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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, 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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Dafarra S, Pattacini U, Romualdi G, Rapetti L, Grieco R, Darvish K, Milani G, Valli E, Sorrentino I, Viceconte PM, Scalzo A, Traversaro S, Sartore C, Elobaid M, Guedelha N, Herron C, Leonessa A, Draicchio F, Metta G, Maggiali M, Pucci D. iCub3 avatar system: Enabling remote fully immersive embodiment of humanoid robots. Sci Robot 2024; 9:eadh3834. [PMID: 38266102 DOI: 10.1126/scirobotics.adh3834] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
We present an avatar system designed to facilitate the embodiment of humanoid robots by human operators, validated through iCub3, a humanoid developed at the Istituto Italiano di Tecnologia. More precisely, the paper makes two contributions: First, we present the humanoid iCub3 as a robotic avatar that integrates the latest significant improvements after about 15 years of development of the iCub series. Second, we present a versatile avatar system enabling humans to embody humanoid robots encompassing aspects such as locomotion, manipulation, voice, and facial expressions with comprehensive sensory feedback including visual, auditory, haptic, weight, and touch modalities. We validated the system by implementing several avatar architecture instances, each tailored to specific requirements. First, we evaluated the optimized architecture for verbal, nonverbal, and physical interactions with a remote recipient. This testing involved the operator in Genoa and the avatar in the Biennale di Venezia, Venice-about 290 kilometers away-thus allowing the operator to visit the Italian art exhibition remotely. Second, we evaluated the optimized architecture for recipient physical collaboration and public engagement on stage, live, at the We Make Future show, a prominent world digital innovation festival. In this instance, the operator was situated in Genoa while the avatar operated in Rimini-about 300 kilometers away-interacting with a recipient who entrusted the avatar with a payload to carry on stage before an audience of approximately 2000 spectators. Third, we present the architecture implemented by the iCub Team for the All Nippon Airways (ANA) Avatar XPrize competition.
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Affiliation(s)
- Stefano Dafarra
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Ugo Pattacini
- iCub Tech Facility, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Giulio Romualdi
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Lorenzo Rapetti
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Riccardo Grieco
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Kourosh Darvish
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Gianluca Milani
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Enrico Valli
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Ines Sorrentino
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
- School of Computer Science, University of Manchester, Manchester, UK
| | - Paolo Maria Viceconte
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
- Department of Computer, Control, and Management Engineering, Sapienza Università di Roma, Rome, Italy
| | | | - Silvio Traversaro
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Carlotta Sartore
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
- School of Computer Science, University of Manchester, Manchester, UK
| | - Mohamed Elobaid
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Nuno Guedelha
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Connor Herron
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Alexander Leonessa
- Department of Mechanical Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Francesco Draicchio
- Department of Medicine, Epidemiology, Occupational and Environmental Hygiene, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Rome, Italy
| | - Giorgio Metta
- iCub Tech Facility, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Marco Maggiali
- iCub Tech Facility, Istituto Italiano di Tecnologia, Genoa, Italy
| | - Daniele Pucci
- Artificial and Mechanical Intelligence, Istituto Italiano di Tecnologia, Genoa, Italy
- School of Computer Science, University of Manchester, Manchester, UK
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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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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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Lazzaroni M, Chini G, Draicchio F, Di Natali C, Caldwell DG, Ortiz J. Control of a Back-Support Exoskeleton to Assist Carrying Activities. IEEE Int Conf Rehabil Robot 2023; 2023:1-6. [PMID: 37941236 DOI: 10.1109/icorr58425.2023.10304691] [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 exoskeletons are commonly used in the workplace to reduce low back pain risk for workers performing demanding activities. However, for the assistance of tasks differing from lifting, back-support exoskeletons potential has not been exploited extensively. This work focuses on the use of an active back-support exoskeleton to assist carrying. A control strategy is designed that modulates the exoskeleton torques to comply with the task assistance requirements. In particular, two gait phase detection frameworks are exploited to adapt the exoskeleton assistance according to the legs' motion. The control strategy is assessed through an experimental analysis on ten subjects. Carrying task is performed without and with the exoskeleton assistance. Results prove the potential of the presented control in assisting the task without hindering the gait movement and improving the usability experienced by users. Moreover, the exoskeleton assistance significantly reduces the lumbar load associated with the task, demonstrating its promising use for risk mitigation in the workplace.
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Tamantini C, Cordella F, Lauretti C, Luzio FSD, Campagnola B, Cricenti L, Bravi M, Bressi F, Draicchio F, Sterzi S, Zollo L. Tailoring Upper-Limb Robot-Aided Orthopedic Rehabilitation on Patients' Psychophysiological State. IEEE Trans Neural Syst Rehabil Eng 2023; 31:3297-3306. [PMID: 37486842 DOI: 10.1109/tnsre.2023.3298381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
Physical therapy keeps exploiting more and more the capabilities of the robot of adapting the treatments to patients' needs. This paper aims at presenting a psychophysiological-aware control strategy for upper limb robot-aided orthopedic rehabilitation. The main features are the capability of i) generating point-to-point trajectories inside an adaptable workspace, ii) providing assistance in guiding the patients' limbs in accomplishing the assigned task allowing them to freely move with a certain degree of spatial and temporal autonomy and iii) tuning the control parameters according to the patients' kinematics performance and psychophysiological state. The implemented control strategy is validated in a real clinical setting on eight orthopedic patients undergoing twenty daily robot-aided rehabilitation sessions. The psychophysiological-aware control strategy evidenced a positive impact on the enrolled participants since they are effectively conducted in a calmer condition with respect to the patients who did not receive the psychophysiological adaptation. Moreover, clinical performance indicators suggest that the proposed tailored control strategy improves motor functions.
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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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Loro A, Borg MB, Battaglia M, Amico AP, Antenucci R, Benanti P, Bertoni M, Bissolotti L, Boldrini P, Bonaiuti D, Bowman T, Capecci M, Castelli E, Cavalli L, Cinone N, Cosenza L, Di Censo R, Di Stefano G, Draicchio F, Falabella V, Filippetti M, Galeri S, Gimigliano F, Grigioni M, Invernizzi M, Jonsdottir J, Lentino C, Massai P, Mazzoleni S, Mazzon S, Molteni F, Morelli S, Morone G, Nardone A, Panzeri D, Petrarca M, Posteraro F, Santamato A, Scotti L, Senatore M, Spina S, Taglione E, Turchetti G, Varalta V, Picelli A, Baricich A. Balance Rehabilitation through Robot-Assisted Gait Training in Post-Stroke Patients: A Systematic Review and Meta-Analysis. Brain Sci 2023; 13:brainsci13010092. [PMID: 36672074 PMCID: PMC9856764 DOI: 10.3390/brainsci13010092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Balance impairment is a common disability in post-stroke survivors, leading to reduced mobility and increased fall risk. Robotic gait training (RAGT) is largely used, along with traditional training. There is, however, no strong evidence about RAGT superiority, especially on balance. This study aims to determine RAGT efficacy on balance of post-stroke survivors. METHODS PubMed, Cochrane Library, and PeDRO databases were investigated. Randomized clinical trials evaluating RAGT efficacy on post-stroke survivor balance with Berg Balance Scale (BBS) or Timed Up and Go test (TUG) were searched. Meta-regression analyses were performed, considering weekly sessions, single-session duration, and robotic device used. RESULTS A total of 18 trials have been included. BBS pre-post treatment mean difference is higher in RAGT-treated patients, with a pMD of 2.17 (95% CI 0.79; 3.55). TUG pre-post mean difference is in favor of RAGT, but not statistically, with a pMD of -0.62 (95%CI - 3.66; 2.43). Meta-regression analyses showed no relevant association, except for TUG and treatment duration (β = -1.019, 95% CI - 1.827; -0.210, p-value = 0.0135). CONCLUSIONS RAGT efficacy is equal to traditional therapy, while the combination of the two seems to lead to better outcomes than each individually performed. Robot-assisted balance training should be the focus of experimentation in the following years, given the great results in the first available trials. Given the massive heterogeneity of included patients, trials with more strict inclusion criteria (especially time from stroke) must be performed to finally define if and when RAGT is superior to traditional therapy.
