Maurizio Petrarca - Academia.edu (original) (raw)

Papers by Maurizio Petrarca

Research paper thumbnail of A system for real-time mapping of foot segment pressures in dynamic posturography

Research paper thumbnail of Visual recognition and visually guided action after early bilateral lesion of occipital cortex: a behavioral study of a 4.6-year-old girl

Neurocase, Nov 1, 2006

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It... more We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child's visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain's potential for reorganisation related to when the damage occurred.

Research paper thumbnail of Time to boundary function to assess upright stance in blind children

2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2015

The goal of this preliminary study was to assess the difference in postural stability between bli... more The goal of this preliminary study was to assess the difference in postural stability between blind and sighted children using the Time to Boundary function (TtB). The experiment was conducted in twelve children (6-12 yrs), six of them had no visual impairment, and other six had congenital blindness. The participants stood on RotoBit force plate maintaining upright stance in static conditions. Each blind subject executed the task three times, each sighted subject executed the task six times, three with eyes closed (EC) and three with eyes open (EO). For all subjects each repetition lasted 30 s. The Centre of Pressure (CoP) coordinates, extracted directly from a force plate, are used to calculate four classical parameters (sway path, sway area, mean amplitude and mean frequency) and a predictive variable called Time to Boundary (TtB). The latter is the time it would take the CoP, given its instantaneous trajectory, to contact a stability boundary. Descriptive statistics were calculated for all parameters. Twoway ANOVA test was done considering the visual condition (EO, EC, BLIND) and the repetitions (RP) as a factor. In the first comparison (BLIND/EO) the results showed significant difference for all the parameters except for TtB. In the second comparison (BLIND/EC) the results showed significant difference only for TtB. In the third comparison (EO/EC) the results showed significant difference for all the calculated parameters. Therefore the TtB would be used to asses the postural control in children with blindness.

Research paper thumbnail of Ability of healthy standing subjects in orienting after imposed rotations

Research paper thumbnail of Patient-centered rehabilitation, three years of gait recovery in a child affected by hemiplegia:. case report

European journal of physical and rehabilitation medicine

The aim of this report was to illustrate and to discuss a method capable of improving the person-... more The aim of this report was to illustrate and to discuss a method capable of improving the person-oriented decision-making process during three years of gait rehabilitation based on the integration of: 1) the fundamental principles of motor learning and 2) the outcomes made available by both clinical standardized assessment tools (SAT) and measures made available by a gait analysis system (GA). The subject studied was a six-year-old child affected by hemiplegia after arterial ischemic stroke (AIS) who had limited upper and lower right-limb function but unaffected sensory and cognitive skills. Four different rehabilitative treatments were chosen when the child was inpatient or outpatient. Measurements of gait performance before and after selected treatments were evaluated using PEDI and GMFM (i.e., SAT) and kinematic and kinetic parameters (i.e., GA). Gait pattern and inter- and intralimb-joint coordination changed over time during the three examined years. However, after the first eight months of recovery, gait pattern modifications were detected by GA measures but not by SAT. The integration of SAT and GA findings, during the examined recovery evolution, resulted effective in the decision-making process for a person-oriented rehabilitative treatment.

Research paper thumbnail of Abnormal adaptation in children affected by cerebral palsy to robot generated dynamic environment

Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2010

This paper aims to investigate how robotic devices can be used to understand the mechanism of sen... more This paper aims to investigate how robotic devices can be used to understand the mechanism of sensorimotor adaptation in pediatric subjects affected by hemiparetic cerebral palsy. Previous studies showed how healthy adults, after training in presence of a systematic structured disturbing force field, show an "after effect" and therefore they highly adapt and compensate the external disturbance. An open issue is whether this adaptive capability is preserved or disrupted in pediatric impaired subjects when they experience a robot generated dynamic environment. Fourteen pediatric Cerebral Palsy subjects (CP group), and age-matched control group were exposed to a robot generated speed-dependant force field; during familiarization (no forces generated by the robot) the movement of the CP subjects were more curved, displaying greater and variable directional error; in the force field phase both the groups showed an after-effect, but the CP group had a non significant adaptation ...

