Design of novel active exosuits address the impact on the muscle activity and metabolic costs but do not consider other critical aspects such as comfort and user perception during the intended tasks. Thus, in this study, we describe a novel soft active exosuit in line with its impact on physiological and subjective measures during lifting. We tested four healthy participants who performed repetitive lifting tasks with and without this exosuit. The exosuit provided assistance proportional to the lumbar flexion angle measured using an inertial measurement unit. We measured the participant's multimodal physiological measures including surface electromyography, metabolic cost, heart rate, and skin temperature. We also measured subjective scores on user exertion, task load, and device acceptability. All participants perceived a reduction in task load when using the exosuit. Three participants showed reduction of muscle activity for the erector spinae muscles. The metabolic costs and heart rate reserve reduced for two participants, with similar trends for skin temperature. For future development of workplace exosuits, we recommend incorporating assessments of both physiological and subjective measures, considering the user-dependent response to the exosuit.
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Correction to: Consensus Paper: Ataxic Gait. Cerebellum 2023; 22:431-432. [PMID: 35536510 DOI: 10.1007/s12311-022-01413-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- Pierre Cabaraux
- Unite Des Ataxies Cerebelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, School of Medicine, Neuroscience Center, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico‑Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Universite Versailles Saint-Quentin, Versailles, France
- Service de NeuroImagerie, Centre Hospitalier National des 15‑20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tubingen, Tubingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
- Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico‑Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesu Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tubingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unite Des Ataxies Cerebelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium
- Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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10
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Castiglia SF, Trabassi D, Conte C, Ranavolo A, Coppola G, Sebastianelli G, Abagnale C, Barone F, Bighiani F, De Icco R, Tassorelli C, Serrao M. Multiscale Entropy Algorithms to Analyze Complexity and Variability of Trunk Accelerations Time Series in Subjects with Parkinson's Disease. Sensors (Basel) 2023; 23:4983. [PMID: 37430896 DOI: 10.3390/s23104983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023]
Abstract
The aim of this study was to assess the ability of multiscale sample entropy (MSE), refined composite multiscale entropy (RCMSE), and complexity index (CI) to characterize gait complexity through trunk acceleration patterns in subjects with Parkinson's disease (swPD) and healthy subjects, regardless of age or gait speed. The trunk acceleration patterns of 51 swPD and 50 healthy subjects (HS) were acquired using a lumbar-mounted magneto-inertial measurement unit during their walking. MSE, RCMSE, and CI were calculated on 2000 data points, using scale factors (τ) 1-6. Differences between swPD and HS were calculated at each τ, and the area under the receiver operating characteristics, optimal cutoff points, post-test probabilities, and diagnostic odds ratios were calculated. MSE, RCMSE, and CIs showed to differentiate swPD from HS. MSE in the anteroposterior direction at τ4 and τ5, and MSE in the ML direction at τ4 showed to characterize the gait disorders of swPD with the best trade-off between positive and negative posttest probabilities and correlated with the motor disability, pelvic kinematics, and stance phase. Using a time series of 2000 data points, a scale factor of 4 or 5 in the MSE procedure can yield the best trade-off in terms of post-test probabilities when compared to other scale factors for detecting gait variability and complexity in swPD.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Monte Porzio Catone, Italy
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Carmela Conte
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Alberto Ranavolo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Chiara Abagnale
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Francesca Barone
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Federico Bighiani
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, 00162 Rome, Italy
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11
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Ranaldi S, De Marchis C, Serrao M, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Characterization of prosthetic knees through a low-dimensional description of gait kinematics. J Neuroeng Rehabil 2023; 20:46. [PMID: 37055813 PMCID: PMC10100472 DOI: 10.1186/s12984-023-01160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
The characterization of both limbs' behaviour in prosthetic gait is of key importance for improving the prosthetic components and increasing the biomechanical capability of trans-femoral amputees. When characterizing human gait, modular motor control theories have been proven to be powerful in providing a compact description of the gait patterns. In this paper, the planar covariation law of lower limb elevation angles is proposed as a compact, modular description of prosthetic gait; this model is exploited for a comparison between trans-femoral amputees walking with different prosthetic knees and control subjects walking at different speeds. Results show how the planar covariation law is maintained in prostheses users, with a similar spatial organization and few temporal differences. Most of the differences among the different prosthetic knees are found in the kinematic coordination patterns of the sound side. Moreover, different geometrical parameters have been calculated over the common projected plane, and their correlation with classical gait spatiotemporal and stability parameters has been investigated. The results from this latter analysis have highlighted a correlation with several parameters of gait, suggesting that this compact description of kinematics unravels a significant biomechanical meaning. These results can be exploited to guide the control mechanisms of prosthetic devices based purely on the measurement of relevant kinematic quantities.
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Affiliation(s)
- Simone Ranaldi
- Department of Industrial Electronics and Mechanical Engineering, University Roma TRE, Rome, Italy.
| | | | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Rome, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Silvia Conforto
- Department of Industrial Electronics and Mechanical Engineering, University Roma TRE, Rome, Italy
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12
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Castiglia SF, Trabassi D, Tatarelli A, Ranavolo A, Varrecchia T, Fiori L, Di Lenola D, Cioffi E, Raju M, Coppola G, Caliandro P, Casali C, Serrao M. Identification of Gait Unbalance and Fallers Among Subjects with Cerebellar Ataxia by a Set of Trunk Acceleration-Derived Indices of Gait. Cerebellum 2023; 22:46-58. [PMID: 35079958 DOI: 10.1007/s12311-021-01361-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
This study aimed to assess the ability of 25 gait indices to characterize gait instability and recurrent fallers among persons with primary degenerative cerebellar ataxia (pwCA), regardless of gait speed, and investigate their correlation with clinical and kinematic variables. Trunk acceleration patterns were acquired during the gait of 34 pwCA, and 34 age- and speed-matched healthy subjects (HSmatched) using an inertial measurement unit. We calculated harmonic ratios (HR), percent recurrence, percent determinism, step length coefficient of variation, short-time largest Lyapunov exponent (sLLE), normalized jerk score, log-dimensionless jerk (LDLJ-A), root mean square (RMS), and root mean square ratio of accelerations (RMSR) in each spatial direction for each participant. Unpaired t-tests or Mann-Whitney tests were performed to identify significant differences between the pwCA and HSmatched groups. Receiver operating characteristics were plotted to assess the ability to characterize gait alterations in pwCA and fallers. Optimal cutoff points were identified, and post-test probabilities were calculated. The HRs showed to characterize gait instability and pwCA fallers with high probabilities. They were correlated with disease severity and stance, swing, and double support duration, regardless of gait speed. sLLEs, RMSs, RMSRs, and LDLJ-A were slightly able to characterize the gait of pwCA but failed to characterize fallers.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Davide Di Lenola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Ettore Cioffi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Manikandan Raju
- Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Pietro Caliandro
- Unità Operativa Complessa Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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13
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Chini G, Fiori L, Tatarelli A, Varrecchia T, Draicchio F, Ranavolo A. Indexes for motor performance assessment in job integration/reintegration of people with neuromuscular disorders: A systematic review. Front Neurol 2022; 13:968818. [PMID: 36158952 PMCID: PMC9493180 DOI: 10.3389/fneur.2022.968818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Individuals of working age affected by neuromuscular disorders frequently experience issues with their capacity to get employment, difficulty at work, and premature work interruption. Anyway, individuals with a disability could be able to return to work, thanks to targeted rehabilitation as well as ergonomic and training interventions. Biomechanical and physiological indexes are important for evaluating motor and muscle performance and determining the success of job integration initiatives. Therefore, it is necessary to determinate which indexes from the literature are the most appropriate to evaluate the effectiveness and efficiency of the return-to-work programs. To identify current and future valuable indexes, this study uses a systematic literature review methodology for selecting articles published from 2011 to March 30, 2021 from Scopus, Web of Science, and PubMed and for checking the eligibility and the potential bias risks. The most used indexes for motor performance assessment were identified, categorized, and analyzed. This review revealed a great potential for kinetic, kinematic, surface electromyography, postural, and other biomechanical and physiological indexes to be used for job integration/reintegration. Indeed, wearable miniaturized sensors, kinematic, kinetic, and sEMG-based indexes can be used to control collaborative robots, classify residual motor functions, and assess pre-post-rehabilitation and ergonomic therapies.