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Affiliation(s)
- Alberto Loro
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
- Correspondence: or
| | - Margherita Beatrice Borg
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Marco Battaglia
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Angelo Paolo Amico
- Physical Medicine and Rehabilitation Unit, Polyclinic of Bari, 70124 Bari, Italy
| | - Roberto Antenucci
- Rehabilitation Unit, Castel San Giovanni Hospital, 29015 Piacenza, Italy
| | - Paolo Benanti
- Theology Department, Pontifical Gregorian University, 00187 Rome, Italy
| | - Michele Bertoni
- Physical Medicine and Rehabilitation, ASST Sette Laghi, 21100 Varese, Italy
| | - Luciano Bissolotti
- Casa di Cura Domus Salutis, Fondazione Teresa Camplani, 25100 Brescia, Italy
| | - Paolo Boldrini
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Donatella Bonaiuti
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Thomas Bowman
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Marianna Capecci
- Experimental and Clinic Medicine Department, Università Politecnica delle Marche (UNIVPM), 60126 Ancona, Italy
| | - Enrico Castelli
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Loredana Cavalli
- Physical Medicine and Rehabilitation Unit, Centro Giusti, 50125 Florence, Italy
| | - Nicoletta Cinone
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Lucia Cosenza
- Rehabilitation Unit, Department of Rehabilitation, “Santi Antonio e Biagio e Cesare Arrigo” National Hospital, 15122 Alessandria, Italy
| | - Rita Di Censo
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Giuseppina Di Stefano
- Robotic Rehabilitation Section, Italian Society of Physical and Rehabilitative Medicine (SIMFER), 00187 Rome, Italy
| | - Francesco Draicchio
- Dipartimento Medicina, Epidemiologia, Igiene del Lavoro e Ambientale, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), 00192 Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FISH), 00197 Rome, Italy
| | - Mirko Filippetti
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Silvia Galeri
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Prevention Medicine, Luigi Vanvitelli University of Campania, 81100 Naples, Italy
| | - Mauro Grigioni
- Department of New Technologies in Public Healthcare, Italian National Institute of Health (ISS), 00161 Rome, Italy
| | - Marco Invernizzi
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo, 15122 Alessandria, Italy
| | - Johanna Jonsdottir
- Neurorehabilitation Department, IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy
| | - Carmelo Lentino
- Rehabilitation Unit, Santa Corona Hospital, 17027 Pietra Ligure, Italy
| | - Perla Massai
- Tuscany Rehabilitation Clinic, 52025 Montevarchi, Italy
| | - Stefano Mazzoleni
- Department of Electrical Engineering and Information Technology, Polytechnic University of Bari, 70126 Bari, Italy
- The BioRobotics Institute, Scuola Superiore Sant’Anna, 56025 Pontedera, Italy
| | - Stefano Mazzon
- Azienda Unità Locale Socio Sanitaria Euganea (AULSS 6), 35100 Padua, Italy
| | - Franco Molteni
- Rehabilitation Department, Valduce Villa Beretta Hospital, 23845 Costa Masnaga, Italy
| | - Sandra Morelli
- Department of New Technologies in Public Healthcare, Italian National Institute of Health (ISS), 00161 Rome, Italy
| | - Giovanni Morone
- Neurorehabilitation Unit, Santa Lucia Foundation IRCCS, 00179 Rome, Italy
| | - Antonio Nardone
- Pediatric, Diagnostical and Clinical-Surgical Sciences Department, University of Pavia, 27100 Pavia, Italy
- Neurorehabilitation Unit, Istituto Clinico-Scientifico Maugeri SPA IRCCS, 27100 Pavia, Italy
| | - Daniele Panzeri
- Pediatric Rehabilitation Unit, IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Maurizio Petrarca
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | | | - Andrea Santamato
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Lorenza Scotti
- Department of Translational Medicine, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
| | - Michele Senatore
- Italian Association of Occupational Therapists (AITO), 00136 Rome, Italy
| | - Stefania Spina
- Unit of Spasticity and Movement Disorders, Division of Physical Medicine and Rehabilitation, University Hospital of Foggia, 71100 Foggia, Italy
| | - Elisa Taglione
- Rehabilitation Unit, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), 56048 Volterra, Italy
| | | | - Valentina Varalta
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Alessandro Picelli
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, 37126 Verona, Italy
| | - Alessio Baricich
- Department of Health Sciences, Università del Piemonte Orientale “Amedeo Avogadro”, 28100 Novara, Italy
- Physical Medicine and Rehabilitation Unit, AOU Maggiore della Carità University Hospital, 28100 Novara, Italy
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10
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Carmignano SM, Fundarò C, Bonaiuti D, Calabrò RS, Cassio A, Mazzoli D, Bizzarini E, Campanini I, Cerulli S, Chisari C, Colombo V, Dalise S, Gazzotti V, Mazzoleni D, Mazzucchelli M, Melegari C, Merlo A, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Andrenelli E. Robot-assisted gait training in patients with Parkinson's disease: Implications for clinical practice. A systematic review. NeuroRehabilitation 2022; 51:649-663. [PMID: 35570502 DOI: 10.3233/nre-220026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 01/11/2023]
Abstract
BACKGROUND Gait impairments are common disabling symptoms of Parkinson's disease (PD). Among the approaches for gait rehabilitation, interest in robotic devices has grown in recent years. However, the effectiveness compared to other interventions, the optimum amount of training, the type of device, and which patients might benefit most remains unclear. OBJECTIVE To conduct a systematic review about the effects on gait of robot-assisted gait training (RAGT) in PD patients and to provide advice for clinical practice. METHODS A search was performed on PubMed, Scopus, PEDro, Cochrane library, Web of science, and guideline databases, following PRISMA guidelines. We included English articles if they used a robotic system with details about the intervention, the parameters, and the outcome measures. We evaluated the level and quality of evidence. RESULTS We included twenty papers out of 230 results: two systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies, and 5 descriptive reports. Nine studies used an exoskeleton device and the remainders end-effector robots, with large variability in terms of subjects' disease-related disability. CONCLUSIONS RAGT showed benefits on gait and no adverse events were recorded. However, it does not seem superior to other interventions, except in patients with more severe symptoms and advanced disease.
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Affiliation(s)
- Simona Maria Carmignano
- Centro Terapeutico Riabilitativo (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Cira Fundarò
- Neurophysiopatology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | | | | | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Emiliana Bizzarini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Isabella Campanini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy.,Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
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11
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Straudi S, Baluardo L, Arienti C, Bozzolan M, Lazzarini SG, Agostini M, Aprile I, Paci M, Casanova E, Marino D, La Rosa G, Bressi F, Sterzi S, Giansanti D, Perrero L, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G. Effectiveness of robot-assisted arm therapy in stroke rehabilitation: An overview of systematic reviews. NeuroRehabilitation 2022; 51:559-576. [PMID: 36530097 DOI: 10.3233/nre-220027] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robot-assisted arm therapy (RAT) has been used mainly in stroke rehabilitation in the last 20 years with rising expectations and growing evidence summarized in systematic reviews (SRs). OBJECTIVE The aim of this study is to provide an overview of SRs about the effectiveness, within the ICF domains, and safety of RAT in the rehabilitation of adult with stroke compared to other treatments. METHODS The search strategy was conducted using search strings adapted explicitly for each database. A screening base on title and abstract was realized to find all the potentially relevant studies. The methodological quality of the included SRs was assessed using AMSTAR-2. A pre-determined standardized form was used to realize the data extraction. RESULTS 18 SRs were included in this overview. Generally, positive effects from the RAT were found for motor function and muscle strength, whereas there is no agreement for muscle tone effects. No effect was found for pain, and only a SR reported the positive impact of RAT in daily living activity. CONCLUSION RAT can be considered a valuable option to increase motor function and muscle strength after stroke. However, the poor quality of most of the included SRs could limit the certainty around the results.
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Affiliation(s)
- Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
| | - Ludovica Baluardo
- Department of Neuroscience and Rehabilitation, Ferrara University, Ferrara, Italy
| | | | - Michela Bozzolan
- Interdepartmental Educational Service, Azienda Ospedaliero Universitaria S. Anna Ferrara, Ferrara, Italy
| | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center "Bonino Pulejo", Messina, Italy
| | | | - Federica Bressi
- Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Silvia Sterzi
- Campus Bio-Medico University Hospital Foundation, Rome, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | | | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital,, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company), Euganea Padova - Distretto 4 "Alta Padovana", Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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12
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Stampacchia G, Gazzotti V, Olivieri M, Andrenelli E, Bonaiuti D, Calabro RS, Carmignano SM, Cassio A, Fundaro C, Companini I, Mazzoli D, Cerulli S, Chisari C, Colombo V, Dalise S, Mazzoleni D, Melegari C, Merlo A, Boldrini P, Mazzoleni S, Posteraro F, Mazzucchelli M, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bizzarrini E. Gait robot-assisted rehabilitation in persons with spinal cord injury: A scoping review. NeuroRehabilitation 2022; 51:609-647. [PMID: 36502343 DOI: 10.3233/nre-220061] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 12/13/2022]
Abstract
BACKGROUND Many robots are available for gait rehabilitation (BWSTRT and ORET) and their application in persons with SCI allowed an improvement of walking function. OBJECTIVE The aim of the study is to compare the effects of different robotic exoskeletons gait training in persons with different SCI level and severity. METHODS Sixty-two studies were included in this systematic review; the study quality was assessed according to GRADE and PEDro's scale. RESULTS Quality assessment of included studies (n = 62) demonstrated a prevalence of evidence level 2; the quality of the studies was higher for BWSTRT (excellent and good) than for ORET (fair and good). Almost all persons recruited for BWSTRT had an incomplete SCI; both complete and incomplete SCI were recruited for ORET. The SCI lesion level in the persons recruited for BWSTRT are from cervical to sacral; mainly from thoracic to sacral for ORET; a high representation of AIS D lesion resulted both for BWSTRT (30%) and for ORET (45%). The walking performance, tested with 10MWT, 6MWT, TUG and WISCI, improved after exoskeleton training in persons with incomplete SCI lesions, when at least 20 sessions were applied. Persons with complete SCI lesions improved the dexterity in walking with exoskeleton, but did not recover independent walking function; symptoms such as spasticity, pain and cardiovascular endurance improved. CONCLUSION Different exoskeletons are available for walking rehabilitation in persons with SCI. The choice about the kind of robotic gait training should be addressed on the basis of the lesion severity and the possible comorbidities.