Research paper thumbnail of The impact of robotic rehabilitation in children with acquired or congenital movement disorders

European journal of physical and rehabilitation medicine, 2009

The aim of this study was to evaluate if the robot-mediated therapy (RMT) can yield positive outc... more The aim of this study was to evaluate if the robot-mediated therapy (RMT) can yield positive outcomes in children with acquired or congenital upper extremity movement disorders. This was an uncontrolled pilot study with pre-post treatment outcome comparison carried out by the Pediatric Rehabilitation Department of a Children's Hospital. The study enrolled 12 children, aged 5 to 15 years, suffering from acquired (at least 12 months post-onset) or congenital upper limb motor impairment. 4 stroke, 6 traumatic brain injuries, and 2 hemiplegic cerebral palsy. RMT was provided 3 times a week for an hour during 6 weeks for a total of 18 robot therapy sessions. The Melbourne Scale (MS) and the upper-extremity subsection of the Fugl-Meyer Assessment (FMA) were used for measurement of impairment. Secondary outcome measurements were made through the Modified Ashworth Scale (MAS); the Reaching Performance Scale (RPS); Parent's Questionnaire, and robot-based evaluation measurements. Spec...

Research paper thumbnail of EMG and Kinematics Assessment of Postural Responses during Balance Perturbation on a 3D Robotic Platform: Preliminary Results in Children with Hemiplegia

Dynamic posturography has been proposed as a valuable tool for the assessment of balance impairme... more Dynamic posturography has been proposed as a valuable tool for the assessment of balance impairments. This paper compares the postural responses of healthy and hemiplegic children while keeping balance on a 3D robotic perturbed platform, addressed as Rotobit 3D. Dynamic postural responses are assessed by using surface EMG, recorded from four muscles of both legs, and lower limb kinematics. These preliminary results show that the used protocol is able to highlight significant differences in the postural responses, in terms of postural asymmetries between the less affected and more affected side for both electrophysiological and kinematic recordings.

Research paper thumbnail of Shoulder motor performance assessment in the sagittal plane in children with hemiplegia during single joint pointing tasks

Biomedical engineering online, Jan 29, 2014

Pointing is a motor task extensively used during daily life activities and it requires complex vi... more Pointing is a motor task extensively used during daily life activities and it requires complex visuo-motor transformation to select the appropriate movement strategy. The study of invariant characteristics of human movements has led to several theories on how the brain solves the redundancy problem, but the application of these theories on children affected by hemiplegia is limited. This study aims at giving a quantitative assessment of the shoulder motor behaviour in children with hemiplegia during pointing tasks. Eight children with hemiplegia were involved in the study and were asked to perform movements on the sagittal plane with both arms, at low and high speed. Subject movements were recorded using an optoelectronic system; a 4-DOF model of children arm has been developed to calculate kinematic and dynamic variables. A set of evaluation indexes has been extracted in order to quantitatively assess whether and how children modify their motor control strategies when perform movem...

Research paper thumbnail of A Novel Robotic System to Study the Upper Limb Strategy During Reaching of a Moving Target

ASME 2007 2nd Frontiers in Biomedical Devices, 2007

The study of the rehabilitation of the upper arm is an important issue in the Rehabilitation fiel... more The study of the rehabilitation of the upper arm is an important issue in the Rehabilitation field due to: (i) the rapid growth of the older population [1, 2] and (ii) traumatic brain injury [3]. More specifically, the increase of the elderly at 2.4% per year and the increase in the probability of a stroke with age; in fact, this pathology is the first cause of invalidity in Europe where it occurs at a rate 60% higher than in the US. Moreover, it is necessary to take into account other degenerative pathologies, such as Parkinson’s. MIT-MANUS is the robotic system developed at the MIT Lab to rehabilitate the upper limb by means of exercises which guide or perturb the spontaneous movement of the brain-injured subject [4]. Its disadvantages are: (i) the loss of reality, because the patient reaches a visual target with the robot handle, which does not correspond to a 3D movement, and, especially, (ii) the high cost. The study of reaching is divided in two branches: reaching towards a st...

Research paper thumbnail of Experimental validation of a novel protocol for dystonia assessment using MIMU sensors

Gait & Posture, 2014

Fig. 1. Characterization of three objects grasp. Time is represented on abscissas; filtered data ... more Fig. 1. Characterization of three objects grasp. Time is represented on abscissas; filtered data is represented on ordinates (sampled data ranges from 0 to 1023). Bend sensors output range is shown in pale yellow: high values represent opened hand; low values represent closed hand.