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Affiliation(s)
- Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
- Department of Physiology and Pharmacology and PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL-Istituto Nazionale Assicurazione Infortuni sul Lavoro, Rome, Italy
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14
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D’Anna C, Varrecchia T, Ranavolo A, De Nunzio AM, Falla D, Draicchio F, Conforto S. Centre of pressure parameters for the assessment of biomechanical risk in fatiguing frequency-dependent lifting activities. PLoS One 2022; 17:e0266731. [PMID: 35947818 PMCID: PMC9365398 DOI: 10.1371/journal.pone.0266731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/28/2022] [Indexed: 11/19/2022] Open
Abstract
Lifting tasks, among manual material handling activities, are those mainly associated with low back pain. In recent years, several instrumental-based tools were developed to quantitatively assess the biomechanical risk during lifting activities. In this study, parameters related to balance and extracted from the Centre of Pressure (CoP) data series are studied in fatiguing frequency-dependent lifting activities to: i) explore the possibility of classifying people with LBP and asymptomatic people during the execution of task; ii) examine the assessment of the risk levels associated with repetitive lifting activities, iii) enhance current understanding of postural control strategies during lifting tasks. Data were recorded from 14 asymptomatic participants and 7 participants with low back pain. The participants performed lifting tasks in three different lifting conditions (with increasing lifting frequency and risk levels) and kinetic and surface electromyography (sEMG) data were acquired. Kinetic data were used to calculated the CoP and parameters extracted from the latter show a discriminant capacity for the groups and the risk levels. Furthermore, sEMG parameters show a trend compatible with myoelectric manifestations of muscular fatigue. Correlation results between sEMG and CoP velocity parameters revealed a positive correlation between amplitude sEMG parameters and CoP velocity in both groups and a negative correlation between frequency sEMG parameters and CoP velocity. The current findings suggest that it is possible to quantitatively assess the risk level when monitoring fatiguing lifting tasks by using CoP parameters as well as identify different motor strategies between people with and without LBP.
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Affiliation(s)
- Carmen D’Anna
- Department of Engineering, Roma Tre University, Roma, Lazio, Italy
- * E-mail:
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Alessandro Marco De Nunzio
- LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., Differdange, Luxembourg
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, United Kingdom
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma Tre University, Roma, Lazio, Italy
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15
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Cabaraux P, Agrawal SK, Cai H, Calabro RS, Casali C, Damm L, Doss S, Habas C, Horn AKE, Ilg W, Louis ED, Mitoma H, Monaco V, Petracca M, Ranavolo A, Rao AK, Ruggieri S, Schirinzi T, Serrao M, Summa S, Strupp M, Surgent O, Synofzik M, Tao S, Terasi H, Torres-Russotto D, Travers B, Roper JA, Manto M. Consensus Paper: Ataxic Gait. Cerebellum 2022; 22:394-430. [PMID: 35414041 DOI: 10.1007/s12311-022-01373-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/19/2022]
Abstract
The aim of this consensus paper is to discuss the roles of the cerebellum in human gait, as well as its assessment and therapy. Cerebellar vermis is critical for postural control. The cerebellum ensures the mapping of sensory information into temporally relevant motor commands. Mental imagery of gait involves intrinsically connected fronto-parietal networks comprising the cerebellum. Muscular activities in cerebellar patients show impaired timing of discharges, affecting the patterning of the synergies subserving locomotion. Ataxia of stance/gait is amongst the first cerebellar deficits in cerebellar disorders such as degenerative ataxias and is a disabling symptom with a high risk of falls. Prolonged discharges and increased muscle coactivation may be related to compensatory mechanisms and enhanced body sway, respectively. Essential tremor is frequently associated with mild gait ataxia. There is growing evidence for an important role of the cerebellar cortex in the pathogenesis of essential tremor. In multiple sclerosis, balance and gait are affected due to cerebellar and spinal cord involvement, as a result of disseminated demyelination and neurodegeneration impairing proprioception. In orthostatic tremor, patients often show mild-to-moderate limb and gait ataxia. The tremor generator is likely located in the posterior fossa. Tandem gait is impaired in the early stages of cerebellar disorders and may be particularly useful in the evaluation of pre-ataxic stages of progressive ataxias. Impaired inter-joint coordination and enhanced variability of gait temporal and kinetic parameters can be grasped by wearable devices such as accelerometers. Kinect is a promising low cost technology to obtain reliable measurements and remote assessments of gait. Deep learning methods are being developed in order to help clinicians in the diagnosis and decision-making process. Locomotor adaptation is impaired in cerebellar patients. Coordinative training aims to improve the coordinative strategy and foot placements across strides, cerebellar patients benefiting from intense rehabilitation therapies. Robotic training is a promising approach to complement conventional rehabilitation and neuromodulation of the cerebellum. Wearable dynamic orthoses represent a potential aid to assist gait. The panel of experts agree that the understanding of the cerebellar contribution to gait control will lead to a better management of cerebellar ataxias in general and will likely contribute to use gait parameters as robust biomarkers of future clinical trials.
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Affiliation(s)
- Pierre Cabaraux
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.
| | | | - Huaying Cai
- Department of Neurology, Neuroscience Center, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310016, China
| | | | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Loic Damm
- EuroMov Digital Health in Motion, Univ Montpellier, IMT Mines Ales, Montpellier, France
| | - Sarah Doss
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Christophe Habas
- Université Versailles Saint-Quentin, Versailles, France.,Service de NeuroImagerie, Centre Hospitalier National des 15-20, Paris, France
| | - Anja K E Horn
- Institute of Anatomy and Cell Biology I, Ludwig Maximilians-University Munich, Munich, Germany
| | - Winfried Ilg
- Section Computational Sensomotorics, Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern, Dallas, TX, USA
| | - Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Vito Monaco
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Maria Petracca
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Ashwini K Rao
- Department of Rehabilitation & Regenerative Medicine (Programs in Physical Therapy), Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Serena Ruggieri
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy.,Neuroimmunology Unit, IRCSS Fondazione Santa Lucia, Rome, Italy
| | - Tommaso Schirinzi
- Department of Systems Medicine, University of Roma Tor Vergata, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Susanna Summa
- MARlab, Neuroscience and Neurorehabilitation Department, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians-University Munich, Munich, Germany
| | - Olivia Surgent
- Neuroscience Training Program and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthis Synofzik
- Department of Neurodegeneration, Hertie Institute for Clinical Brain Research and Centre of Neurology, Tübingen, Germany
| | - Shuai Tao
- Dalian Key Laboratory of Smart Medical and Health, Dalian University, Dalian, 116622, China
| | - Hiroo Terasi
- Department of Neurology, Tokyo Medical University, Tokyo, Japan
| | - Diego Torres-Russotto
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, USA
| | - Brittany Travers
- Department of Kinesiology and Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jaimie A Roper
- School of Kinesiology, Auburn University, Auburn, AL, USA
| | - Mario Manto
- Unité Des Ataxies Cérébelleuses, Department of Neurology, CHU de Charleroi, Charleroi, Belgium.,Service Des Neurosciences, University of Mons, UMons, Mons, Belgium
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16
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De Marchis C, Ranaldi S, Varrecchia T, Serrao M, Castiglia SF, Tatarelli A, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Characterizing the Gait of People With Different Types of Amputation and Prosthetic Components Through Multimodal Measurements: A Methodological Perspective. Front Rehabilit Sci 2022; 3:804746. [PMID: 36189078 PMCID: PMC9397865 DOI: 10.3389/fresc.2022.804746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Cristiano De Marchis
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
- Department of Engineering, University of Messina, Messina, Italy
- *Correspondence: Cristiano De Marchis
| | - Simone Ranaldi
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
| | - Tiwana Varrecchia
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Mariano Serrao
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Stefano Filippo Castiglia
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonella Tatarelli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Alberto Ranavolo
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Draicchio
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Center of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | - Silvia Conforto
- Department of Industrial, Electronics and Mechanical Engineering, Roma Tre University, Rome, Italy
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17
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Varrecchia T, Conforto S, De Nunzio AM, Draicchio F, Falla D, Ranavolo A. Trunk Muscle Coactivation in People with and without Low Back Pain during Fatiguing Frequency-Dependent Lifting Activities. Sensors 2022; 22:s22041417. [PMID: 35214319 PMCID: PMC8874369 DOI: 10.3390/s22041417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 01/31/2023]
Abstract
Lifting tasks are manual material-handling activities and are commonly associated with work-related low back disorders. Instrument-based assessment tools are used to quantitatively assess the biomechanical risk associated with lifting activities. This study aims at highlighting different motor strategies in people with and without low back pain (LBP) during fatiguing frequency-dependent lifting tasks by using parameters of muscle coactivation. A total of 15 healthy controls (HC) and eight people with LBP performed three lifting tasks with a progressively increasing lifting index (LI), each lasting 15 min. Bilaterally erector spinae longissimus (ESL) activity and rectus abdominis superior (RAS) were recorded using bipolar surface electromyography systems (sEMG), and the time-varying multi-muscle coactivation function (TMCf) was computed. The TMCf can significantly discriminate each pair of LI and it is higher in LBP than HC. Collectively, our findings suggest that it is possible to identify different motor strategies between people with and without LBP. The main finding shows that LBP, to counteract pain, coactivates the trunk muscles more than HC, thereby adopting a strategy that is stiffer and more fatiguing.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
- Department of Industrial, Electronic and Mechanical Engineering, Roma Tre University, 00146 Rome, Italy
| | - Silvia Conforto
- Department of Industrial, Electronic and Mechanical Engineering, Roma Tre University, 00146 Rome, Italy
- Correspondence:
| | - Alessandro Marco De Nunzio
- Department of Sport and Exercise Science, LUNEX International University of Health, Exercise and Sports, 4671 Luxembourg, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 4671 Luxembourg, Luxembourg
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK;
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Rome, Italy; (T.V.); (F.D.); (A.R.)