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Affiliation(s)
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | | | | | - Simona Maria Carmignano
- Rehabilitation Therapeutic Center (CTR), Potenza, Italy.,University of Salerno, Salerno, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Isabella Companini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - David Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Emiliana Bizzarrini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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13
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Bressi F, Cricenti L, Campagnola B, Bravi M, Miccinilli S, Santacaterina F, Sterzi S, Straudi S, Agostini M, Paci M, Casanova E, Marino D, La Rosa G, Giansanti D, Perrero L, Battistini A, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Morone G, Gallotti M, Germanotta M, Aprile I. Effects of robotic upper limb treatment after stroke on cognitive patterns: A systematic review. NeuroRehabilitation 2022; 51:541-558. [PMID: 36530099 PMCID: PMC9837692 DOI: 10.3233/nre-220149] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Robotic therapy (RT) has been internationally recognized for the motor rehabilitation of the upper limb. Although it seems that RT can stimulate and promote neuroplasticity, the effectiveness of robotics in restoring cognitive deficits has been considered only in a few recent studies. OBJECTIVE To verify whether, in the current state of the literature, cognitive measures are used as inclusion or exclusion criteria and/or outcomes measures in robotic upper limb rehabilitation in stroke patients. METHODS The systematic review was conducted according to PRISMA guidelines. Studies eligible were identified through PubMed/MEDLINE and Web of Science from inception to March 2021. RESULTS Eighty-one studies were considered in this systematic review. Seventy-three studies have at least a cognitive inclusion or exclusion criteria, while only seven studies assessed cognitive outcomes. CONCLUSION Despite the high presence of cognitive instruments used for inclusion/exclusion criteria their heterogeneity did not allow the identification of a guideline for the evaluation of patients in different stroke stages. Therefore, although the heterogeneity and the low percentage of studies that included cognitive outcomes, seemed that the latter were positively influenced by RT in post-stroke rehabilitation. Future larger RCTs are needed to outline which cognitive scales are most suitable and their cut-off, as well as what cognitive outcome measures to use in the various stages of post-stroke rehabilitation.
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Affiliation(s)
- Federica Bressi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Laura Cricenti
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Benedetta Campagnola
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy,Address for correspondence: Benedetta Campagnola, Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy. E-mail:
| | - Marco Bravi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sandra Miccinilli
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Fabio Santacaterina
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Silvia Sterzi
- Physical Medicine and Rehabilitation Unit, Campus Bio-Medico University Polyclinic Foundation, Rome, Italy
| | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, Italy
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, Messina, Italy
| | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Battistini
- Unità Operativa di Medicina Riabilitativa e Neuroriabilitazione (SC), IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Serena Filoni
- Padre Pio Onlus Rehabilitation Centers Foundation, San Giovanni Rotondo, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova – Distretto 4 “Alta Padovana”, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children’s Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital – AUSL12, Viareggio, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | | | | | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
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14
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Mazzucchelli M, Mazzoleni D, Campanini I, Merlo A, Mazzoli D, Melegari C, Colombo V, Cerulli S, Piscitelli D, Perin C, Andrenelli E, Bizzarini E, Calabro RS, Carmignano SM, Cassio A, Chisari C, Dalise S, Fundaro C, Gazzotti V, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bonaiuti D. Evidence-based improvement of gait in post-stroke patients following robot-assisted training: A systematic review. NeuroRehabilitation 2022; 51:595-608. [PMID: 36502342 DOI: 10.3233/nre-220024] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The recovery of walking after stroke is a priority goal for recovering autonomy. In the last years robotic systems employed for Robotic Assisted Gait Training (RAGT) were developed. However, literature and clinical practice did not offer standardized RAGT protocol or pattern of evaluation scales. OBJECTIVE This systematic review aimed to summarize the available evidence on the use of RAGT in post-stroke, following the CICERONE Consensus indications. METHODS The literature search was conducted on PubMed, Cochrane Library and PEDro, including studies with the following criteria: 1) adult post-stroke survivors with gait disability in acute/subacute/chronic phase; 2) RAGT as intervention; 3) any comparators; 4) outcome regarding impairment, activity, and participation; 5) both primary studies and reviews. RESULTS Sixty-one articles were selected. Data about characteristics of patients, level of disability, robotic devices used, RAGT protocols, outcome measures, and level of evidence were extracted. CONCLUSION It is possible to identify robotic devices that are more suitable for specific phase disease and level of disability, but we identified significant variability in dose and protocols. RAGT as an add-on treatment seemed to be prevalent. Further studies are needed to investigate the outcomes achieved as a function of RAGT doses delivered.
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Affiliation(s)
| | - Daniele Mazzoleni
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Isabella Campanini
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Merlo
- Department of Neuromotor and Rehabilitation, LAM-Motion Analysis Laboratory, San Sebastiano Hospital, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Ospedale Privato Accreditato, Rimini, Italy
| | | | | | - Simona Cerulli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Cecilia Perin
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,San Donato Group, Istituti Clinici Zucchi, Monza, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Emiliana Bizzarini
- Department of Rehabilitation Medicine, Spinal Cord Unit, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | | | | | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, Ospedale di Fiorenzuola d'Arda, AUSL Piacenza, Piacenza, Italy
| | - Carmelo Chisari
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Stefania Dalise
- Department of Translational Research and New Technologies in Medicine and Surgery, Neurorehabiltation Section, University of Pisa, Pisa, Italy
| | - Cira Fundaro
- Neurophysiopathology Unit, Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Pavia, Italy
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Bologna, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Enrico Castelli
- Department of Paediatric Neurorehabilitation, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
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15
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Castelli E, Beretta E, De Tanti A, Arduini F, Biffi E, Colazza A, Di Pede C, Guzzetta A, Lucarini L, Maghini I, Mandalà M, Nespoli M, Pavarelli C, Policastro F, Polverelli M, Rossi A, Sgandurra G, Boldrini P, Bonaiuti D, Mazzoleni S, Posteraro F, Benanti P, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Saviola D, Turchetti G. Robot-assisted rehabilitation for children with neurological disabilities: Results of the Italian consensus conference CICERONE. NeuroRehabilitation 2022; 51:665-679. [PMID: 36530098 DOI: 10.3233/nre-220036] [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] [Indexed: 12/15/2022]
Abstract
BACKGROUND The use of robotic technologies in pediatric rehabilitation has seen a large increase, but with a lack of a comprehensive framework about their effectiveness. OBJECTIVE An Italian Consensus Conference has been promoted to develop recommendations on these technologies: definitions and classification criteria of devices, indications and limits of their use in neurological diseases, theoretical models, ethical and legal implications. In this paper, we present the results for the pediatric age. METHODS A systematic search on Cochrane Library, PEDro and PubMed was performed. Papers published up to March 1st, 2020, in English, were included and analyzed using the methodology of the Centre for Evidence-Based Medicine in Oxford, AMSTAR2 and PEDro scales for systematic reviews and RCT, respectively. RESULTS Some positives aspects emerged in the area of gait: an increased number of children reaching the stance, an improvement in walking distance, speed and endurance. Critical aspects include the heterogeneity of the studied cases, measurements and training protocols. CONCLUSION Many studies demonstrate the benefits of robotic training in developmental age. However, it is necessary to increase the number of trials to achieve greater homogeneity between protocols and to confirm the effectiveness of pediatric robotic rehabilitation.