Research paper thumbnail of Gait analysis bladder exstrophy patients with and without pelvic osteotomy: a controlled experimental study

European journal of physical and rehabilitation medicine

Background: The role of bony pelvic anomalies in bladder exstrophy is long established and has ge... more Background: The role of bony pelvic anomalies in bladder exstrophy is long established and has generated many papers addressing walking problems. Biomechanical studies and kinematic gait analysis were performed on very young children. Aim: A direct kinetic gait evaluation has never been performed, nor has the effect of pelvis dimorphism on the upper body been studied. Design: Controlled experimental study. Setting: Outpatients were studied at the time of periodic follow up. Population: Nineteen patients with bladder exstrophy, age 14±8 years, and twenty-five healthy control participants, age 15±8 years, were enrolled in the present gait analysis study. Methods: Clinical evaluation and standard gait analysis were performed. Results: Gait analysis deviations between exstrophy patients and controls and between patients that received pelvic osteotomy (OT ‑ 6 patients) and those that did not (no-OT ‑ 13 patients) were analyzed. Bladder exstrophy significantly affects kinematics and kinet...

Research paper thumbnail of Kinetic and Kinematic Evaluation of Walking Joints In Bladder Exstrophy Patients with and without Osteotomy

Purpose Bony pelvis anomalies in bladder exstrophy have prompted a great deal of papers addressin... more Purpose Bony pelvis anomalies in bladder exstrophy have prompted a great deal of papers addressing biomechanical analysis and kinematic of walking joints. However, a direct evaluation of forces applied to each joint (moments and powers) has never been performed nor has it been correlated to osteotomy Methods Exstrophy patients in a collaborative age were asked to participate in gait studies using a Vicon MX, a 3-dimensional motion analysis system with 8 cameras – kinematics - and two force plates (AMTI, USA) - kinetics. Kinematics analysis included pelvic tilt and hip, knee and ankle flexion-extension angles. Kinetics analysis consisted in the evaluation of hip, knee and ankle moments and powers. Normal healthy peers acted as controls. Correlations were sought between exstrophy patients and controls and between patients non osteotomized (Group 1) and those with osteotomy (Group 2) In particular, were analyzed: i)knee angle at contact with floor, during load response , in late stance...

Research paper thumbnail of Innovativa Per Analisi DI Posturografia Dinamica

Sommario La postura è un compito complesso per il Sistema Nervoso Centrale e deve essere mantenut... more Sommario La postura è un compito complesso per il Sistema Nervoso Centrale e deve essere mantenuto sia in seguito a movimenti autonomi che a perturbazioni introdotte dall'esterno. Imporre una perturbazione nota permette di analizzare le differenti strategie posturali scelte dai soggetti. In particolare, la piattaforma motorizzata in esame ha un grado di libertà e permette di ruotare i soggetti intorno

Research paper thumbnail of Upper body balance control strategy during continuous 3D postural perturbation in young adults

Research paper thumbnail of Visual Recognition and Visually Guided Action After Early Bilateral Lesion of Occipital Cortex: A Behavioral Study of a 4.6-year-old Girl

Neurocase, 2006

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It... more We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child's visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain's potential for reorganisation related to when the damage occurred.

Research paper thumbnail of FP12-MO-01 3-D dynamic postural task-related evaluation in cerebral palsy

Journal of the Neurological Sciences, 2009

Research paper thumbnail of Reach-to-grasp interjoint coordination for moving object in children with hemiplegia

Journal of Rehabilitation Medicine, 2009

Objective: To evaluate interjoint coordination in children with hemiplegia as they reach to grasp... more Objective: To evaluate interjoint coordination in children with hemiplegia as they reach to grasp objects, in both static and dynamic conditions. An ad hoc robotic device was used to study the dynamic condition. Design: Observational study. Patients: Six children with hemiplegia and 6 young adults. Methods: Kinematics of the trunk and arm were studied using an optoelectronic system. In the dynamic condition the target object, a cup, was moved by the robotic device along clockwise and counterclockwise circular trajectories. Results: Two main strategies were used to study the onset and offset of shoulder and elbow movements and their maximum velocities. The hand velocity profile was bell-shaped in the static condition and compatible with ramp movements for the more affected side in the dynamic condition. The time to object contact was higher for the more affected side in the dynamic condition. The temporal coordination index illustrated an immature and less flexible behaviour in children's reaching in all the examined conditions. Conclusion: Study of the hand velocity profiles, the time to object contact and the temporal coordination index highlighted, first, the dependence of upper limb interjoint coordination on task, context, residual resources and individual solution, and secondly, the sensory-motor deficit characteristics of the children's more affected side during dynamic reaching, raising the prospect of a promising training context in children with hemiplegia.