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Silvetti A, Ranavolo A, Varrecchia T, Chini G, Papale A, Fiori L, Fiorelli A, Tatarelli A, Trovato R, Draicchio F. Biomechanical overload risk assessment in Industry 4.0. Saf Health Work 2022. [DOI: 10.1016/j.shaw.2021.12.1212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Castiglia SF, Tatarelli A, Ranavolo A, Magnifica F, Trabassi D, De Icco R, Grillo V, Denaro A, Tassorelli C, Serrao M. Ability of a set of trunk acceleration-derived gait stability indexes to identify gait unbalance and recurrent fallers in subjects with Parkinson's disease. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Varrecchia T, Ranavolo A, Conforto S, De Nunzio AM, Arvanitidis M, Draicchio F, Falla D. Bipolar versus high-density surface electromyography for evaluating risk in fatiguing frequency-dependent lifting activities. Appl Ergon 2021; 95:103456. [PMID: 33984582 DOI: 10.1016/j.apergo.2021.103456] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Workers often develop low back pain due to manually lifting heavy loads. Instrumental-based assessment tools are used to quantitatively assess the biomechanical risk in lifting activities. This study aims to verify the hypothesis that high-density surface electromyography (HDsEMG) allows an optimized discrimination of risk levels associated with different fatiguing lifting conditions compared to traditional bipolar sEMG. 15 participants performed three lifting tasks with a progressively increasing lifting index (LI) each lasting 15 min. Erector spinae (ES) activity was recorded using both bipolar and HDsEMG systems. The amplitude of both bipolar and HDsEMG can significantly discriminate each pair of LI. HDsEMG data could discriminate across the different LIs starting from the fourth minute of the task while bipolar sEMG could only do so towards the end. The higher discriminative power of HDsEMG data across the lifting tasks makes such methodology a valuable tool to be used to monitor fatigue while lifting and could extend the possibilities offered by currently available instrumental-based tools.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040, Rome, Italy; Department of Engineering, Roma Tre University, Via Vito Volterra 62, Roma, Lazio, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040, Rome, Italy.
| | - Silvia Conforto
- Department of Engineering, Roma Tre University, Via Vito Volterra 62, Roma, Lazio, Italy.
| | - Alessandro Marco De Nunzio
- LUNEX International University of Health, Exercise and Sports, 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg; Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, Differdange, 4671, Luxembourg.
| | - Michail Arvanitidis
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B152TT, United Kingdom.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040, Rome, Italy.
| | - Deborah Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B152TT, United Kingdom.
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Varrecchia T, Castiglia SF, Ranavolo A, Conte C, Tatarelli A, Coppola G, Di Lorenzo C, Draicchio F, Pierelli F, Serrao M. An artificial neural network approach to detect presence and severity of Parkinson's disease via gait parameters. PLoS One 2021; 16:e0244396. [PMID: 33606730 PMCID: PMC7894951 DOI: 10.1371/journal.pone.0244396] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/08/2020] [Indexed: 01/16/2023] Open
Abstract
Introduction Gait deficits are debilitating in people with Parkinson’s disease (PwPD), which inevitably deteriorate over time. Gait analysis is a valuable method to assess disease-specific gait patterns and their relationship with the clinical features and progression of the disease. Objectives Our study aimed to i) develop an automated diagnostic algorithm based on machine-learning techniques (artificial neural networks [ANNs]) to classify the gait deficits of PwPD according to disease progression in the Hoehn and Yahr (H-Y) staging system, and ii) identify a minimum set of gait classifiers. Methods We evaluated 76 PwPD (H-Y stage 1–4) and 67 healthy controls (HCs) by computerized gait analysis. We computed the time-distance parameters and the ranges of angular motion (RoMs) of the hip, knee, ankle, trunk, and pelvis. Principal component analysis was used to define a subset of features including all gait variables. An ANN approach was used to identify gait deficits according to the H-Y stage. Results We identified a combination of a small number of features that distinguished PwPDs from HCs (one combination of two features: knee and trunk rotation RoMs) and identified the gait patterns between different H-Y stages (two combinations of four features: walking speed and hip, knee, and ankle RoMs; walking speed and hip, knee, and trunk rotation RoMs). Conclusion The ANN approach enabled automated diagnosis of gait deficits in several symptomatic stages of Parkinson’s disease. These results will inspire future studies to test the utility of gait classifiers for the evaluation of treatments that could modify disease progression.
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Affiliation(s)
- Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
- * E-mail:
| | - Stefano Filippo Castiglia
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
| | | | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
- Department of Human Neurosciences, University of Rome Sapienza, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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Ranavolo A, Serrao M, Draicchio F. Critical Issues and Imminent Challenges in the Use of sEMG in Return-To-Work Rehabilitation of Patients Affected by Neurological Disorders in the Epoch of Human–Robot Collaborative Technologies. Front Neurol 2020; 11:572069. [PMID: 33414754 PMCID: PMC7783040 DOI: 10.3389/fneur.2020.572069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/30/2020] [Indexed: 01/07/2023] Open
Abstract
Patients affected by neurological pathologies with motor disorders when they are of working age have to cope with problems related to employability, difficulties in working, and premature work interruption. It has been demonstrated that suitable job accommodation plans play a beneficial role in the overall quality of life of pathological subjects. A well-designed return-to-work program should consider several recent innovations in the clinical and ergonomic fields. One of the instrument-based methods used to monitor the effectiveness of ergonomic interventions is surface electromyography (sEMG), a multi-channel, non-invasive, wireless, wearable tool, which allows in-depth analysis of motor coordination mechanisms. Although the scientific literature in this field is extensive, its use remains significantly underexploited and the state-of-the-art technology lags expectations. This is mainly attributable to technical and methodological (electrode-skin impedance, noise, electrode location, size, configuration and distance, presence of crosstalk signals, comfort issues, selection of appropriate sensor setup, sEMG amplitude normalization, definition of correct sEMG-related outcomes and normative data) and cultural limitations. The technical and methodological problems are being resolved or minimized also thanks to the possibility of using reference books and tutorials. Cultural limitations are identified in the traditional use of qualitative approaches at the expense of quantitative measurement-based monitoring methods to design and assess ergonomic interventions and train operators. To bridge the gap between the return-to-work rehabilitation and other disciplines, several teaching courses, accompanied by further electrodes and instrumentations development, should be designed at all Bachelor, Master and PhD of Science levels to enhance the best skills available among physiotherapists, occupational health and safety technicians and ergonomists.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
- *Correspondence: Alberto Ranavolo
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
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Ranavolo A, Ajoudani A, Cherubini A, Bianchi M, Fritzsche L, Iavicoli S, Sartori M, Silvetti A, Vanderborght B, Varrecchia T, Draicchio F. The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics. Sensors (Basel) 2020; 20:s20205750. [PMID: 33050438 PMCID: PMC7599507 DOI: 10.3390/s20205750] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/24/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
Due to the epochal changes introduced by “Industry 4.0”, it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human–robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative “direct instrumental evaluations” and “rating of standard methods”, allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers’ awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.
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Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy; (S.I.); (A.S.); (T.V.); (F.D.)
- Correspondence: ; Tel.: +39-043-224-0233
| | - Arash Ajoudani
- HRI2 Laboratory, Istituto Italiano di Tecnologia, 16163 Genova, Italy;
| | | | - Matteo Bianchi
- Centro di Ricerca “Enrico Piaggio” and Department of Information Engineering, Università di Pisa, 56126 Pisa, Italy;
| | - Lars Fritzsche
- Ergonomics Division, IMK Automotive GmbH, 09128 Chemnitz, Germany;
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy; (S.I.); (A.S.); (T.V.); (F.D.)
| | - Massimo Sartori
- Department of Biomechanical Engineering, University of Twente, 7522 NB Enschede, The Netherlands;
| | - Alessio Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy; (S.I.); (A.S.); (T.V.); (F.D.)
| | - Bram Vanderborght
- Brubotics, Vrije Universiteit Brussel, 1050 Brussels, Belgium;
- Flanders Make, Oude Diestersebaan 133, 3920 Lommel, Belgium
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy; (S.I.); (A.S.); (T.V.); (F.D.)
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy; (S.I.); (A.S.); (T.V.); (F.D.)