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Affiliation(s)
| | - Elena Beretta
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Antonio De Tanti
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
| | | | - Emilia Biffi
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | | | - Chiara Di Pede
- IRCCS Eugenio Medea, La Nostra Famiglia, Ponte Lambro, Italy
| | - Andrea Guzzetta
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | | | - Irene Maghini
- Department of Women's and Children's Health, Pediatric Pain and Palliative Care Service, University of Padua, Padua, Italy
| | - Martina Mandalà
- IRCCS Santa Maria Nascente - Fondazione Don C. Gnocchi, Milan, Italy
| | | | - Claudia Pavarelli
- Servizio di Neuropsichiatria Infanzia e dell'Adolescenza (NPIA), Vignola, Italy
| | - Francesca Policastro
- Dipartimento Scienze Mediche e Chirurgiche, Università degli Studi di Trieste, Trieste, Italy
| | - Marco Polverelli
- Dipartimento Riabilitazione, Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Andrea Rossi
- ASST Spedali Civili di Brescia, Ospedale dei Bambini, Brescia, Italy
| | - Giuseppina Sgandurra
- Dipartimento di Medicina Clinica e Sperimentale, Università di Pisa, Pisa, Italy.,Dipartimento di Neuroscienze dello Sviluppo, IRCCS Stella Maris, Pisa, Italy
| | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Donatella Bonaiuti
- Italian Society of Physical Medicine and Rehabilitation, (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital - AUSL12, Viareggio, Italy
| | | | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Autority) Euganea, Camposampietro Hospital, Padua, Italy
| | - Franco Molteni
- Department of Rehabilitation Medicine, Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
| | | | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Donatella Saviola
- KOS-CARE, Santo Stefano Rehabilitation, Cardinal Ferrari Center, Parma, Italy
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16
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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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17
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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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18
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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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19
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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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20
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Turolla A, Kiper P, Mazzarotto D, Cecchi F, Colucci M, D'Avenio G, Facciorusso S, Gatti R, Giansanti D, Iosa M, Bonaiuti D, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Molteni F. Reference theories and future perspectives on robot-assisted rehabilitation in people with neurological conditions: A scoping review and recommendations from the Italian Consensus Conference on Robotics in Neurorehabilitation (CICERONE). NeuroRehabilitation 2022; 51:681-691. [PMID: 36530100 DOI: 10.3233/nre-220160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robot-based treatments are developing in neurorehabilitation settings. Recently, the Italian National Health Systems recognized robot-based rehabilitation as a refundable service. Thus, the Italian neurorehabilitation community promoted a national consensus on this topic. OBJECTIVE To conceptualize undisclosed perspectives for research and applications of robotics for neurorehabilitation, based on a qualitative synthesis of reference theoretical models. METHODS A scoping review was carried out based on a specific question from the consensus Jury. A foreground search strategy was developed on theoretical models (context) of robot-based rehabilitation (exposure), in neurological patients (population). PubMed and EMBASE® databases were searched and studies on theoretical models of motor control, neurobiology of recovery, human-robot interaction and economic sustainability were included, while experimental studies not aimed to investigate theoretical frameworks, or considering prosthetics, were excluded. RESULTS Overall, 3699 records were screened and finally 9 papers included according to inclusion and exclusion criteria. According to the population investigated, structured information on theoretical models and indications for future research was summarized in a synoptic table. CONCLUSION The main indication from the Italian consensus on robotics in neurorehabilitation is the priority to design research studies aimed to investigate the role of robotic and electromechanical devices in promoting neuroplasticity.
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Affiliation(s)
- Andrea Turolla
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
- Division of Occupational Medicine, IRCCS Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | - Deborah Mazzarotto
- Medicina Fisica e Riabilitazione, ULSS 4 Veneto Orientale, San Donà di Piave, Italy
| | - Francesca Cecchi
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
- IRCSS Fondazione Don Carlo Gnocchi, Firenze, Italy
| | | | - Giuseppe D'Avenio
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | | | - Roberto Gatti
- Humanitas University, Department of Biomedical Sciences, via Rita Levi Montalcini 4, 20090 Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza Università di Roma, Rome, Italy
- Smart Lab, IRCSS Santa Lucia Foundation, Rome, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Federico Posteraro
- Department of Rehabilitation, AUSL Toscana Nord Ovest - Camaiore, Versilia Hospital, Lucca, Italy
| | | | - Enrico Castelli
- Department of Neurorehabilitation and Robotics, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental, Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory (MARlab), IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana dei Terapisti Occupazionali (AITO), Rome, Italy
| | | | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Lecco, Italy
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21
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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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22
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Lazzaroni M, Fanti V, Sposito M, Chini G, Draicchio F, Natali CD, G. Caldwell D, Ortiz J. Improving the Efficacy of an Active Back-Support Exoskeleton for Manual Material Handling Using the Accelerometer Signal. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3183757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Maria Lazzaroni
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Vasco Fanti
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Matteo Sposito
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, 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
| | - Christian Di Natali
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Darwin G. Caldwell
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
| | - Jesus Ortiz
- Department of Advanced Robotics, Istituto Italiano di Tecnologia (IIT), Genova, Italy
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Morone G, de Sire A, Martino Cinnera A, Paci M, Perrero L, Invernizzi M, Lippi L, Agostini M, Aprile I, Casanova E, Marino D, La Rosa G, Bressi F, Sterzi S, Giansanti D, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Gandolfi M, Posteraro F, Senatore M, Turchetti G, Straudi S. Upper Limb Robotic Rehabilitation for Patients with Cervical Spinal Cord Injury: A Comprehensive Review. Brain Sci 2021; 11:brainsci11121630. [PMID: 34942935 PMCID: PMC8699455 DOI: 10.3390/brainsci11121630] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023] Open
Abstract
The upper extremities limitation represents one of the essential functional impairments in patients with cervical spinal cord injury. Electromechanics assisted devices and robots are increasingly used in neurorehabilitation to help functional improvement in patients with neurological diseases. This review aimed to systematically report the evidence-based, state-of-art on clinical applications and robotic-assisted arm training (RAT) in motor and functional recovery in subjects affected by cervical spinal cord injury. The present study has been carried out within the framework of the Italian Consensus Conference on “Rehabilitation assisted by robotic and electromechanical devices for persons with disability of neurological origin” (CICERONE). PubMed/MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases were systematically searched from inception to September 2021. The 10-item PEDro scale assessed the study quality for the RCT and the AMSTAR-2 for the systematic review. Two different authors rated the studies included in this review. If consensus was not achieved after discussion, a third reviewer was interrogated. The five-item Oxford CEBM scale was used to rate the level of evidence. A total of 11 studies were included. The selected studies were: two systematic reviews, two RCTs, one parallel-group controlled trial, one longitudinal intervention study and five case series. One RCT was scored as a high-quality study, while the systematic review was of low quality. RAT was reported as feasible and safe. Initial positive effects of RAT were found for arm function and quality of movement in addition to conventional therapy. The high clinical heterogeneity of treatment programs and the variety of robot devices could severely affect the generalizability of the study results. Therefore, future studies are warranted to standardize the type of intervention and evaluate the role of robotic-assisted training in subjects affected by cervical spinal cord injury.
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Affiliation(s)
- Giovanni Morone
- IRCCS Santa Lucia Foundation, 00179 Rome, Italy;
- Correspondence: (G.M.); (A.d.S.); Tel.: +39-0651501005 (G.M.); +39-0961712819 (A.d.S.)
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (G.M.); (A.d.S.); Tel.: +39-0651501005 (G.M.); +39-0961712819 (A.d.S.)
| | | | - Matteo Paci
- AUSL (Unique Sanitary Local Company), 50123 Florence, Italy;
| | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy;
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 10121 Novara, Italy; (M.I.); (L.L.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 10121 Novara, Italy; (M.I.); (L.L.)
| | - Michela Agostini
- Section of Rehabilitation, Department of Neuroscience, University General Hospital of Padova, 35128 Padua, Italy;
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50123 Florence, Italy;
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy; (E.C.); (A.B.)
| | - Dario Marino
- IRCCS Neurolysis Center “Bonino Pulejo”, 98124 Messina, Italy;
| | - Giuseppe La Rosa
- C.S.R.—Consorzio Siciliano di Riabilitazione, 95123 Catania, Italy;
| | - Federica Bressi
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Silvia Sterzi
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, 00161 Rome, Italy; (D.G.); (M.G.)
| | - Alberto Battistini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, 40139 Bologna, Italy; (E.C.); (A.B.)
| | - Sandra Miccinilli
- Campus Bio-Medico University Hospital, University of Rome, 00128 Rome, Italy; (F.B.); (S.S.); (S.M.)
| | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Center, San Giovanni Rotondo 71013, Italy;
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.S.); (S.P.)
| | - Salvatore Petrozzino
- A.O.U. Città della Salute e della Scienza di Torino, 10126 Turin, Italy; (M.S.); (S.P.)
| | | | | | - Paolo Benanti
- Department of Moral Theology, Pontifical Gregorian University, 00187 Rome, Italy;
| | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), 00198 Rome, Italy; (P.B.); (D.B.)
| | - Donatella Bonaiuti
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), 00198 Rome, Italy; (P.B.); (D.B.)
| | - Enrico Castelli
- Paediatric Neurorehabilitation Department, IRCCS Bambino Gesù Children’s Hospital, 00163 Rome, Italy;
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy;
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), 00195 Rome, Italy;
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milan, Italy;
| | - Francesca Gimigliano
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, 00161 Rome, Italy; (D.G.); (M.G.)