Research paper thumbnail of Robot-mediated and clinical scales evaluation after upper limb botulinum toxin type A injection in children with hemiplegia

Journal of Rehabilitation Medicine, 2009

The aim of this pilot study was to examine changes in different aspects of impairment, including ... more The aim of this pilot study was to examine changes in different aspects of impairment, including spasticity in the upper limbs, of hemiplegic children following botulinum toxin type A intervention. Progress was assessed using standard clinical measurements and a robotic device. Design: Pre-post multiple baseline. Subjects: Six children with hemiplegia. Methods: Botulinium toxin type A injections were administered into the affected upper limb muscles. Outcomes were evaluated before and one month after the injection. Outcome assessments included: Melbourne Scale, Modified Ashworth Scale (MAS) and Passive Range of Motion. Furthermore, a robotic device was employed as an evaluation tool. Results: Patients treated with botulinum toxin type A had significantly greater reduction in spasticity (MAS, p < 0.01), which explains an improvement in upper limb function and quality movement measured with the Melbourne Scale (p < 0.01). These improvements are consistent with robot-based evaluation results that showed statistically significant changes (p < 0.01) following botulinum toxin type A injections. Conclusion: The upper limb performs a wide variety of movements. The multi-joint nature of the task during the robotmediated evaluation required active control of joint interaction forces. There was good correlation between clinical scales and robotic evaluation. Hence the robot-mediated assessment may be used as an additional tool to quantify the degree of motor improvement after botulinum toxin type A injections.

Research paper thumbnail of Gait analysis in patients operated on for sacrococcygeal teratoma

Journal of Pediatric Surgery, 2004

Background: Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, li... more Background: Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, little is known about the effects of extensive surgery in the pelvic and perineal region, which involves disruption of muscles providing maximal support in normal walking. Methods: Thirteen patients operated on at birth for SCT with extensive muscle dissection underwent gait studies with a Vicon 3-D motion analysis system with 6 cameras. Results were compared with 15 age-matched controls. Statistical analysis was performed with Mann-Whitney test; correlations were sought with Spearman's correlation coefficient. Results: All subjects were independent ambulators, and no statistically significant differences were seen in walking velocity and stride length. However, in all patients, toe-off occurred earlier (at 58% Ϯ 1.82% of stride length) than controls (at 65.5% Ϯ 0.52%; P Ͻ .05). On kinetics, all patients exhibited, on both limbs, a significant reduction of hip extensory moment (Ϫ0.11 Ϯ 0.11 left; Ϫ0.16 Ϯ 0.15 right v 1.19 Ϯ 0.08 Newtonmeter/kg; P Ͻ .05) and of ankle dorsi/ plantar moment (Ϫ0.07 Ϯ 0.09 right; Ϫ0.08 Ϯ 0.16 v Ϫ0.15 Ϯ 0.05 Nm/kg, p Ͻ 0.05). Knee power was also significantly reduced (0.44 Ϯ 0.55 right, 0.63 Ϯ 0.45 left v 0.04 Ϯ 0.05 W/kg), whereas ankle power was increased (3 Ϯ 1.5 right; 2.8 Ϯ 0.9 left v 1.97 Ϯ 0.2 W/kg; P Ͻ .05). No statistically significant correlation was found between tumor size and either muscle power generation or flexory/extensory moments. Conclusions: Patients operated on for SCT exhibit nearly normal gait patterns. However, this normal pattern is accompanied by abnormal kinetics of some ambulatory muscles, and the extent of these abnormalities appears to be independent of tumor size. A careful follow-up is warranted to verify if such modifications are stable or progress over the years, thereby impairing ambulatory potential or leading to early arthrosis.

Research paper thumbnail of A system for real-time mapping of foot segment pressures in dynamic posturography

Research paper thumbnail of Visual recognition and visually guided action after early bilateral lesion of occipital cortex: a behavioral study of a 4.6-year-old girl

Neurocase, Nov 1, 2006

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It... more We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s potential for reorganisation related to when the damage occurred.