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Del Ferraro S, Falcone T, Ranavolo A, Molinaro V. The Effects of Upper-Body Exoskeletons on Human Metabolic Cost and Thermal Response during Work Tasks-A Systematic Review. Int J Environ Res Public Health 2020; 17:E7374. [PMID: 33050273 PMCID: PMC7600262 DOI: 10.3390/ijerph17207374] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND New wearable assistive devices (exoskeletons) have been developed for assisting people during work activity or rehabilitation. Although exoskeletons have been introduced into different occupational fields in an attempt to reduce the risk of work-related musculoskeletal disorders, the effectiveness of their use in workplaces still needs to be investigated. This systematic review focused on the effects of upper-body exoskeletons (UBEs) on human metabolic cost and thermophysiological response during upper-body work tasks. METHODS articles published until 22 September 2020 were selected from Scopus, Web of Science, and PubMed for eligibility and the potential risk of bias was assessed. RESULTS Nine articles resulted in being eligible for the metabolic aspects, and none for the thermal analysis. All the studies were based on comparisons between conditions with and without exoskeletons and considered a total of 94 participants (mainly males) performing tasks involving the trunk or overhead work, 7 back-support exoskeletons, and 1 upper-limb support exoskeleton. Eight studies found a significant reduction in the mean values of the metabolic or cardiorespiratory parameters considered and one found no differences. CONCLUSIONS The reduction found represents a preliminary finding that needs to be confirmed in a wider range of conditions, especially in workplaces, where work tasks show different characteristics and durations compared to those simulated in the laboratory. Future developments should investigate the dependence of metabolic cost on specific UBE design approaches during tasks involving the trunk and the possible statistical correlation between the metabolic cost and the surface ElectroMyoGraphy (sEMG) parameters. Finally, it could be interesting to investigate the effect of exoskeletons on the human thermophysiological response.
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Affiliation(s)
- Simona Del Ferraro
- INAIL—Department of Occupational and Environmental Medicine, Epidemiology and Hygiene—Laboratory of Ergonomics and Physiology, via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (T.F.); (A.R.); (V.M.)
| | - Tiziana Falcone
- INAIL—Department of Occupational and Environmental Medicine, Epidemiology and Hygiene—Laboratory of Ergonomics and Physiology, via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (T.F.); (A.R.); (V.M.)
- Unit of Advanced Robotics and Human-Centred Technologies, Campus Bio-Medico University of Rome, 00128 Rome, Italy
| | - Alberto Ranavolo
- INAIL—Department of Occupational and Environmental Medicine, Epidemiology and Hygiene—Laboratory of Ergonomics and Physiology, via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (T.F.); (A.R.); (V.M.)
| | - Vincenzo Molinaro
- INAIL—Department of Occupational and Environmental Medicine, Epidemiology and Hygiene—Laboratory of Ergonomics and Physiology, via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy; (T.F.); (A.R.); (V.M.)
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Castiglia SF, Ranavolo A, Varrecchia T, De Marchis C, Tatarelli A, Magnifica F, Fiori L, Conte C, Draicchio F, Conforto S, Serrao M. Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation. Gait Posture 2020; 80:280-284. [PMID: 32563728 DOI: 10.1016/j.gaitpost.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking. RESEARCH QUESTION This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis. METHODS The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis. RESULTS Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls. SIGNIFICANCE Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Fabrizio Magnifica
- Department of Neuroscience, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy; Italian Air Force Aerospace Medicine Department, Diagnostic Therapeutic and Rehabilitative Aeromedical Center, via Piero Gobetti 2, 00185, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy; Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Carmela Conte
- IRCCS Fondazione Don Carlo Gnocchi, Piazzale Morandi, 6, 20121, Milan, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, via Vito Volterra 62, 00146, Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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Tatarelli A, Serrao M, Varrecchia T, Fiori L, Draicchio F, Silvetti A, Conforto S, De Marchis C, Ranavolo A. Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation. Sensors (Basel) 2020; 20:s20092543. [PMID: 32365715 PMCID: PMC7249183 DOI: 10.3390/s20092543] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Antonella Tatarelli
- Department of Human Neurosciences, University of Rome Sapienza, 00185 Rome, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
- Correspondence:
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, 04100 Latina, Italy;
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Lorenzo Fiori
- Department of Physiology and Pharmacology, University of Rome Sapienza, 00185 Rome, Italy;
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Alessio Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Cristiano De Marchis
- Department of Engineering, Roma TRE University, 00185 Rome, Italy; (S.C.); (C.D.M.)
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy; (T.V.); (F.D.); (A.S.); (A.R.)
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Ranavolo A, Serrao M, Varrecchia T, Casali C, Filla A, Roca A, Silvetti A, Marcotulli C, Rondinone BM, Iavicoli S, Draicchio F. The Working Life of People with Degenerative Cerebellar Ataxia. Cerebellum 2020; 18:910-921. [PMID: 31468336 DOI: 10.1007/s12311-019-01065-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The aim of the present study was to characterize and analyze the most important individual and organizational variables associated with job accommodation in subjects with degenerative cerebellar ataxia by administering a series of international and validated work activity-related scales. Twenty-four workers (W) and 58 non-workers (NW) were recruited: 34 with autosomal dominant ataxia and 48 with autosomal recessive ataxia (27 with Friedreich ataxia and 21 with sporadic adult-onset ataxia of unknown etiology). The severity of ataxia was rated using the Scale for the Assessment and Rating of Ataxia. Our results showed that the ataxic W were predominantly middle-aged (41-50 years), high school graduate, and married men with a permanent work contract, who had been working for more than 7 years. The W with ataxia exhibited a good level of residual working capacity, irrespective of gender, age range, and duration of the disease, and they were observed to have a low or average-to-low job stress-related risk. Supporting patients with ataxia to find an appropriate job is an important priority because about 78% of NW search for a job and W and NW have the same potential work abilities (no relevant differences were found in terms of disease characteristics, gender, and work resilience). In this view, introducing NW to work-life may have a potential rehabilitative aspect. Findings of this study highlight that equal job opportunities for subjects affected by cerebellar ataxia are recommended.
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Affiliation(s)
- A Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078, Rome, Italy.
| | - M Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 40100, Latina, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - T Varrecchia
- Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00146, Rome, Italy
| | - C Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 40100, Latina, Italy
| | - A Filla
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II, Naples, Italy
| | - A Roca
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II, Naples, Italy
| | - A Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078, Rome, Italy
| | - C Marcotulli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 40100, Latina, Italy
| | - B M Rondinone
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078, Rome, Italy
| | - S Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078, Rome, Italy
| | - F Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078, Rome, Italy
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De Marchis C, Ranaldi S, Serrao M, Ranavolo A, Draicchio F, Lacquaniti F, Conforto S. Modular motor control of the sound limb in gait of people with trans-femoral amputation. J Neuroeng Rehabil 2019; 16:132. [PMID: 31694650 PMCID: PMC6836453 DOI: 10.1186/s12984-019-0616-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/25/2019] [Indexed: 01/12/2023] Open
Abstract
Background The above-knee amputation of a lower limb is a severe impairment that affects significantly the ability to walk; considering this, a complex adaptation strategy at the neuromuscular level is needed in order to be able to move safely with a prosthetic knee. In literature, it has been demonstrated that muscle activity during walking can be described via the activation of a small set of muscle synergies. The analysis of the composition and the time activation profiles of such synergies have been found to be a valid tool for the description of the motor control schemes in pathological subjects. Methods In this study, we used muscle synergy analysis techniques to characterize the differences in the modular motor control schemes between a population of 14 people with trans-femoral amputation and 12 healthy subjects walking at two different (slow and normal self-selected) speeds. Muscle synergies were extracted from a 12 lower-limb muscles sEMG recording via non-negative matrix factorization. Equivalence of the synergy vectors was quantified by a cross-validation procedure, while differences in terms of time activation coefficients were evaluated through the analysis of the activity in the different gait sub-phases. Results Four synergies were able to reconstruct the muscle activity in all subjects. The spatial component of the synergy vectors did not change in all the analysed populations, while differences were present in the activity during the sound limb’s stance phase. Main features of people with trans-femoral amputation’s muscle synergy recruitment are a prolonged activation of the module composed of calf muscles and an additional activity of the hamstrings’ module before and after the prosthetic heel strike. Conclusions Synergy-based results highlight how, although the complexity and the spatial organization of motor control schemes are the same found in healthy subjects, substantial differences are present in the synergies’ recruitment of people with trans femoral amputation. In particular, the most critical task during the gait cycle is the weight transfer from the sound limb to the prosthetic one. Future studies will integrate these results with the dynamics of movement, aiming to a complete neuro-mechanical characterization of people with trans-femoral amputation’s walking strategies that can be used to improve the rehabilitation therapies.
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Affiliation(s)
| | - Simone Ranaldi
- Department of Engineering, University Roma TRE, Roma, Italy.