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, 70125 Bari, Italy;
| | - Stefano Mazzon
- AULSS6 (Unique Sanitary Local Company) Euganea Padova, Rehabilitation Department, 35128 Padua, Italy;
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Department of Rehabilitation Medicine, Valduce Hospital, 23845 Costa Masnaga, Italy;
| | - Maurizio Petrarca
- Movement Analysis and Robotics Laboratory MARlab, IRCCS Bambino Gesù Children’s Hospital, 00163 Rome, Italy;
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (A.P.); (M.G.)
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy; (A.P.); (M.G.)
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, Versilia Hospital AUSL Toscana Nord Ovest, 55049 Lido di Camaiore, Italy;
| | - Michele Senatore
- AITO (Associazione Italiana Terapisti Occupazionali), 00136 Rome, Italy;
| | - Giuseppe Turchetti
- Management Institute, Sant’Anna School of Advanced Studies, 56127 Pisa, Italy;
| | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44121 Ferrara, Italy;
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Calabrò RS, Cassio A, Mazzoli D, Andrenelli E, Bizzarini E, Campanini I, Carmignano SM, Cerulli S, Chisari C, Colombo V, Dalise S, Fundarò C, Gazzotti V, Mazzoleni D, Mazzucchelli M, Melegari C, Merlo A, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Petrarca M, Picelli A, Senatore M, Turchetti G, Morone G, Bonaiuti D. What does evidence tell us about the use of gait robotic devices in patients with multiple sclerosis? A comprehensive systematic review on functional outcomes and clinical recommendations. Eur J Phys Rehabil Med 2021; 57:841-849. [PMID: 34547886 DOI: 10.23736/s1973-9087.21.06915-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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
INTRODUCTION There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.
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Affiliation(s)
| | - Anna Cassio
- Spinal Cord and Intensive Rehabilitation Medicine Unit, AUSL Piacenza, Castel San Giovanni, Piacenza, Italy
| | - Davide Mazzoli
- OPA Sol et Salus Gait and Motion Analysis Laboratory, Torre Pedrera, Rimini, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Emiliana Bizzarini
- Spinal Cord Unit, Department of Rehabilitation Medicine, Gervasutta Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Department of Neuromotor and Rehabilitation Sciences, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Cerulli
- University Polyclinic Foundation A. Gemelli IRCCS, Rome, Italy
| | - Carmelo Chisari
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Cira Fundarò
- Unit of Neurophysiopathology, Istituti Clinici Scientifici Maugeri IRCCS, Montescano, Pavia, Italy
| | - Valeria Gazzotti
- Vigorso Prostheses Center, National Institute for Insurance against Accidents at Work (INAIL), Budrio, Bologna, Italy
| | - Daniele Mazzoleni
- School of Physical and Rehabilitation Medicine, Bicocca University of Milan, Milan, Italy
| | - Miryam Mazzucchelli
- School of Physical and Rehabilitation Medicine, Bicocca University of Milan, Milan, Italy
| | | | - Andrea Merlo
- OPA Sol et Salus Gait and Motion Analysis Laboratory, Torre Pedrera, Rimini, Italy.,LAM-Motion Analysis Laboratory, Department of Neuromotor and Rehabilitation Sciences, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Polytechnical University of Bari, Bari, Italy
| | | | | | - Enrico Castelli
- Department of Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, National Institute for Insurance against Accidents at Work (INAIL), Monte Porzio Catone, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Rehabilitation Unit, ULSS Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Italian Association of Occupational Therapists (AITO), Rome, Italy
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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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26
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Gimigliano F, Palomba A, Arienti C, Morone G, Perrero L, Agostini M, Aprile I, Paci M, Casanova E, Marino D, LA Rosa G, Bressi F, Sterzi S, Giansanti D, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Straudi S. Robot-assisted arm therapy in neurological health conditions: rationale and methodology for the evidence synthesis in the CICERONE Italian Consensus Conference. Eur J Phys Rehabil Med 2021; 57:824-830. [PMID: 34128606 DOI: 10.23736/s1973-9087.21.07011-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robot-assisted Arm Therapy (RAT) has been increasingly applied in the last years for promoting functional recovery in patients with disabilities related to neurological health conditions. Evidence of a knowledge-to-action gap for applying robot-assisted technologies in the rehabilitation of patients with neurological health conditions and the difficulty to apply and tailor the knowledge to the local contexts solicited the need for a national consensus conference on these interventions. AIM This paper aims to explain the methodology used by the working group dedicated to synthesize evidence on the effectiveness of RAT in neurological health conditions in the context of the CICERONE Italian Consensus Conference. DESIGN The methodological approach of the working group. SETTING All rehabilitation settings. POPULATION Patients with disability following a neurological health condition. METHODS Following the indications proposed by the Methodological Manual published by the Italian National Institute of Health, a Promoting Committee and a Technical Scientific Committee have been set up. Six working groups (WGs) have been composed to collect evidence on different questions, among which WG2.2 was focused on the effectiveness of RAT in neurological health conditions. RESULTS WG2.2 started its work defining the specific research questions. It was decided to adopt the ICF as the reference framework for the reporting of all outcomes. Literature search, data extraction and qualitative assessment, evidence analysis and synthesis have been performed. CONCLUSIONS This paper summarizes the methodological approaches used by the WG2.2 of the CICERONE Italian Consensus Conference to define the effectiveness of RAT in the management of patients with neurological health conditions. CLINICAL REHABILITATION IMPACT WG2.2 synthesis might help clinicians, researchers, and all rehabilitation stakeholders to address the use of RAT in the Individualized Rehabilitation Plan, to guide the allocation of resources and define clinical protocols and indications for the management of patients with different neurological health conditions.
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Affiliation(s)
- Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Angela Palomba
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, University of Campania "Luigi Vanvitelli", Naples, Italy -
| | | | | | - Luca Perrero
- Neurorehabilitation Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | | | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Matteo Paci
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Medicina Riabilitativa e Neuroriabilitazione, Bologna, Italia
| | - Dario Marino
- IRCCS Neurolysis Center "Bonino Pulejo", Messina, Italy
| | | | | | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Alberto Battistini
- AUSL (Unique Sanitary Local Company) District of Central Tuscany, Florence, Italy
| | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | - Monica Sicari
- A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER)
| | | | - Enrico Castelli
- Paediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Vincenzo Falabella
- President Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | - Stefano Mazzon
- Rehabilitation Department, AULSS6 (Unique Sanitary Local Company) Euganea Padova, Padova, Italy
| | | | - Maurizio Petrarca
- "Bambino Gesù" Children's Hospital - IRCCS, Movement Analysis and Robotics Laboratory MARlab, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Versilia Hospital AUSL Toscana Nord Ovest, Lido di Camaiore, Lucca, Italy
| | | | | | - Sofia Straudi
- Neuroscience and Rehabilitation Department, Ferrara University Hospital, Ferrara, Italy
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27
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Gandolfi M, Valè N, Posteraro F, Morone G, Dell'orco A, Botticelli A, Dimitrova E, Gervasoni E, Goffredo M, Zenzeri J, Antonini A, Daniele C, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Petrarca M, Picelli A, Senatore M, Turchetti G, Giansanti D, Mazzoleni S. State of the art and challenges for the classification of studies on electromechanical and robotic devices in neurorehabilitation: a scoping review. Eur J Phys Rehabil Med 2021; 57:831-840. [PMID: 34042413 DOI: 10.23736/s1973-9087.21.06922-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The rapid development of electromechanical and robotic devices has profoundly influenced neurorehabilitation. Growth in the scientific and technological aspects thereof is crucial for increasing the number of newly developed devices, and clinicians have welcomed such growth with enthusiasm. Nevertheless, improving the standard for the reporting clinical, technical, and normative aspects of such electromechanical and robotic devices remains an unmet need in neurorehabilitation. Accordingly, this study aimed to analyse the existing literature on electromechanical and robotic devices used in neurorehabilitation, considering the current clinical, technical, and regulatory classification systems. EVIDENCE ACQUISITION Within the CICERONE Consensus Conference framework, studies on electromechanical and robotic devices used for upper- and lower-limb rehabilitation in persons with neurological disabilities in adulthood and childhood were reviewed. We have conducted a literature search using the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, Science Direct, and Google Scholar. Clinical, technical, and regulatory classification systems were applied to collect information on the electromechanical and robotic devices. The study designs and populations were investigated. EVIDENCE SYNTHESIS Overall, 316 studies were included in the analysis. More than half (52%) of the studies were randomised controlled trials (RCTs). The population investigated the most suffered from strokes, followed by spinal cord injuries, multiple sclerosis, cerebral palsy, and traumatic brain injuries. In total, 100 devices were described; of these, 19% were certified with the CE mark. Overall, the main type of device was an exoskeleton. However, end-effector devices were primarily used for the upper limbs, whereas exoskeletons were used for the lower limbs (for both children and adults). CONCLUSIONS The current literature on robotic neurorehabilitation lacks detailed information regarding the technical characteristics of the devices used. This affects the understanding of the possible mechanisms underlying recovery. Unfortunately, many electromechanical and robotic devices are not provided with CE marks, strongly hindering the research on the clinical outcomes of rehabilitation treatments based on these devices. A more significant effort is needed to improve the description of the robotic devices used in neurorehabilitation in terms of the technical and functional details, along with high-quality RCT studies.
