1,720,989 research outputs found
Embodied the Healthy Arm: Virtual Reality Rehabilitation for Stroke Patients with Proprioceptive Upper-Limb Deficit.
No full textThe article focuses on the use of virtual reality (VR) in the rehabilitation of stroke patients with upper-limb motor deficits, particularly addressing the body illusion paradigm to improve motor abilities. Topics include the neuroscience perspective of post-stroke motor deficits, the application of VR in upper-limb rehabilitation, and the Stroke-VR Project's investigation into the effectiveness of embodying a virtual arm for motor rehabilitation.The main consequence of stroke is upper-limb motor deficits, with partial or complete inability to move the right or left arm, depending on which hemisphere is affected, and limited ability to perform grasping tasks due to lack of motor coordination and control of grip and finger strength.2 As a result, activities of daily living such as eating alone, dressing, and performing personal hygiene are challenging, with constant dependence on a caregiver.
From a neuroscience perspective, the deficit in planning, preparing, and executing movements is due to damage to the primary motor cortex, which is responsible for body representation, leading to alteration of proprioceptive and kinesthetic signals and the perception of peripersonal space.3 Thus, a stroke could distort the sense of embodiment in terms of ownership, agency, and location that enables the person to perceive and coordinate the body according to the environment.
Considering the role of neural plasticity, a growing number of studies in the field of multisensory integration techniques use the body ownership illusion to modulate the distorted body representation after brain damage.4 This could be possible because the illusion through virtual reality (VR) improves the reorganization of the body representation, demonstrating its effectiveness in upper-limb rehabilitation
Cognitive rehabilitation in the metaverse: insights from the tele-neurorehab project.
No full textStroke and severe brain injury are the main causes of cognitive
impairments resulting from brain damage that more frequently
affects the parietal, frontal, midbrain, or brainstem structures.
Injuries may be reflected in language, attention, memory, and
executive dysfunctions, with a significant impact on daily life
activities.After discharge from hospital, patients must undergo a
long rehabilitation program to restore their cognitive and motor
functions. However, only 25% of them recover completely, and
the remaining 75% need constant and profound rehabilitation,
varying from weeks to several months or years.1
Cognitive rehabilitation encompasses a wide range of
therapeutic cognitive interventions to achieve functional
changes for strengthening or reestablishing previously learned
patterns of behavior or establishing new patterns of cognitive
activities to compensate for impaired neurological systems.
Nevertheless, most patients encounter many barriers in receiving
medical attention due to geographical or time limitations,
or to the loss of motivation in pursuing the
rehabilitation, with negative consequences for treatment adherence.
2 Furthermore, in most countries, public hospitals are
suffering from an economic crisis, resulting in a limited
number of rehabilitators (developments in the health system
have led to the number of stroke survivors doubling over the
last 30 years). Thus, the healthcare system must be revitalized
Biophysical stimulation improves clinical results of matrix-assisted autologous chondrocyte implantation in the treatment of chondral lesions of the knee
No full textPurpose: The purpose of the present study was to evaluate the effects of pulsed electromagnetic fields (PEMFs) on clinical outcome in patients who underwent arthroscopic matrix-assisted autologous chondrocyte implantation (MACI) for chondral lesions of the knee. Methods: Thirty patients affected by grade III and IV International Cartilage Repair Society chondral lesions of the knee underwent MACI. After surgery, patients were randomly assigned to either experimental group (PEMFs 4 h per day for 60 days) or control group. Clinical outcome was evaluated through International Knee Documentation Committee (IKDC) subjective knee evaluation form, Visual Analog Scale, Short Form-36 (SF-36) and EuroQoL before surgery and 1, 2, 6, and 60 months postoperative. Results: Mean size of chondral lesion was 2.4 ± 0.6 cm2in the PEMFs group and 2.5 ± 0.5 cm2in the control one. No differences were found between groups at