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Roma, Italy.,Rehabilitation Centre, Policlinico Italia, Roma, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Roma, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Roma, Italy
| | - Francesco Lacquaniti
- Department of Systems Medicine and Centre of Space Biomedicine, University of Rome Tor Vergata, Roma, Italy.,Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, Roma, Italy
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29
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Serrao M, Pierelli F, Sinibaldi E, Chini G, Castiglia SF, Priori M, Gimma D, Sellitto G, Ranavolo A, Conte C, Bartolo M, Monari G. Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover. Front Neurol 2019; 10:902. [PMID: 31543859 PMCID: PMC6730596 DOI: 10.3389/fneur.2019.00902] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022] Open
Abstract
Introduction: The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity. Design: Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period. Participants: Forty individuals with idiopathic PD in Hoehn and Yahr stages 1–4. Intervention: Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B). Primary outcome measures: Spatiotemporal gait parameters, joint kinematics, and trunk kinematics. Secondary outcome measures: UPDRS-III scale scores. Results: The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously. Conclusions: The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT03346265.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,Movement Analysis Laboratory, Policlinico Italia, Rome, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Elisabetta Sinibaldi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giorgia Chini
- Movement Analysis Laboratory, Policlinico Italia, Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Marina Priori
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,Movement Analysis Laboratory, Policlinico Italia, Rome, Italy
| | - Dario Gimma
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Giovanni Sellitto
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | | | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Bergamo, Italy
| | - Giuseppe Monari
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
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30
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Serrao M, Chini G, Caramanico G, Bartolo M, Castiglia SF, Ranavolo A, Conte C, Venditto T, Coppola G, di Lorenzo C, Cardinali P, Pierelli F. Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease. Front Neurol 2019; 10:826. [PMID: 31428039 PMCID: PMC6688512 DOI: 10.3389/fneur.2019.00826] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/17/2019] [Indexed: 01/14/2023] Open
Abstract
Background: Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. Objectives: The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Methods: Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1–3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. Results: At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Conclusions: Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Giorgia Chini
- Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | - Guido Caramanico
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,Movement Analysis LAB, Policlinico Italia, Rome, Italy
| | | | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | | | | | | | | | | | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.,IRCCS - Neuromed, Pozzilli, Italy
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31
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Varrecchia T, Serrao M, Rinaldi M, Ranavolo A, Conforto S, De Marchis C, Simonetti A, Poni I, Castellano S, Silvetti A, Tatarelli A, Fiori L, Conte C, Draicchio F. Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components. Hum Mov Sci 2019; 66:9-21. [PMID: 30889496 DOI: 10.1016/j.humov.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.
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32
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Martino G, Ivanenko Y, Serrao M, Ranavolo A, Draicchio F, Casali C, Lacquaniti F. Locomotor coordination in patients with Hereditary Spastic Paraplegia. J Electromyogr Kinesiol 2019; 45:61-69. [PMID: 30836301 DOI: 10.1016/j.jelekin.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022] Open
Abstract
Locomotion is a complex behaviour that requires the coordination of multiple body segments and muscle groups. Here we investigated how the weakness and spasticity in individuals with Hereditary Spastic Paraplegia (HSP) affect the coordination patterns of the lower limbs. We analysed kinematics and electromyographic (EMG) activity from 12 leg muscles in 21 persons with HSP and 20 control subjects at matched walking speeds. To assess the locomotor coordination, we examined the covariation between thigh, shank and foot elevation angles by means of principal component analysis and the modular organization of EMG patterns using the non-negative matrix factorization algorithm. The characteristic features of the HSP gait consisted in changes of the elevation angles covariation, the shape of the gait loop, reduced range of motion of the distal segments and significantly lower foot lift. The EMG factorization analysis revealed a comparable structure of the motor output between HSP and control groups, but significantly wider basic temporal patterns associated with muscles innervated from the sacral spinal segments in HSP. Overall, the applied methodology highlighted the impact of the corticospinal degeneration and spasticity on the coordination of distal limb segments and basic muscle modules associated with distal spinal segments.
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Affiliation(s)
- G Martino
- Centre of Space Bio-medicine, University of Rome Tor Vergata, 00133 Rome, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy.
| | - Y Ivanenko
- Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy
| | - M Serrao
- Rehabilitation Centre Policlinico Italia, 00162 Rome, Italy; Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - A Ranavolo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy
| | - F Draicchio
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, 00078 Rome, Italy
| | - C Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, Italy
| | - F Lacquaniti
- Centre of Space Bio-medicine, University of Rome Tor Vergata, 00133 Rome, Italy; Laboratory of Neuromotor Physiology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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33
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Ranavolo A, Draicchio F, Varrecchia T, Silvetti A, Iavicoli S. Erratum: Alberto, R. et al., Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 2001. Int J Environ Res Public Health 2018; 15:ijerph15112569. [PMID: 30453581 PMCID: PMC6265804 DOI: 10.3390/ijerph15112569] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.
| | - Tiwana Varrecchia
- Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00146 Rome, Italy.
| | - Alessio Silvetti
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.
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34
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Varrecchia T, Rinaldi M, Serrao M, Draicchio F, Conte C, Conforto S, Schmid M, Ranavolo A. Global lower limb muscle coactivation during walking at different speeds: Relationship between spatio-temporal, kinematic, kinetic, and energetic parameters. J Electromyogr Kinesiol 2018; 43:148-157. [PMID: 30292137 DOI: 10.1016/j.jelekin.2018.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 08/01/2018] [Accepted: 09/27/2018] [Indexed: 12/12/2022] Open
Abstract
Muscle coactivation is the mechanism that regulates the simultaneous activity of antagonist muscles around the same joint. During walking, muscle joint coactivation varies within the gait cycle according to the functional role of the lower limb joints. In the present study, we used a time-varying multi-muscle coactivation function (TMCf) with the aim of investigating the coactivation of 12 lower limb muscles and its relationship with the gait cycle, gait speed (low, self-selected, and fast), ground reaction force, gait variability, and mechanical energy consumption, and recovery in a sample of 20 healthy subjects. Results show that the TMCf is speed dependent and highly repeatable within and between subjects, similar to the vertical force profile, and negatively correlated with energy recovery and positively correlated with both energy consumption and balance-related gait parameters. These findings suggest that the global lower limb coactivation behavior could be a useful measure of the motor control strategy, limb stiffness, postural stability, energy efficiency optimization, and several aspects in pathological conditions.
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Affiliation(s)
- T Varrecchia
- Department of Engineering, Roma TRE University, Rome, Italy
| | - M Rinaldi
- Department of Engineering, Roma TRE University, Rome, Italy
| | - M Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy; Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - F Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - C Conte
- Fondazione Don Gnocchi, Milan, Italy
| | - S Conforto
- Department of Engineering, Roma TRE University, Rome, Italy
| | - M Schmid
- Department of Engineering, Roma TRE University, Rome, Italy
| | - A Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy.