Research paper thumbnail of Time to boundary function to assess upright stance in blind children

2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC), 2015

The goal of this preliminary study was to assess the difference in postural stability between bli... more The goal of this preliminary study was to assess the difference in postural stability between blind and sighted children using the Time to Boundary function (TtB). The experiment was conducted in twelve children (6-12 yrs), six of them had no visual impairment, and other six had congenital blindness. The participants stood on RotoBit force plate maintaining upright stance in static conditions. Each blind subject executed the task three times, each sighted subject executed the task six times, three with eyes closed (EC) and three with eyes open (EO). For all subjects each repetition lasted 30 s. The Centre of Pressure (CoP) coordinates, extracted directly from a force plate, are used to calculate four classical parameters (sway path, sway area, mean amplitude and mean frequency) and a predictive variable called Time to Boundary (TtB). The latter is the time it would take the CoP, given its instantaneous trajectory, to contact a stability boundary. Descriptive statistics were calculated for all parameters. Twoway ANOVA test was done considering the visual condition (EO, EC, BLIND) and the repetitions (RP) as a factor. In the first comparison (BLIND/EO) the results showed significant difference for all the parameters except for TtB. In the second comparison (BLIND/EC) the results showed significant difference only for TtB. In the third comparison (EO/EC) the results showed significant difference for all the calculated parameters. Therefore the TtB would be used to asses the postural control in children with blindness.

Research paper thumbnail of Ability of healthy standing subjects in orienting after imposed rotations

Research paper thumbnail of Patient-centered rehabilitation, three years of gait recovery in a child affected by hemiplegia:. case report

European journal of physical and rehabilitation medicine

The aim of this report was to illustrate and to discuss a method capable of improving the person-... more The aim of this report was to illustrate and to discuss a method capable of improving the person-oriented decision-making process during three years of gait rehabilitation based on the integration of: 1) the fundamental principles of motor learning and 2) the outcomes made available by both clinical standardized assessment tools (SAT) and measures made available by a gait analysis system (GA). The subject studied was a six-year-old child affected by hemiplegia after arterial ischemic stroke (AIS) who had limited upper and lower right-limb function but unaffected sensory and cognitive skills. Four different rehabilitative treatments were chosen when the child was inpatient or outpatient. Measurements of gait performance before and after selected treatments were evaluated using PEDI and GMFM (i.e., SAT) and kinematic and kinetic parameters (i.e., GA). Gait pattern and inter- and intralimb-joint coordination changed over time during the three examined years. However, after the first eight months of recovery, gait pattern modifications were detected by GA measures but not by SAT. The integration of SAT and GA findings, during the examined recovery evolution, resulted effective in the decision-making process for a person-oriented rehabilitative treatment.

Research paper thumbnail of Abnormal adaptation in children affected by cerebral palsy to robot generated dynamic environment

Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference, 2010

This paper aims to investigate how robotic devices can be used to understand the mechanism of sen... more This paper aims to investigate how robotic devices can be used to understand the mechanism of sensorimotor adaptation in pediatric subjects affected by hemiparetic cerebral palsy. Previous studies showed how healthy adults, after training in presence of a systematic structured disturbing force field, show an "after effect" and therefore they highly adapt and compensate the external disturbance. An open issue is whether this adaptive capability is preserved or disrupted in pediatric impaired subjects when they experience a robot generated dynamic environment. Fourteen pediatric Cerebral Palsy subjects (CP group), and age-matched control group were exposed to a robot generated speed-dependant force field; during familiarization (no forces generated by the robot) the movement of the CP subjects were more curved, displaying greater and variable directional error; in the force field phase both the groups showed an after-effect, but the CP group had a non significant adaptation ...

Research paper thumbnail of The impact of robotic rehabilitation in children with acquired or congenital movement disorders

European journal of physical and rehabilitation medicine, 2009

The aim of this study was to evaluate if the robot-mediated therapy (RMT) can yield positive outc... more The aim of this study was to evaluate if the robot-mediated therapy (RMT) can yield positive outcomes in children with acquired or congenital upper extremity movement disorders. This was an uncontrolled pilot study with pre-post treatment outcome comparison carried out by the Pediatric Rehabilitation Department of a Children's Hospital. The study enrolled 12 children, aged 5 to 15 years, suffering from acquired (at least 12 months post-onset) or congenital upper limb motor impairment. 4 stroke, 6 traumatic brain injuries, and 2 hemiplegic cerebral palsy. RMT was provided 3 times a week for an hour during 6 weeks for a total of 18 robot therapy sessions. The Melbourne Scale (MS) and the upper-extremity subsection of the Fugl-Meyer Assessment (FMA) were used for measurement of impairment. Secondary outcome measurements were made through the Modified Ashworth Scale (MAS); the Reaching Performance Scale (RPS); Parent's Questionnaire, and robot-based evaluation measurements. Spec...