baseline. IKDC score increased in both groups till 6 months, but afterward improvement was observed only in the experimental group with a significant difference between groups at 60 months (p = 0.001). A significant difference between groups was recorded at 60 months for SF-36 (p = 0.006) and EuroQol (p = 0.020). A significant pain reduction was observed in the experimental group at 1-, 2- and 60-month follow-up. Conclusion: Biophysical stimulation with PEMFs improves clinical outcome after arthroscopic MACI for chondral lesions of the knee in the short- and long-term follow-up. Biophysical stimulation should be considered as an effective tool in order to ameliorate clinical results of regenerative medicine. The use of PEMFs represents an innovative therapeutic approach for the survival of cartilage-engineered constructs and consequently the success of orthopaedic surgery. Level of evidence: II
Functional evaluation of bilateral subtalar arthroereisis for the correction of flexible flatfoot in children: 1-year follow-up
No full textBackground: Flexible flatfoot (FFF) is a common alteration of the foot diagnosed in the pediatric population causing pain and decreased quality of life. Surgical treatment via arthroereisis of the subtalar joint can be recommended when non-invasive options do not result in sufficient pain relief. While clinical outcome of subtalar joint arthroereisis is generally positive, no functional evaluation has thus far been reported following surgery. Research question: The aim of this study was to assess the effects of two arthroereisis implants for the correction of bilateral FFF on foot and lower limb biomechanics during gait. Methods: This is a prospective study following 13 children affected by bilateral symptomatic FFF. The patients underwent bilateral subtalar arthroereisis during the same surgery using two types of poly-L-lactide bioabsorbable implants: an expanding endo-orthotic implant, and a calcaneo-stop screw. Radiological parameters and gait analysis were performed preoperatively and at 1 year follow-up and compared to those from an age-matched normal-arched control population. Lower limb and multisegment foot kinematic analysis, along with EMG of the main ankle flexor/extensor muscles, were performed during level walking at comfortable speed. Paired non-parametric Wilcoxon signed-rank test was used to assess differences in radiological and kinematic parameters between pre-op and post-op assessments. Results: All radiological parameters, and frontal-plane orientation of the rearfoot in double-leg standing were improved at 1-year follow-up in both implant groups (e.g calcaneo-stop: pre-op = 15 ± 7 deg; post-op = 6 ± 9 deg; p < 0.01). The endo-orthotic implant group showed significantly lower pronation/supination at the ankle and midtarsal joint. Activation of the tibialis anterior muscle was more physiological after surgery in both groups. Significance: According to the present analysis, both implants appear effective in restoring physiological alignment of the rearfoot, however the endo-orthotic implant appeared more effective in restoring a more correct frontal-plane mobility of foot joints
In shoe pressure measurements during different motor tasks while wearing safety shoes: The effect of custom made insoles vs. prefabricated and off-the-shelf
Full text linkHealth and safety regulations in many countries require workers at risk to wear safety shoes in a factory environment. These shoes are often heavy, rigid, and uncomfortable. Wearing safety shoes daily leads to foot problems, discomfort and fatigue, resulting also in the loss of numerous working days. Currently, knowledge of the biomechanical effects of insoles in safety shoes, during working activities, is very limited. Seventeen workers from a metalworking factory were selected and clinically examined for any foot conditions. Workers feet were 3D scanned, with regards to their plantar view, and the images used to design 34 custom-insoles, based on foot and safety shoe models. Three insoles were blind-tested by each worker: custom (CUS); prefabricated with the safety-shoe (PSS), and off-the-shelf (OTS). Foot-to-insole pressure distribution was measured in seven motor tasks replicating typical working activities: single and double-leg standing; weight lifting; stair ascending and descending; normal and fast walking. Wearing CUS within safety shoes resulted in a greater uniform pressure distribution across plantar regions for most of the working activities. Peak pressure at the forefoot during normal walking was the lowest in the custom insole (CUS 275.9 ± 55.3 kPa; OTS 332.7 ± 75.5 kPa; PSS 304.5 ± 54.2 kPa). Normal and fast walking were found to be the most demanding activities in terms of peak pressure. Wearing safety shoes results in high pedobarographic parameters in several foot regions. The use of custom insoles designed on the foot morphology helps decrease peak pressure and pressure-time integral compared to prefabricated featureless insoles