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35
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Rinaldi M, Nasr Y, Atef G, Bini F, Varrecchia T, Conte C, Chini G, Ranavolo A, Draicchio F, Pierelli F, Amin M, Marinozzi F, Serrao M. Biomechanical characterization of the Junzuki karate punch: indexes of performance. Eur J Sport Sci 2018; 18:796-805. [DOI: 10.1080/17461391.2018.1455899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Martina Rinaldi
- Department of Engineering, Roma TRE University, Rome, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - Yasmen Nasr
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Rome, Italy
| | - Ghada Atef
- Faculty of Physical Education, Beni-Suef University, Beni Suef, Egypt
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Rome, Italy
| | - Tiwana Varrecchia
- Department of Engineering, Roma TRE University, Rome, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
| | - Carmela Conte
- Movement Analysis Laboratory, Don Gnocchi Foundation, Milan, Italy
| | - Giorgia Chini
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- Department of Neurorehabilitation, IRCCS Neuromed, Pozzilli (IS), Italy
| | - Mokhtar Amin
- Faculty of Physical Education, Beni-Suef University, Beni Suef, Egypt
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Rome, Italy
| | - Mariano Serrao
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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Abstract
Beyond the classic clinical description, recent studies have quantitatively evaluated gait and balance dysfunction in cerebellar ataxias by means of modern motion analysis systems. These systems have the aim of clearly and quantitatively describing the differences, with respect to healthy subjects, in kinematic, kinetic, and surface electromyography variables, establishing the basis for a rehabilitation strategy and assessing its efficacy. The main findings which characterize the gait pattern of cerebellar patients are: increased step width, reduced ankle joint range of motion with increased coactivation of the antagonist muscles, and increased stride-to-stride variability. Whereas the former is a compensatory strategy adopted by patients to keep the center of mass within the base of support, the latter indicates the inability of patients to maintain dynamic balance through a regular walking pattern and may reflect the primary deficit directly related to cerebellar dysfunction and the consequent lack of muscle coordination during walking. Moreover, during the course of the disease, with the progressive loss of walking autonomy, step length, and lower-limb joint range of motion are drastically reduced. As to the joint coordination defect, abnormal intralimb joint coordination during walking, in terms of both joint kinematics and interaction torques, has been reported in several studies. Furthermore, patients with cerebellar ataxia show a poor intersegmental coordination, with a chaotic coordinative behavior between trunk and hip, leading to increased upper-body oscillations that affect gait performance and stability, sustaining a vicious circle that transforms the upper body into a generator of perturbations. The use of motion analysis laboratories allows a deeper segmental and global characterization of walking impairment in these patients and can shed light on the nature of both the primary specific gait disorder and compensatory mechanisms. Such deeper understanding might reasonably represent a valid prerequisite for establishing better-targeted rehabilitation strategies.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
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Serrao M, Chini G, Bergantino M, Sarnari D, Casali C, Conte C, Ranavolo A, Marcotulli C, Rinaldi M, Coppola G, Bini F, Pierelli F, Marinozzi F. Dataset on gait patterns in degenerative neurological diseases. Data Brief 2017; 16:806-816. [PMID: 29379852 PMCID: PMC5773445 DOI: 10.1016/j.dib.2017.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/07/2017] [Accepted: 12/07/2017] [Indexed: 11/26/2022] Open
Abstract
We collected the gait parameters and lower limb joint kinematics of patients with three different types of primary degenerative neurological diseases: (i) cerebellar ataxia (19 patients), (ii) hereditary spastic paraparesis (26 patients), and (iii) Parkinson’s disease (32 patients). Sixty-five gender-age matched healthy subjects were enrolled as control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 40100, Italy
- Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
- Corresponding author at: Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 40100, Italy.Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of RomeCorso della Repubblica 79Latina40100Italy
| | - Giorgia Chini
- Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
- Biolab3, Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00149 Roma, Italy
| | - Matteo Bergantino
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Via Eudossiana 18 – 00184 Roma, Italy
| | - Diego Sarnari
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Via Eudossiana 18 – 00184 Roma, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 40100, Italy
| | | | - Alberto Ranavolo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy
| | - Christian Marcotulli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 40100, Italy
| | - Martina Rinaldi
- Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
- Biolab3, Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00149 Roma, Italy
| | - Gianluca Coppola
- G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Via Livenza 3, 00198 Rome, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Via Eudossiana 18 – 00184 Roma, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina 40100, Italy
- IRCCS Neuromed, Pozzilli (IS), Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, “Sapienza” University of Rome, Via Eudossiana 18 – 00184 Roma, Italy
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Serrao M, Chini G, Iosa M, Casali C, Morone G, Conte C, Bini F, Marinozzi F, Coppola G, Pierelli F, Draicchio F, Ranavolo A. Corrigendum to "Harmony as a convergence attractor that minimizes the energy expenditure and variability in physiological gait and the loss of harmony in cerebellar ataxia."[Clin. Biomech. 48 (2017) 15-23]. Clin Biomech (Bristol, Avon) 2017; 50:160. [PMID: 29128742 DOI: 10.1016/j.clinbiomech.2017.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy; Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
| | - Giorgia Chini
- Biolab3, Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00149 Roma, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy
| | | | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Rome, Italy
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Rome, Italy
| | - Gianluca Coppola
- G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Via Livenza 3, 00198 Rome, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy
| | - Francesco Draicchio
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy
| | - Alberto Ranavolo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy
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Conte C, Serrao M, Cuius L, Ranavolo A, Conforto S, Pierelli F, Padua L. Effect of Restraining the Base of Support on the Other Biomechanical Features in Patients with Cerebellar Ataxia. Cerebellum 2017; 17:264-275. [PMID: 29143300 DOI: 10.1007/s12311-017-0897-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study aimed to analyze the biomechanical consequences of reducing the base of support in patients with ataxia. Specifically, we evaluated the spatio-temporal parameters, upper- and lower-body kinematics, muscle co-activation, and energy recovery and expenditure. The gaits of 13 patients were recorded using a motion analysis system in unperturbed and perturbed walking conditions. In the latter condition, patients had to walk using the same step width and speed of healthy controls. The perturbed walking condition featured reduced gait speed, step length, hip and knee range of motion, and energy recovery and increased double support duration, gait variability, trunk oscillation, and ankle joint muscle co-activation. Narrowing the base of support increased gait instability (e.g., gait variability and trunk oscillations) and induced patients to further use alternative compensatory mechanisms to maintain dynamic balance at the expense of a reduced ability to recover mechanical energy. A widened step width gait is a global strategy employed by patients to increase dynamic stability, reduce the need for further compensatory mechanisms, and thus recover mechanical energy. Our findings suggest that rehabilitative treatment should more specifically focus on step width training.
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Affiliation(s)
- C Conte
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy. .,Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162, Rome, Italy.
| | - L Cuius
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - A Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida 1, 00078, Monte Porzio Catone, Rome, Italy
| | - S Conforto
- Biolab3, Department of Engineering, Roma TRE University, ViaVito Volterra 62, 00149, Rome, Italy
| | - F Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza, Polo Pontino, University of Rome, via Franco Faggiana 1668, 04100, Latina, Italy.,IRCSS, Neuromed, Pozzilli, IS, Italy
| | - L Padua
- Fondazione Don Carlo Gnocchi, Piazzale Morandi 6, 20121, Milan, Italy.,Department of Geriatrics, Neuroscience & Orthopaedics, Catholic University, L.go F. Vito, 1, 00168, Rome, Italy
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Rinaldi M, Ranavolo A, Conforto S, Martino G, Draicchio F, Conte C, Varrecchia T, Bini F, Casali C, Pierelli F, Serrao M. Increased lower limb muscle coactivation reduces gait performance and increases metabolic cost in patients with hereditary spastic paraparesis. Clin Biomech (Bristol, Avon) 2017; 48:63-72. [PMID: 28779695 DOI: 10.1016/j.clinbiomech.2017.07.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 05/22/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis. METHODS Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated. FINDINGS Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery. INTERPRETATION Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity.
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Affiliation(s)
- Martina Rinaldi
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy.
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Silvia Conforto
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy.
| | - Giovanni Martino
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Via Orazio Raimondo 18, 00173 Rome, Italy; Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy
| | - Carmela Conte
- Fondazione Don Gnocchi, Piazzale Morandi 6, 20121 Milan, Italy
| | - Tiwana Varrecchia
- Department of Engineering, Roma TRE University, Via Ostiense 159, 00154 Rome, Italy; Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy
| | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, Mechanical & Thermal Measurement Lab, University of Rome Sapienza, Via Eudossiana 18, 00184 Rome, Italy.
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
| | - Mariano Serrao
- Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy.
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Serrao M, Chini G, Iosa M, Casali C, Morone G, Conte C, Bini F, Marinozzi F, Coppola G, Pierelli F, Draicchio F, Ranavolo A. Harmony as a convergence attractor that minimizes the energy expenditure and variability in physiological gait and the loss of harmony in cerebellar ataxia. Clin Biomech (Bristol, Avon) 2017; 48:15-23. [PMID: 28704694 DOI: 10.1016/j.clinbiomech.2017.07.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 06/20/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The harmony of the human gait was recently found to be related to the golden ratio value (ϕ). The ratio between the duration of the stance and that of the swing phases of a gait cycle was in fact found to be close to ϕ, which implies that, because of the fractal property of autosimilarity of that number, the gait ratios stride/stance, stance/swing, swing/double support, were not significantly different from one another. We studied a group of patients with cerebellar ataxia to investigate how the differences between their gait ratios and the golden ratio are related to efficiency and stability of their gait, assessed by energy expenditure and stride-to-stride variability, respectively. METHODS The gait of 28 patients who were affected by degenerative cerebellar ataxia and of 28 healthy controls was studied using a stereophotogrammetric system. The above mentioned gait ratios, the energy expenditure estimated using the pelvis reconstructed method and the gait variability in terms of the stride length were computed, and their relationships were analyzed. Matching procedures have also been used to avoid multicollinearity biases. FINDINGS The gait ratio values of the patients were farther from the controls (and hence from ϕ), even in speed matched conditions (P=0.011, Cohen's D=0.76), but not when the variability and energy expenditure were matched between the two groups (Cohen's D=0.49). In patients with cerebellar ataxia, the farther the stance-swing ratio was from ϕ, the larger the total mechanical work (R2adj=0.64). Further, a significant positive correlation was observed between the difference of the gait ratio from the golden ratio and the severity of the disease (R=0.421, P=0.026). INTERPRETATION Harmony of gait appears to be a benchmark of physiological gait leading to physiological energy recovery and gait reliability. Neurorehabilitation of patients with ataxia might benefit from the restoration of harmony of their locomotor patterns.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy; Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy.
| | - Giorgia Chini
- Biolab3, Department of Engineering, Roma TRE University, Via Vito Volterra 62, 00149 Roma, Italy
| | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy.
| | - Giovanni Morone
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Via Ardeatina 306, 00179 Rome, Italy.
| | | | - Fabiano Bini
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Rome, Italy.
| | - Franco Marinozzi
- Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Rome, Italy.
| | - Gianluca Coppola
- G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Via Livenza 3, 00198 Rome, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 34, 40100 Latina, Italy.
| | - Francesco Draicchio
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy.
| | - Alberto Ranavolo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy.