Research paper thumbnail of EMG and Kinematics Assessment of Postural Responses during Balance Perturbation on a 3D Robotic Platform: Preliminary Results in Children with Hemiplegia

Dynamic posturography has been proposed as a valuable tool for the assessment of balance impairme... more Dynamic posturography has been proposed as a valuable tool for the assessment of balance impairments. This paper compares the postural responses of healthy and hemiplegic children while keeping balance on a 3D robotic perturbed platform, addressed as Rotobit 3D. Dynamic postural responses are assessed by using surface EMG, recorded from four muscles of both legs, and lower limb kinematics. These preliminary results show that the used protocol is able to highlight significant differences in the postural responses, in terms of postural asymmetries between the less affected and more affected side for both electrophysiological and kinematic recordings.

Research paper thumbnail of Shoulder motor performance assessment in the sagittal plane in children with hemiplegia during single joint pointing tasks

Biomedical engineering online, Jan 29, 2014

Pointing is a motor task extensively used during daily life activities and it requires complex vi... more Pointing is a motor task extensively used during daily life activities and it requires complex visuo-motor transformation to select the appropriate movement strategy. The study of invariant characteristics of human movements has led to several theories on how the brain solves the redundancy problem, but the application of these theories on children affected by hemiplegia is limited. This study aims at giving a quantitative assessment of the shoulder motor behaviour in children with hemiplegia during pointing tasks. Eight children with hemiplegia were involved in the study and were asked to perform movements on the sagittal plane with both arms, at low and high speed. Subject movements were recorded using an optoelectronic system; a 4-DOF model of children arm has been developed to calculate kinematic and dynamic variables. A set of evaluation indexes has been extracted in order to quantitatively assess whether and how children modify their motor control strategies when perform movem...

Research paper thumbnail of A Novel Robotic System to Study the Upper Limb Strategy During Reaching of a Moving Target

ASME 2007 2nd Frontiers in Biomedical Devices, 2007

The study of the rehabilitation of the upper arm is an important issue in the Rehabilitation fiel... more The study of the rehabilitation of the upper arm is an important issue in the Rehabilitation field due to: (i) the rapid growth of the older population [1, 2] and (ii) traumatic brain injury [3]. More specifically, the increase of the elderly at 2.4% per year and the increase in the probability of a stroke with age; in fact, this pathology is the first cause of invalidity in Europe where it occurs at a rate 60% higher than in the US. Moreover, it is necessary to take into account other degenerative pathologies, such as Parkinson’s. MIT-MANUS is the robotic system developed at the MIT Lab to rehabilitate the upper limb by means of exercises which guide or perturb the spontaneous movement of the brain-injured subject [4]. Its disadvantages are: (i) the loss of reality, because the patient reaches a visual target with the robot handle, which does not correspond to a 3D movement, and, especially, (ii) the high cost. The study of reaching is divided in two branches: reaching towards a st...

Research paper thumbnail of Experimental validation of a novel protocol for dystonia assessment using MIMU sensors

Gait & Posture, 2014

Fig. 1. Characterization of three objects grasp. Time is represented on abscissas; filtered data ... more Fig. 1. Characterization of three objects grasp. Time is represented on abscissas; filtered data is represented on ordinates (sampled data ranges from 0 to 1023). Bend sensors output range is shown in pale yellow: high values represent opened hand; low values represent closed hand.