Co-designing an interactive artificial intelligent system for people with neurological lesions: a human-centric approach
No full textHierarchical psychophysiological pathways subtend perceptual asymmetries in Neglect
Full text linkStroke patients with left Hemispatial Neglect (LHN) show deficits in perceiving left contralesional stimuli with biased visuospatial perception towards the right hemifield. However, very little is known about the functional organization of the visuospatial perceptual neural network and how this can account for the profound reorganization of space representation in LHN. In the present work, we aimed at (1) identifying EEG measures that discriminate LHN patients against controls and (2) devise a causative neurophysiological model between the discriminative EEG measures. To these aims, EEG was recorded during exposure to lateralized visual stimuli which allowed for pre-and post-stimulus activity investigation across three groups: LHN patients, lesioned controls, and healthy individuals. Moreover, all participants performed a standard behavioral test assessing the perceptual asymmetry index in detecting lateralized stimuli. The between-groups discriminative EEG patterns were entered into a Structural Equation Model for the identification of causative hierarchical associations (i.e., pathways) between EEG measures and the perceptual asymmetry index. The model identified two pathways. A first pathway showed that the combined contribution of pre-stimulus frontoparietal connectivity and individual-alpha-frequency predicts post-stimulus processing, as measured by visual-evoked N100, which, in turn, predicts the perceptual asymmetry index. A second pathway directly links the inter-hemispheric distribution of alpha-amplitude with the perceptual asymmetry index. The two pathways can collectively explain 83.1% of the variance in the perceptual asymmetry index. Using causative modeling, the present study identified how psychophysiological correlates of visuospatial perception are organized and predict the degree of behavioral asymmetry in LHN patients and controls
Overcoming the Technical Challenges of Total Knee Arthroplasty in Patients Affected by Hereditary Multiple Exostoses: a Case Report and Literature Review
No full textHereditary multiple exostoses (HME), also known as familiar osteochondromatosis or diaphyseal aclasis, are an autosomal dominant inherited genetic pathology that is characterized by the presence of multiple benign osteochondromas. Knee deformity is common in patients with HME, with nearly a third of patients developing genu valgus. Total knee arthroplasty (TKA) has been used to correct valgus deformities with advanced knee osteoarthritis (OA). However, concomitant limb deformities and altered anatomy of the knee make this surgery particularly challenging. We present a case report and a mini-review of the literature on this topic. We present the case of a 50-year-old Caucasian woman, affected by hereditary multiple exostoses, who came to our attention for progressive pain in the right knee. Upon further examination, the knee had a prominent valgus alignment, concomitant valgus instability, and flexion contraction. The patient was treated with total knee arthroplasty using a semi-constrained design. The patient was re-evaluated at 24-month follow-up, and there were no signs of implant loosening, the knee function improved significantly, and the patient was very satisfied. Given the recurring technical difficulties of such procedure in these patients, we describe our experience as well as the need for preoperative planning, the use of appropriate constraint when required, the high frequency of ligament instability, bony defects, and patellar maltracking. TKA must be considered when necessary, in these patients, as good to excellent clinical results can be achieved and maintained, allowing for significant improvements in quality of life
Pedobarographic and kinematic analysis in the functional evaluation of two post-operative forefoot offloading shoes