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Ranavolo A, Chini G, Silvetti A, Mari S, Serrao M, Draicchio F. Myoelectric manifestation of muscle fatigue in repetitive work detected by means of miniaturized sEMG sensors. Int J Occup Saf Ergon 2017; 24:464-474. [PMID: 28942714 DOI: 10.1080/10803548.2017.1357867] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Upper limb work-related musculoskeletal disorders have a 12-month prevalence ranging from 12 to 41% worldwide and can be partly caused by handling low loads at high frequency. The association between the myoelectric manifestation of elbow flexor muscle fatigue and occupational physical demand has never been investigated. It was hypothesized that an elbow flexor muscle fatigue index could be a valid risk indicator in handling low loads at high frequency. This study aims to measure the myoelectric manifestation of muscle fatigue of the three elbow flexor muscles during the execution of the work tasks in different risk conditions. Fifteen right-handed healthy adults were screened using a movement analysis laboratory consisting of optoelectronic, dynamometer and surface electromyographic systems. The main result indicates that the fatigue index calculated from the brachioradialis is sensitive to the interaction among risk classes, session and gender, and above all it is sensitive to the risk classes.
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Affiliation(s)
- Alberto Ranavolo
- a Department of Occupational and Environmental Medicine, Epidemiology and Hygiene , INAIL , Italy
| | - Giorgia Chini
- b Department of Engineering , Roma TRE University , Italy
| | - Alessio Silvetti
- a Department of Occupational and Environmental Medicine, Epidemiology and Hygiene , INAIL , Italy
| | - Silvia Mari
- c Rehabilitation Centre Policlinico Italia , Italy
| | - Mariano Serrao
- c Rehabilitation Centre Policlinico Italia , Italy.,d Department of Medical and Surgical Sciences and Biotechnologies , Sapienza University of Rome , Italy
| | - Francesco Draicchio
- a Department of Occupational and Environmental Medicine, Epidemiology and Hygiene , INAIL , Italy
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Serrao M, Casali C, Ranavolo A, Mari S, Conte C, Chini G, Leonardi L, Coppola G, DI Lorenzo C, Harfoush M, Padua L, Pierelli F. Use of dynamic movement orthoses to improve gait stability and trunk control in ataxic patients. Eur J Phys Rehabil Med 2017. [PMID: 28627859 DOI: 10.23736/s1973-9087.17.04480-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with cerebellar ataxia show increased upper body movements, which have an impact on balance and walking. AIM In this study, we investigated the effect of using dynamic movement orthoses (DMO), designed as elastic suits, on trunk motion and gait parameters. DESIGN Longitudinal uncontrolled study. SETTING Outpatient rehabilitation unit. POPULATION Eleven patients (7 men, 4 women; mean age: 49.9±9.5 years) with degenerative cerebellar ataxia were enrolled in this study. METHODS Linear overground gait of patients was recorded by means of an optoelectronic gait analysis system before DMO use (DMO-) and during DMO use (DMO+). Time-distance parameters, lower limb joint kinematics, body sway, trunk oscillations, and gait variability (coefficient of variation [CV]) were recorded. Patient satisfaction with DMO device was measured using Quebec user evaluation of satisfaction with assistive technology. RESULTS When using the DMO, patients showed a significant decrease in stance phase duration, double support phase duration, swing phase CV, pelvic range of motion (ROM), body sway, and trunk ROMs. A significant increase was observed in the swing phase duration and knee joint ROM. Out of 11 patients, 10 were either quite satisfied (8 points) or very satisfied (2 points) with the assistive device. CONCLUSIONS The DMO reduce the upper body motion and in improve balance-related gait parameters. CLINICAL REHABILITATION IMPACT We propose use of DMO as an assistive/rehabilitative device in the neurorehabilitation of cerebellar ataxia to improve the trunk control and gait stability. DMO may be considered a prototype that can be modified in terms of material characteristics, textile layers, elastic components, and diagonal and lateral seams.
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Affiliation(s)
- Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy - .,Movement Analysis Lab, Rehabilitation Center, Policlinico Italia Private Clinic, Rome, Italy -
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology, and Hygiene, INAIL, Rome, Italy
| | | | | | - Giorgia Chini
- Movement Analysis Lab, Rehabilitation Center, Policlinico Italia Private Clinic, Rome, Italy.,Department of Occupational and Environmental Medicine, Epidemiology, and Hygiene, INAIL, Rome, Italy
| | - Luca Leonardi
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy
| | - Gianluca Coppola
- Department of Neurophysiology of Vision and Neuro-Ophthalmology, G.B. Bietti Foundation and Institute for Research and Care, Rome, Italy
| | - Cherubino DI Lorenzo
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy
| | - Mahmoud Harfoush
- Movement Analysis Lab, Rehabilitation Center, Policlinico Italia Private Clinic, Rome, Italy
| | - Luca Padua
- Don Gnocchi Foundation, Milan, Italy.,Department of Geriatrics, Neuroscience and Orthopedics, Sacro Cuore Catholic University, Rome, Italy
| | - Francesco Pierelli
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy.,Neuromed Institute for Research and Care, Pozzilli, Isernia, Italy
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Morrone M, Miccinilli S, Bravi M, Paolucci T, Melgari JM, Salomone G, Picelli A, Spadini E, Ranavolo A, Saraceni VM, DI Lazzaro V, Sterzi S. Perceptive rehabilitation and trunk posture alignment in patients with Parkinson disease: a single blind randomized controlled trial. Eur J Phys Rehabil Med 2016; 52:799-809. [PMID: 27171537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Recent studies aimed to evaluate the potential effects of perceptive rehabilitation in Parkinson Disease reporting promising preliminary results for postural balance and pain symptoms. To date, no randomized controlled trial was carried out to compare the effects of perceptive rehabilitation and conventional treatment in patients with Parkinson Disease. AIM To evaluate whether a perceptive rehabilitation treatment could be more effective than a conventional physical therapy program in improving postural control and gait pattern in patients with Parkinson Disease. DESIGN Single blind, randomized controlled trial. SETTING Department of Physical and Rehabilitation Medicine of a University Hospital. POPULATION Twenty outpatients affected by idiopathic Parkinson Disease at Hoehn and Yahr stage ≤3. METHODS Recruited patients were divided into two groups: the first one underwent individual treatment with Surfaces for Perceptive Rehabilitation (Su-Per), consisting of rigid wood surfaces supporting deformable latex cones of various dimensions, and the second one received conventional group physical therapy treatment. Each patient underwent a training program consisting of ten, 45-minute sessions, three days a week for 4 consecutive weeks. Each subject was evaluated before treatment, immediately after treatment and at one month of follow-up, by an optoelectronic stereophotogrammetric system for gait and posture analysis, and by a computerized platform for stabilometric assessment. RESULTS Kyphosis angle decreased after ten sessions of perceptive rehabilitation, thus showing a substantial difference with respect to the control group. No significant differences were found as for gait parameters (cadence, gait speed and stride length) within Su-Per group and between groups. Parameters of static and dynamic evaluation on stabilometric platform failed to demonstrate any statistically relevant difference both within-groups and between-groups. CONCLUSIONS Perceptive training may help patients affected by Parkinson Disease into restoring a correct midline perception and, in turn, to improve postural control. CLINICAL REHABILITATION IMPACT Perceptive surfaces represent an alternative to conventional rehabilitation of postural disorders in Parkinson Disease. Further studies are needed to determine if the association of perceptive treatment and active motor training would be useful in improving also gait dexterity.
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Affiliation(s)
- Michelangelo Morrone
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy -
| | - Sandra Miccinilli
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Marco Bravi
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Teresa Paolucci
- Unit of Physical and Rehabilitation Medicine, Umberto I Hospital, "La Sapienza" University, Rome, Italy
| | - Jean M Melgari
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
- Movement Disorder Service, Neurology, Azienda Ospedaliera di Treviglio, Treviglio, Bergamo, Italy
| | - Gaetano Salomone
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Alessandro Picelli
- Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Ennio Spadini
- Neuromotor Rehabilitation Unit, S. Filippo Neri Hospital, "La Sapienza" University, Rome, Italy
| | - Alberto Ranavolo
- INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy
| | - Vincenzo M Saraceni
- Unit of Physical and Rehabilitation Medicine, Umberto I Hospital, "La Sapienza" University, Rome, Italy
| | - Vincenzo DI Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitation Medicine, Department of Medicine, Campus Bio-Medico University, Rome, Italy
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Serrao M, Rinaldi M, Ranavolo A, Lacquaniti F, Martino G, Leonardi L, Conte C, Varrecchia T, Draicchio F, Coppola G, Casali C, Pierelli F. Gait Patterns in Patients with Hereditary Spastic Paraparesis. PLoS One 2016; 11:e0164623. [PMID: 27732632 PMCID: PMC5061421 DOI: 10.1371/journal.pone.0164623] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/28/2016] [Indexed: 11/25/2022] Open
Abstract
Background Spastic gait is a key feature in patients with hereditary spastic paraparesis, but the gait characterization and the relationship between the gait impairment and clinical characteristics have not been investigated. Objectives To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking. Methods We evaluated fifty patients by computerized gait analysis and compared them to healthy participants. We computed time-distance parameters of walking and the range of angular motion at hip, knee, and ankle joints, and at the trunk and pelvis. Lower limb joint moments and muscle co-activation values were also evaluated. Results We identified three distinct subgroups of patients based on the range of motion values. Subgroup one was characterized by reduced hip, knee, and ankle joint range of motion. These patients were the most severely affected from a clinical standpoint, had the highest spasticity, and walked at the slowest speed. Subgroup three was characterized by an increased hip joint range of motion, but knee and ankle joint range of motion values close to control values. These patients were the most mildly affected and had the highest walking speed. Finally, subgroup two showed reduced knee and ankle joint range of motion, and hip range of motion values close to control values. Disease severity and gait speed in subgroup two were between those of subgroups one and three. Conclusions We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data. Distinguishing specific features in the gait patterns of these patients may help tailor pharmacological and rehabilitative treatments and may help evaluate therapeutic effects over time.