Research paper thumbnail of Gait analysis bladder exstrophy patients with and without pelvic osteotomy: a controlled experimental study

European journal of physical and rehabilitation medicine

Background: The role of bony pelvic anomalies in bladder exstrophy is long established and has ge... more Background: The role of bony pelvic anomalies in bladder exstrophy is long established and has generated many papers addressing walking problems. Biomechanical studies and kinematic gait analysis were performed on very young children. Aim: A direct kinetic gait evaluation has never been performed, nor has the effect of pelvis dimorphism on the upper body been studied. Design: Controlled experimental study. Setting: Outpatients were studied at the time of periodic follow up. Population: Nineteen patients with bladder exstrophy, age 14±8 years, and twenty-five healthy control participants, age 15±8 years, were enrolled in the present gait analysis study. Methods: Clinical evaluation and standard gait analysis were performed. Results: Gait analysis deviations between exstrophy patients and controls and between patients that received pelvic osteotomy (OT ‑ 6 patients) and those that did not (no-OT ‑ 13 patients) were analyzed. Bladder exstrophy significantly affects kinematics and kinet...

Research paper thumbnail of Kinetic and Kinematic Evaluation of Walking Joints In Bladder Exstrophy Patients with and without Osteotomy

Purpose Bony pelvis anomalies in bladder exstrophy have prompted a great deal of papers addressin... more Purpose Bony pelvis anomalies in bladder exstrophy have prompted a great deal of papers addressing biomechanical analysis and kinematic of walking joints. However, a direct evaluation of forces applied to each joint (moments and powers) has never been performed nor has it been correlated to osteotomy Methods Exstrophy patients in a collaborative age were asked to participate in gait studies using a Vicon MX, a 3-dimensional motion analysis system with 8 cameras – kinematics - and two force plates (AMTI, USA) - kinetics. Kinematics analysis included pelvic tilt and hip, knee and ankle flexion-extension angles. Kinetics analysis consisted in the evaluation of hip, knee and ankle moments and powers. Normal healthy peers acted as controls. Correlations were sought between exstrophy patients and controls and between patients non osteotomized (Group 1) and those with osteotomy (Group 2) In particular, were analyzed: i)knee angle at contact with floor, during load response , in late stance...

Research paper thumbnail of Innovativa Per Analisi DI Posturografia Dinamica

Sommario La postura è un compito complesso per il Sistema Nervoso Centrale e deve essere mantenut... more Sommario La postura è un compito complesso per il Sistema Nervoso Centrale e deve essere mantenuto sia in seguito a movimenti autonomi che a perturbazioni introdotte dall'esterno. Imporre una perturbazione nota permette di analizzare le differenti strategie posturali scelte dai soggetti. In particolare, la piattaforma motorizzata in esame ha un grado di libertà e permette di ruotare i soggetti intorno

Research paper thumbnail of Upper body balance control strategy during continuous 3D postural perturbation in young adults

Research paper thumbnail of Visual Recognition and Visually Guided Action After Early Bilateral Lesion of Occipital Cortex: A Behavioral Study of a 4.6-year-old Girl

Neurocase, 2006

We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It... more We report the case of a 4.6-year-old girl born pre-term with early bilateral occipital damage. It was revealed that the child had non-severely impaired basic visual abilities and ocular motility, a selective perceptual deficit of figure-ground segregation, impaired visual recognition and abnormal navigating through space. Even if the child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s visual functioning was not optimal, this was the expression of adaptive anatomic and functional brain modifications that occurred following the early lesion. Anatomic brain structure was studied with anatomic MRI and Diffusor Tensor Imaging (DTI)-MRI. This behavioral study may provide an important contribution to understanding the impact of an early lesion of the visual system on the development of visual functions and on the immature brain&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s potential for reorganisation related to when the damage occurred.

Research paper thumbnail of FP12-MO-01 3-D dynamic postural task-related evaluation in cerebral palsy

Journal of the Neurological Sciences, 2009

Research paper thumbnail of Reach-to-grasp interjoint coordination for moving object in children with hemiplegia

Journal of Rehabilitation Medicine, 2009

Objective: To evaluate interjoint coordination in children with hemiplegia as they reach to grasp... more Objective: To evaluate interjoint coordination in children with hemiplegia as they reach to grasp objects, in both static and dynamic conditions. An ad hoc robotic device was used to study the dynamic condition. Design: Observational study. Patients: Six children with hemiplegia and 6 young adults. Methods: Kinematics of the trunk and arm were studied using an optoelectronic system. In the dynamic condition the target object, a cup, was moved by the robotic device along clockwise and counterclockwise circular trajectories. Results: Two main strategies were used to study the onset and offset of shoulder and elbow movements and their maximum velocities. The hand velocity profile was bell-shaped in the static condition and compatible with ramp movements for the more affected side in the dynamic condition. The time to object contact was higher for the more affected side in the dynamic condition. The temporal coordination index illustrated an immature and less flexible behaviour in children's reaching in all the examined conditions. Conclusion: Study of the hand velocity profiles, the time to object contact and the temporal coordination index highlighted, first, the dependence of upper limb interjoint coordination on task, context, residual resources and individual solution, and secondly, the sensory-motor deficit characteristics of the children's more affected side during dynamic reaching, raising the prospect of a promising training context in children with hemiplegia.