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Affiliation(s)
- Marialuisa Gandolfi
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy -
| | - Nicola Valè
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Rehabilitation Department Versilia Hospital, ASL Toscana Nord-Ovest, Italy
| | | | - Antonella Dell'orco
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Anita Botticelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | - Eleonora Dimitrova
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michela Goffredo
- Neurorehabilitation Research Laboratory, Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | - Jacopo Zenzeri
- Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | | | | | | | - Paolo Boldrini
- Italian Society of Physical Medicine and Rehabilitation (SIMFER), Italy
| | | | - Enrico Castelli
- Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- President Italian Federation of Persons with Spinal Cord Injuries (Flip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli, " Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- ULSS 6 (Unique Sanitary Local Company) Euganea Padova - Distretto IV Alta Padovana, Padova, Italy
| | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine, and Movement Sciences, University of Verona, Neurorehabilitation Unit, University Hospital of Verona, Italy
| | | | | | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Italy
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Calabrò RS, Sorrentino G, Cassio A, Mazzoli D, Andrenelli E, Bizzarini E, Campanini I, Carmignano SM, Cerulli S, Chisari C, Colombo V, Dalise S, Fundarò C, Gazzotti V, Mazzoleni D, Mazzucchelli M, Melegari C, Merlo A, Stampacchia G, Boldrini P, Mazzoleni S, Posteraro F, Benanti P, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Molteni F, Morone G, Petrarca M, Picelli A, Senatore M, Turchetti G, Bonaiuti D. Robotic-assisted gait rehabilitation following stroke: a systematic review of current guidelines and practical clinical recommendations. Eur J Phys Rehabil Med 2021; 57:460-471. [PMID: 33947828 DOI: 10.23736/s1973-9087.21.06887-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stroke is the third leading cause of adult disability worldwide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. EVIDENCE ACQUISITION We systematically reviewed stroke rehabilitation guideline recommendations between January 1, 2010 and October 31, 2020. We explored electronic databases (N.=4), guideline repositories and professional rehabilitation networks (N.=12). Two independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and brief syntheses were used to evaluate and compare the different recommendations, considering only the most recent version. EVIDENCE SYNTHESIS From the 1219 papers screened, ten eligible guidelines were identified from seven different regions/countries. Four of the included guidelines focused on stroke management, the other six on stroke rehabilitation. Robotic rehabilitation is generally recommended to improve lower limb motor function, including gait and strength. Unfortunately, there is still no consensus about the timing, frequency, training session duration and the exact characteristics of subjects who could benefit from robotics. CONCLUSIONS Our systematic review shows that the introduction of robotic rehabilitation in standard treatment protocols seems to be the future of stroke rehabilitation. However, robot assisted gait training (RAGT) for stroke needs to be improved with new solutions and in clinical practice guidelines, especially in terms of applicability.
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Affiliation(s)
| | - Gregorio Sorrentino
- Department of Medicine and Rehabilitation, Polyclinic of Monza, Monza-Brianza, Italy
| | - Anna Cassio
- Spinal Cord Unit and Intensive Rehabilitation Medicine, AUSL Piacenza, Villanova sull'Arda and Castel San Giovanni, Piacenza, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory OPA Sol et Salus, Torre Pedrera, Rimini, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine Università Politecnica delle Marche (UNIVPM), Ancona, Italy
| | - Emiliana Bizzarini
- Spinal Cord Unit, Department of Rehabilitation Medicine, Gervasutta Hospital, Udine, Italy.,Azienda Sanitaria Universitaria Friuli Centrale (ASU-FC), Udine, Italy
| | - Isabella Campanini
- Neuromotor and Rehabilitation Department, LAM-Motion Analysis Laboratory, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Simona Cerulli
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Carmelo Chisari
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | | | - Stefania Dalise
- Section of Neurorehabilitation, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Cira Fundarò
- Unit of Neurophysiopathology, ICS Maugeri, Montescano Institute, Pavia, Italy
| | - Valeria Gazzotti
- Centro Protesi Vigorso di Budrio, Istituto Nazionale Assicurazione Infortuni sul Lavoro (INAIL), Budrio, Bologna, Italy
| | - Daniele Mazzoleni
- School of Physical and Rehabilitation Medicine, University of Milano-Bicocca, Milan, Italy
| | | | | | - Andrea Merlo
- Gait and Motion Analysis Laboratory OPA Sol et Salus, Torre Pedrera, Rimini, Italy.,Neuromotor and Rehabilitation Department, LAM-Motion Analysis Laboratory, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Polytechnic of Bari, Bari, Italy
| | | | | | - Enrico Castelli
- Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (FAIP Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Unit of Rehabilitation, ULSS (Local Health Authority) Euganea, Camposampiero Hospital, Padua, Italy
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy
| | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Senatore
- Associazione Italiana Terapisti Occupazionali (AITO), Rome, Italy
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Picelli A, Capecci M, Filippetti M, Varalta V, Fonte C, DI Censo R, Zadra A, Chignola I, Scarpa S, Amico AP, Antenucci R, Baricich A, Benanti P, Bissolotti L, Boldrini P, Bonaiuti D, Castelli E, Cavalli L, DI Stefano G, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Jonsdodttir J, Lentino C, Massai P, Mazzoleni S, Mazzon S, Molteni F, Morelli S, Morone G, Panzeri D, Petrarca M, Posteraro F, Senatore M, Taglione E, Turchetti G, Bowman T, Nardone A. Effects of robot-assisted gait training on postural instability in Parkinson's disease: a systematic review. Eur J Phys Rehabil Med 2021; 57:472-477. [PMID: 33826278 DOI: 10.23736/s1973-9087.21.06939-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Postural instability is a cardinal feature of Parkinson's disease, together with rest tremor, rigidity and bradykinesia. It is a highly disabling symptom that becomes increasingly common with disease progression and represents a major source of reduced quality of life in patients with Parkinson's disease. Rehabilitation aims to enable patients with Parkinson's disease to maintain their maximum level of mobility, activity and independence. To date, a wide range of rehabilitation approaches has been employed to treat postural instability in Parkinson's disease, including robotic training. Our main aim was to conduct a systematic review of current literature about the effects of robot-assisted gait training on postural instability in patients with Parkinson's disease. EVIDENCE ACQUISITION A systematic search using the following MeSH terms "Parkinson disease," "postural balance," "robotics," "rehabilitation" AND string "robotics [mh]" OR "robot-assisted" OR "electromechanical" AND "rehabilitation [mh]" OR "training" AND "postural balance [mh]" was conducted on PubMed, Cochrane Library and Pedro electronic databases. Full text articles in English published up to December 2020 were included. Data about patient characteristics, robotic devices, treatment procedures and outcome measures were considered. Every included article got checked for quality. Level of evidence was defined for all studies. EVIDENCE SYNTHESIS Three authors independently extracted and verified data. In total, 18 articles (2 systematic reviews, 9 randomized controlled trials, 4 uncontrolled studies and 3 case series/case reports) were included. Both end-effector and exoskeleton devices were investigated as to robot-assisted gait training modalities. No clear relationship between treatment parameters and clinical conditions was observed. We found a high level of evidence about the effects of robot-assisted gait training on balance and freezing of gait in patients with Parkinson's disease. CONCLUSIONS This systematic review provides to the reader a complete overview of current literature and levels of evidence about the effects of robot-assisted gait training on postural instability issues (static and dynamic balance, freezing of gait, falls, confidence in activities of daily living and gait parameters related to balance skills) in patients with Parkinson's disease.