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Affiliation(s)
- Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- Rehabilitation Centre, Policlinico Italia, Rome, Italy
- * E-mail:
| | | | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Francesco Lacquaniti
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Martino
- Centre of Space Bio-Medicine, University of Rome Tor Vergata, Rome, Italy
- Laboratory of Neuromotor Physiology, Istituto Di Ricovero e Cura a Carattere Scientifico Santa Lucia Foundation, Rome, Italy
| | - Luca Leonardi
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | | | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Gianluca Coppola
- G.B. Bietti Foundation-IRCCS, Department of Neurophysiology of Vision and Neurophthalmology, Rome, Italy
| | - Carlo Casali
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy
- IRCCS, Neuromed, Pozzilli, Isernia, Italy
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Serrao M, Cortese F, Andersen OK, Conte C, Spaich EG, Fragiotta G, Ranavolo A, Coppola G, Perrotta A, Pierelli F. Modular organization of the head retraction responses elicited by electrical painful stimulation of the facial skin in humans. Clin Neurophysiol 2015; 126:2306-13. [PMID: 25769929 DOI: 10.1016/j.clinph.2015.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 11/25/2022]
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Martino G, Ivanenko YP, d'Avella A, Serrao M, Ranavolo A, Draicchio F, Cappellini G, Casali C, Lacquaniti F. Neuromuscular adjustments of gait associated with unstable conditions. J Neurophysiol 2015; 114:2867-82. [PMID: 26378199 DOI: 10.1152/jn.00029.2015] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 09/11/2015] [Indexed: 12/20/2022] Open
Abstract
A compact description of coordinated muscle activity is provided by the factorization of electromyographic (EMG) signals. With the use of this approach, it has consistently been shown that multimuscle activity during human locomotion can be accounted for by four to five modules, each one comprised of a basic pattern timed at a different phase of gait cycle and the weighting coefficients of synergistic muscle activations. These modules are flexible, in so far as the timing of patterns and the amplitude of weightings can change as a function of gait speed and mode. Here we consider the adjustments of the locomotor modules related to unstable walking conditions. We compared three different conditions, i.e., locomotion of healthy subjects on slippery ground (SL) and on narrow beam (NB) and of cerebellar ataxic (CA) patients on normal ground. Motor modules were computed from the EMG signals of 12 muscles of the right lower limb using non-negative matrix factorization. The unstable gait of SL, NB, and CA showed significant changes compared with controls in the stride length, stride width, range of angular motion, and trunk oscillations. In most subjects of all three unstable conditions, >70% of the overall variation of EMG waveforms was accounted for by four modules that were characterized by a widening of muscle activity patterns. This suggests that the nervous system adopts the strategy of prolonging the duration of basic muscle activity patterns to cope with unstable conditions resulting from either slippery ground, reduced support surface, or pathology.
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Affiliation(s)
- G Martino
- Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy; Laboratory of Neuromotor Physiology, Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy;
| | - Y P Ivanenko
- Laboratory of Neuromotor Physiology, Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy
| | - A d'Avella
- Laboratory of Neuromotor Physiology, Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy; Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - M Serrao
- Rehabilitation Centre Policlinico Italia, Rome, Italy; Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - A Ranavolo
- Istituto Nazionale per l'Assicurazione Contro gli Infortuni sul Lavoro, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy; and
| | - F Draicchio
- Istituto Nazionale per l'Assicurazione Contro gli Infortuni sul Lavoro, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Monte Porzio Catone, Rome, Italy; and
| | - G Cappellini
- Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy
| | - C Casali
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - F Lacquaniti
- Centre of Space Biomedicine, University of Rome Tor Vergata, Rome, Italy; Laboratory of Neuromotor Physiology, Istituto di Ricovero e Cura a Carattere Scientifico, Santa Lucia Foundation, Rome, Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Conte C, Pierelli F, Casali C, Ranavolo A, Draicchio F, Martino G, Harfoush M, Padua L, Coppola G, Sandrini G, Serrao M. Upper body kinematics in patients with cerebellar ataxia. Cerebellum 2015; 13:689-97. [PMID: 25063003 DOI: 10.1007/s12311-014-0586-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Although abnormal oscillations of the trunk are a common clinical feature in patients with cerebellar ataxia, the kinematic behaviour of the upper body in ataxic patients has yet to be investigated in quantitative studies. In this study, an optoelectronic motion analysis system was used to measure the ranges of motion (ROMs) of the head and trunk segments in the sagittal, frontal and yaw planes in 16 patients with degenerative cerebellar ataxia during gait at self-selected speed. The data obtained were compared with those collected in a gender-, age- and gait speed-matched sample of healthy subjects and correlated with gait variables (time-distance means and coefficients of variation) and clinical variables (disease onset, duration and severity). The results showed significantly larger head and/or trunk ROMs in ataxic patients compared with controls in all three spatial planes, and significant correlations between trunk ROMs and disease duration and severity (in sagittal and frontal planes) and time-distance parameters (in the yaw plane), and between both head and trunk ROMs and swing phase duration variability (in the sagittal plane). Furthermore, the ataxic patients showed a flexed posture of both the head and the trunk during walking. In conclusion, our study revealed abnormal motor behaviour of the upper body in ataxic patients, mainly resulting in a flexed posture and larger oscillations of the head and trunk. The results of the correlation analyses suggest that the longer and more severe the disease, the larger the upper body oscillations and that large trunk oscillations may explain some aspects of gait variability. These results suggest the need of specific rehabilitation treatments or the use of elastic orthoses that may be particularly useful to reduce trunk oscillations and improve dynamic stability.
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Affiliation(s)
- Carmela Conte
- Rehabilitation Centre, Movement Analysis LAB, Policlinico Italia, Rome, Italy
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Silvetti A, Mari S, Ranavolo A, Forzano F, Iavicoli S, Conte C, Draicchio F. Kinematic and electromyographic assessment of manual handling on a supermarket green- grocery shelf. Work 2015; 51:261-71. [DOI: 10.3233/wor-141900] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | | | | | - Carmela Conte
- Department of Neuroscience, University of Pavia, Pavia, Italy
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Ranavolo A, Mari S, Conte C, Serrao M, Silvetti A, Iavicoli S, Draicchio F. A new muscle co-activation index for biomechanical load evaluation in work activities. Ergonomics 2015; 58:966-979. [PMID: 25555042 DOI: 10.1080/00140139.2014.991764] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 11/14/2014] [Indexed: 06/04/2023]
Abstract
Low-back disorders (LBDs) are the most common and costly musculoskeletal problem. Muscle co-activation, a mechanism that stabilises the spine, is adopted by the central nervous system to provide added protection and avoid LBDs. However, during high-risk lifting tasks, the compressive load on the spine grows owing to increased co-activation. The aim of this study was to develop a method for the sample-by-sample monitoring of the co-activation of more than two muscles, and to compare this method with agonist-antagonist methods. We propose a time-varying multi-muscle co-activation function that considers electromyographic (EMG) signals as input. EMG data of 10 healthy subjects were recorded while they manually lifted loads at three progressively heavier conditions. The repeated measures ANOVA revealed a significant effect of lifting condition on our co-activation index. Heavier conditions resulted in higher muscle co-activation values. Significant correlations were found between the time-varying multi-muscle co-activation index and other agonist-antagonist methods. Practitioner Summary: We have developed a method to quantify muscle co-activation during the execution of a lifting task. To do this we used surface electromyography. Our algorithm provides a measure of time-varying co-activation between more than two muscles.
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Affiliation(s)
- Alberto Ranavolo
- a Department of Occupational Medicine , INAIL, Via Fontana Candida 1, Monte Porzio Catone, Rome 00040 , Italy
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