Research paper thumbnail of Robot-mediated and clinical scales evaluation after upper limb botulinum toxin type A injection in children with hemiplegia

Journal of Rehabilitation Medicine, 2009

The aim of this pilot study was to examine changes in different aspects of impairment, including ... more The aim of this pilot study was to examine changes in different aspects of impairment, including spasticity in the upper limbs, of hemiplegic children following botulinum toxin type A intervention. Progress was assessed using standard clinical measurements and a robotic device. Design: Pre-post multiple baseline. Subjects: Six children with hemiplegia. Methods: Botulinium toxin type A injections were administered into the affected upper limb muscles. Outcomes were evaluated before and one month after the injection. Outcome assessments included: Melbourne Scale, Modified Ashworth Scale (MAS) and Passive Range of Motion. Furthermore, a robotic device was employed as an evaluation tool. Results: Patients treated with botulinum toxin type A had significantly greater reduction in spasticity (MAS, p < 0.01), which explains an improvement in upper limb function and quality movement measured with the Melbourne Scale (p < 0.01). These improvements are consistent with robot-based evaluation results that showed statistically significant changes (p < 0.01) following botulinum toxin type A injections. Conclusion: The upper limb performs a wide variety of movements. The multi-joint nature of the task during the robotmediated evaluation required active control of joint interaction forces. There was good correlation between clinical scales and robotic evaluation. Hence the robot-mediated assessment may be used as an additional tool to quantify the degree of motor improvement after botulinum toxin type A injections.

Research paper thumbnail of Gait analysis in patients operated on for sacrococcygeal teratoma

Journal of Pediatric Surgery, 2004

Background: Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, li... more Background: Long-term follow-up of sacrococcygeal teratoma (SCT) is well established; however, little is known about the effects of extensive surgery in the pelvic and perineal region, which involves disruption of muscles providing maximal support in normal walking. Methods: Thirteen patients operated on at birth for SCT with extensive muscle dissection underwent gait studies with a Vicon 3-D motion analysis system with 6 cameras. Results were compared with 15 age-matched controls. Statistical analysis was performed with Mann-Whitney test; correlations were sought with Spearman's correlation coefficient. Results: All subjects were independent ambulators, and no statistically significant differences were seen in walking velocity and stride length. However, in all patients, toe-off occurred earlier (at 58% Ϯ 1.82% of stride length) than controls (at 65.5% Ϯ 0.52%; P Ͻ .05). On kinetics, all patients exhibited, on both limbs, a significant reduction of hip extensory moment (Ϫ0.11 Ϯ 0.11 left; Ϫ0.16 Ϯ 0.15 right v 1.19 Ϯ 0.08 Newtonmeter/kg; P Ͻ .05) and of ankle dorsi/ plantar moment (Ϫ0.07 Ϯ 0.09 right; Ϫ0.08 Ϯ 0.16 v Ϫ0.15 Ϯ 0.05 Nm/kg, p Ͻ 0.05). Knee power was also significantly reduced (0.44 Ϯ 0.55 right, 0.63 Ϯ 0.45 left v 0.04 Ϯ 0.05 W/kg), whereas ankle power was increased (3 Ϯ 1.5 right; 2.8 Ϯ 0.9 left v 1.97 Ϯ 0.2 W/kg; P Ͻ .05). No statistically significant correlation was found between tumor size and either muscle power generation or flexory/extensory moments. Conclusions: Patients operated on for SCT exhibit nearly normal gait patterns. However, this normal pattern is accompanied by abnormal kinetics of some ambulatory muscles, and the extent of these abnormalities appears to be independent of tumor size. A careful follow-up is warranted to verify if such modifications are stable or progress over the years, thereby impairing ambulatory potential or leading to early arthrosis.