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Affiliation(s)
- Alessandro Picelli
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy -
| | | | - Mirko Filippetti
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Valentina Varalta
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Cristina Fonte
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Rita DI Censo
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Alessandro Zadra
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Irene Chignola
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | - Stefano Scarpa
- Unit of Neurorehabilitation, Department of Neuroscience, Biomedicine, and Movement Sciences, University Hospital of Verona, University of Verona, Verona, Italy
| | | | | | | | | | | | - Paolo Boldrini
- Italian Society of Physical and Rehabilitative Medicine, Rome, Italy
| | | | | | | | | | | | | | | | | | | | | | | | - Perla Massai
- Tuscany Rehabilitation Clinic, Montevarchi, Arezzo, Italy
| | - Stefano Mazzoleni
- Polytechnic University of Bari, Bari, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | | | - Franco Molteni
- Valduce Villa Beretta Hospital, Costa Masnaga, Lecco, Italy
| | | | | | | | | | | | - Michele Senatore
- Italian Association of Occupational Therapists (AITO), Rome, Italy
| | | | | | - Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | - Antonio Nardone
- University of Pavia, Pavia, Italy.,ICS Maugeri SPA SB (IRCCS), Pavia, Italy
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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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31
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Bowman T, Gervasoni E, Amico AP, Antenucci R, Benanti P, Boldrini P, Bonaiuti D, Burini A, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzon S, Mazzoleni S, Mestanza Mattos FG, Molteni F, Morone G, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Crea S, Cattaneo D, Carrozza MC. What is the impact of robotic rehabilitation on balance and gait outcomes in people with multiple sclerosis? A systematic review of randomized control trials. Eur J Phys Rehabil Med 2021; 57:246-253. [PMID: 33541044 DOI: 10.23736/s1973-9087.21.06692-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION In recent years, robot-assisted gait training (RAGT) has been proposed as therapy for balance and gait dysfunctions in people with multiple sclerosis (PwMS). Through this systematic review, we aimed to discuss the impact of RAGT on balance and gait outcomes. Furthermore, characteristics of the training in terms of robots used, participants characteristics, protocols and combined therapeutic approaches have been described. EVIDENCE ACQUISITION As part of the Italian Consensus on robotic rehabilitation "CICERONE" a systematic search was provided in PubMed, the Cochrane Library and PEDro to identify relevant studies published before December 2019. Only randomized control trials (RCT) involving RAGT for PwMS were included. PEDro scale was used to assess the risk of bias and the Oxford Center for Evidence-Based Medicine (OCEBM) was used to assess level of evidence of included studies. EVIDENCE SYNTHESIS The search on databases resulted in 336 records and, finally, 12 studies were included. RAGT was provided with Exoskeleton in ten studies (6-40 session, 2-5 per week) and with end-effector in two studies (12 sessions, 2-3 per week) with large variability in terms of participants' disability. All the exoskeletons were combined with bodyweight support treadmill and movement assistance varied from 0% to 100% depending on participants' disability, two studies combined exoskeleton with virtual reality. The end-effector speed ranged between 1.3 and 1.8 km/h, with bodyweight support starting from 50% and progressively reduced. In seven out of twelve studies RAGT was provided in a multimodal rehabilitation program or in combination with standard physical therapy. There is level 2 evidence that RAGT has positive impact in PwMS, reaching the minimally clinically importance difference in Berg Balance Scale, six-minute walking test and gait speed. CONCLUSIONS In available RCT, RAGT is mostly provided with exoskeleton devices and improves balance and gait outcomes in a clinically meaningful way. Considering several advantages in terms of safety, motor assistance and intensity of training provided, RAGT should be promoted for PwMS with severe disability in a multimodal rehabilitation context as an opportunity to maximize recovery.
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Affiliation(s)
- Thomas Bowman
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy - .,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy -
| | | | - Angelo P Amico
- Spinal Unit, Policlinico di Bari University Hospital, Bari, Italy
| | - Roberto Antenucci
- Unit of Rehabilitation Medicine, Hospital of Castelsangiovanni, AUSL, Piacenza, Italy
| | - Paolo Benanti
- Department of Moral Theology, Pontifical Gregorian University, Rome, Italy
| | - Paolo Boldrini
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy.,General Secretary European Society of Physical and Rehabilitation Medicine (ESPRM), Rotterdam, the Netherlands
| | - Donatella Bonaiuti
- Italian Society of Physical and Rehabilitation Medicine (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Department of Intensive Neurorehabilitation and Robotics, Bambino Gesù Children's Hospital, Passoscuro Fiumicino, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | - Silvia Galeri
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzon
- Unit of Rehabilitation, ULSS (Local Health Authority) Euganea - Camposampiero Hospital, Padua, Italy
| | - Stefano Mazzoleni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy.,Department of Electrical and Information Engineering (DEI), Polytechnic University of Bari, Bari, Italy
| | | | - Franco Molteni
- Valduce Villa Beretta Hospital, Costa Masnaga, Lecco, Italy
| | | | - Maurizio Petrarca
- Department of Neurorehabilitation and Robotics, Movement Analysis and Robotics Laboratory (MARlab), Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alessandro Picelli
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Federico Posteraro
- Department of Rehabilitation, Versilia Hospital, AUSL Toscana Nord Ovest, Camaiore, Lucca, Italy
| | - Michele Senatore
- Italian Association of Occupational Therapists (AITO), Rome, Italy
| | | | - Simona Crea
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
| | | | - Maria C Carrozza
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy.,The BioRobotics Institute, Scuola Superiore Sant'Anna, Pontedera, Pisa, Italy
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Morone G, Palomba A, Martino Cinnera A, Agostini M, Aprile I, Arienti C, Paci M, Casanova E, Marino D, LA Rosa G, Bressi F, Sterzi S, Gandolfi M, Giansanti D, Perrero L, Battistini A, Miccinilli S, Filoni S, Sicari M, Petrozzino S, Solaro CM, Gargano S, Benanti P, Boldrini P, Bonaiuti D, Castelli E, Draicchio F, Falabella V, Galeri S, Gimigliano F, Grigioni M, Mazzoleni S, Mazzon S, Molteni F, Petrarca M, Picelli A, Posteraro F, Senatore M, Turchetti G, Straudi S. Systematic review of guidelines to identify recommendations for upper limb robotic rehabilitation after stroke. Eur J Phys Rehabil Med 2021; 57:238-245. [PMID: 33491943 DOI: 10.23736/s1973-9087.21.06625-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Upper limb motor impairment is one of the most frequent stroke consequences. Robot therapy may represent a valid option for upper limb stroke rehabilitation, but there are still gaps between research evidence and their use in clinical practice. The aim of this study was to determine the quality, scope, and consistency of guidelines clinical practice recommendations for upper limb robotic rehabilitation in stroke populations. EVIDENCE ACQUISITION We searched for guideline recommendations on stroke published between January 1st, 2010 and January 1st, 2020. Only the most recent guidelines for writing group were selected. Electronic databases (N.=4), guideline repertories and professional rehabilitation networks (N.=12) were searched. We systematically reviewed and assessed guidelines containing recommendation statements about upper limb robotic rehabilitation for adults with stroke (PROSPERO registration number: CRD42020173386). EVIDENCE SYNTHESIS Four independent reviewers used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and textual syntheses were used to appraise and compare recommendations. From 1324 papers that were screened, eight eligible guidelines were identified from six different regions/countries. Half of the included guidelines focused on stroke management, the other half on stroke rehabilitation. Rehabilitation assisted by robotic devices is generally recommended to improve upper limb motor function and strength. The exact characteristics of patients who could benefit from this treatment as well as the correct timing to use it are not known. CONCLUSIONS This systematic review has identified many opportunities to modernize and otherwise improve stroke patients' upper limb robotic therapy. Rehabilitation assisted by robot or electromechanical devices for stroke needs to be improved in clinical practice guidelines in particular in terms of applicability.
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Affiliation(s)
| | - Angela Palomba
- Multidisciplinary Department of Medicine for Surgery and Orthodontics, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | | | - Irene Aprile
- IRCCS Don Carlo Gnocchi Foundation, Florence, Italy
| | | | - Matteo Paci
- AUSL District of Central Tuscany, Florence, Italy
| | - Emanuela Casanova
- Unit of Rehabilitation and Neurorehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche, Bologna, Italy
| | - Dario Marino
- IRCCS Neurolysis Center "Bonino Pulejo, " Messina, Italy
| | - Giuseppe LA Rosa
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | | | - Silvia Sterzi
- Biomedical Campus University Foundation, Rome, Italy
| | - Marialuisa Gandolfi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Daniele Giansanti
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Luca Perrero
- Unit of Neurorehabilitation, SS. Antonio e Biagio e Cesare Arrigo University Hospital, Alessandria, Italy
| | | | | | - Serena Filoni
- Padre Pio Foundation and Rehabilitation Centers, San Giovanni Rotondo, Foggia, Italy
| | | | | | | | | | | | - Paolo Boldrini
- Società Italiana di Medicina Fisica e Riabilitativa (SIMFER), Rome, Italy
| | | | - Enrico Castelli
- Unit of Pediatric Neurorehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, Rome, Italy
| | - Vincenzo Falabella
- Italian Federation of Persons with Spinal Cord Injuries (Faip Onlus), Rome, Italy
| | | | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Luigi Vanvitelli University of Campania, Naples, Italy
| | - Mauro Grigioni
- National Center for Innovative Technologies in Public Health, Italian National Institute of Health, Rome, Italy
| | - Stefano Mazzoleni
- Department of Electrical and Information Engineering, Politecnico di Bari, Bari, Italy
| | | | | | - Maurizio Petrarca
- The Movement Analysis and Robotics Laboratory, Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro Picelli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Michele Senatore
- AITO (Associazione Italiana Terapisti Occupazionali), Rome, Italy
| | | | - Sofia Straudi
- Department of Neuroscience and Rehabilitation, Ferrara University Hospital, Ferrara, 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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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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Scotto di Luzio F, Lauretti C, Cordella F, Draicchio F, Zollo L. Visual vs vibrotactile feedback for posture assessment during upper-limb robot-aided rehabilitation. Appl Ergon 2020; 82:102950. [PMID: 31542573 DOI: 10.1016/j.apergo.2019.102950] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/20/2019] [Accepted: 09/09/2019] [Indexed: 06/10/2023]
Abstract
Repetitive and intensive exercises during robot-aided rehabilitation may expose patients to inappropriate and unsafe postures. The introduction of a sensory feedback can help the subject to perform the rehabilitation task with an ergonomic posture. In this work, the introduction of visual and vibrotactile feedback in a robotic platform for upper limb rehabilitation has been proposed to ensure ergonomic posture during rehabilitation. The two feedback modalities have been used to provide information about incorrect neck and trunk posture. Ten healthy subjects have been involved in this study. Each of them performed 3D reaching movements with the aid of the robotic platform in three different conditions, i.e. without feedback, with visual feedback and with vibrotactile feedback, and a comparative analysis has been carried out to evaluate feedback effectiveness, acceptance and performance. Experimental results show that in case of no feedback the subjects reach and maintain configurations that can lead to incorrect neck and trunk configurations and therefore, if repeated, to musculoskeletal disorders. Conversely, with visual or vibrotactile feedback, the subjects tend to correct inappropriate posture with both trunk and head during task performing.
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Affiliation(s)
- Francesco Scotto di Luzio
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy.
| | - Clemente Lauretti
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Cordella
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Draicchio
- INAIL, Department of Occupational & Environmental Medicine, Monte Porzio Catone, Rome, Italy
| | - Loredana Zollo
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, 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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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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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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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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Scotto di Luzio F, Simonetti D, Cordella F, Miccinilli S, Sterzi S, Draicchio F, Zollo L. Bio-Cooperative Approach for the Human-in-the-Loop Control of an End-Effector Rehabilitation Robot. Front Neurorobot 2018; 12:67. [PMID: 30364325 PMCID: PMC6193510 DOI: 10.3389/fnbot.2018.00067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 03/30/2018] [Accepted: 09/20/2018] [Indexed: 11/13/2022] Open
Abstract
The design of patient-tailored rehabilitative protocols represents one of the crucial factors that influence motor recovery mechanisms, such as neuroplasticity. This approach, including the patient in the control loop and characterized by a control strategy adaptable to the user's requirements, is expected to significantly improve functional recovery in robot-aided rehabilitation. In this paper, a novel 3D bio-cooperative robotic platform is developed. A new arm-weight support system is included into an operational robotic platform for 3D upper limb robot-aided rehabilitation. The robotic platform is capable of adapting therapy characteristics to specific patient needs, thanks to biomechanical and physiological measurements, and thus closing the subject in the control loop. The level of arm-weight support and the level of the assistance provided by the end-effector robot are varied on the basis of muscular fatigue and biomechanical indicators. An assistance-as-needed approach is applied to provide the appropriate amount of assistance. The proposed platform has been experimentally validated on 10 healthy subjects; they performed 3D point-to-point tasks in two different conditions, i.e., with and without assistance-as-needed. The results have demonstrated the capability of the proposed system to properly adapt to real needs of the patients. Moreover, the provided assistance was shown to reduce the muscular fatigue without negatively influencing motion execution.
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Affiliation(s)
- Francesco Scotto di Luzio
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Davide Simonetti
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesca Cordella
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sandra Miccinilli
- Unit of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Silvia Sterzi
- Unit of Physical and Rehabilitation Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Draicchio
- INAIL, Department of Occupational & Environmental Medicine, Monte Porzio Catone, Rome, Italy
| | - Loredana Zollo
- Research Unit of Biomedical Robotics and Biomicrosystems, Università Campus Bio-Medico di Roma, Rome, Italy
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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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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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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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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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48
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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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49
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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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50
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Holtermann A, Schellewald V, Mathiassen SE, Gupta N, Pinder A, Punakallio A, Veiersted KB, Weber B, Takala EP, Draicchio F, Enquist H, Desbrosses K, García Sanz MP, Malińska M, Villar M, Wichtl M, Strebl M, Forsman M, Lusa S, Tokarski T, Hendriksen P, Ellegast R. A practical guidance for assessments of sedentary behavior at work: A PEROSH initiative. Appl Ergon 2017; 63:41-52. [PMID: 28502405 DOI: 10.1016/j.apergo.2017.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 11/18/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 06/07/2023]
Abstract
Sedentary behavior is defined as sitting or lying with low energy expenditure. Humans in industrialized societies spend an increasing amount of time in sedentary behaviors every day. This has been associated with detrimental health outcomes. Despite a growing interest in the health effects of sedentary behavior at work, associations remain unclear, plausibly due to poor and diverse methods for assessing sedentary behavior. Thus, good practice guidance for researchers and practitioners on how to assess occupational sedentary behavior are needed. The aim of this paper is to provide a practical guidance for practitioners and researchers on how to assess occupational sedentary behavior. Ambulatory systems for use in field applications (wearables) are a promising approach for sedentary behavior assessment. Many different small-size consumer wearables, with long battery life and high data storage capacity are commercially available today. However, no stand-alone commercial system is able to assess sedentary behavior in accordance with its definition. The present paper offers decision support for practitioners and researchers in selecting wearables and data collection strategies for their purpose of study on sedentary behavior. Valid and reliable assessment of occupational sedentary behavior is currently not easy. Several aspects need to be considered in the decision process on how to assess sedentary behavior. There is a need for development of a cheap and easily useable wearable for assessment of occupational sedentary behavior by researchers and practitioners.
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Affiliation(s)
- Andreas Holtermann
- National Research Centre for the Working Environment (NRCWE), Copenhagen, Denmark.
| | - Vera Schellewald
- German Sport University Cologne (DSHS), Köln, Germany; Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
| | | | - Nidhi Gupta
- National Research Centre for the Working Environment (NRCWE), Copenhagen, Denmark
| | - Andrew Pinder
- HSE's Health & Safety Laboratory (HSL), Buxton, Derbyshire, United Kingdom
| | - Anne Punakallio
- Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
| | | | - Britta Weber
- Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
| | - Esa-Pekka Takala
- Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
| | - Francesco Draicchio
- National Institute for Insurance Against Accidents at Work (INAIL), Rome, Italy
| | - Henrik Enquist
- Lund University, Skane Medical Services, Department of Laboratory Medicine, Occupational and Environmental Medicine, Lund, Sweden
| | - Kevin Desbrosses
- French National Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), Vandoeuvre Les Nancy, France
| | | | - Marzena Malińska
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Warszawa, Poland
| | - María Villar
- Spanish National Institute for Safety and Hygiene at Work (INSHT), Madrid, Spain
| | - Michael Wichtl
- Austrian Workers' Compensation Board (AUVA), Wien, Austria
| | | | | | - Sirpa Lusa
- Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
| | - Tomasz Tokarski
- Central Institute for Labour Protection - National Research Institute (CIOP-PIB), Warszawa, Poland
| | - Peter Hendriksen
- National Research Centre for the Working Environment (NRCWE), Copenhagen, Denmark
| | - Rolf Ellegast
- Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), Sankt Augustin, Germany
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