Full text linkBackground: Forefoot offloading shoes are special orthopaedic footwear designed to protect and unload the injured part of the foot after surgery and for conservative treatments. The offloading action is often achieved by transferring plantar load to the rearfoot via rocker shoes with reduced contact area between shoe and ground. While these shoes are intended to be worn only for short periods, a compromise must be found between functionality and the risk of alterations in gait patterns at the lower limb joints. In this study, the pedobarographic, kinematic and kinetic effects of a traditional half-shoe and a double-rocker full-outsole shoe were compared to those of a comfortable shoe (control). Methods: Ten healthy female participants (28.2±10.0 years) were asked to walk in three different footwear conditions for the left/right foot: control/half-shoe, control/full-outsole, and control/control. Full gait analysis was obtained in three walking trials for each participant in each condition. Simultaneously a sensor insole system recorded plantar pressure in different foot regions. Normalized root-mean-square error, coefficient of determination, and frame-by-frame statistical analysis were used to assess differences in time-histories of kinematic and kinetic parameters between shoes. Results: The half -shoe group showed the slowest walking speed and the shortest stride length. Forefoot plantar load was significantly reduced in the half-shoe (maximum force as % of Body Weight: half-shoe=62.1; full-outsole=86.9; control=93.5; p<0.001). At the rearfoot, mean pressure was the highest in the full-outsole shoe. At the ankle, sagittal-plane kinematics in the full-outsole shoe had a pattern more similar to control. Conclusions: The half-shoe appears significantly more effective in reducing plantar load at the forefoot than a double-rocker full-outsole shoe, which is designed to reduce forefoot loading by using an insole with a thicker profile anteriorly as to maintain the foot in slight dorsiflexion. However, the half-shoe is also associated with altered gait spatio-temporal parameters, more kinematic modifications at the proximal lower limb joints and reduced propulsion in late stance
Better joint motion and muscle activity are achieved using kinematic alignment than neutral mechanical alignment in total knee replacement
No full textIntroduction: In total knee replacement (TKR), neutral mechanical
alignment (NMA) is generally targeted during prosthetic
component implantation. An original implantation approach has
been recently proposed, referred to as kinematic alignment (KA).
This is based on the alignment of the pre-arthritic lower limb undergoing
TKR, which is reconstructed using suitable image-based
techniques during the surgical planning phase. Particularly, KA is
thought to allow better soft-tissue balance [1] and restoration of
knee physiological function than NMA.
Patient-specific instrumentation (PSI), recently introduced in
TKR to execute more accurate and personalized prosthesis component
implantation, can be used in the achievement of KA. In detail,
KA approach via PSI has the potential to result in more physiological
knee motion, including relevant muscle activity, but this has not
been demonstrated yet. The aim of this study was to report knee
kinematics and electromyography (EMG) for a number lower limb
muscles from two TKR patient groups, i.e. operated according to
NMA via conventional instrumentation, or according to KA via PSI.
Methods: A four-centre randomized study of 144 patients
was designed; in each centre, 36 patients affected by primary
gonarthrosis were recruited for TKR and implanted with a
cruciate-retaining fixed-bearing prosthesis with patella resurfacing
(Triathlon® by Stryker®, Kalamazoo, MI-USA). In our centre 20
patients were implanted so far. 17 of these patients, i.e. 11 operated
targeting NMA (group A) via convention instrumentation and
6 targetingKA(group B) via PSI (ShapeMatch® by Stryker®, Kalamazoo,
MI-USA), were assessed clinically using the International Knee
Society Scoring (IKSS) System and biomechanically at 6-month
follow-up. Knee kinematics during stair-climbing, chair-rising and
extension-against-gravity was evaluated by 3D video-fluoroscopy
(CAT® Medical System, Monterotondo, Italy) synchronized with
4-channel EMG analysis (EMG Mate, Cometa®, Milan, Italy) of
the main knee ad/abductor and flexor/extensor muscles. Knee
motion data were reconstructed to calculate flex/extension (FE),
ad/abduction (AA), and internal/external rotation (IE), together
with the rotation of tibial base-plate contact-line (CLR), this being
the line connecting the medial (MCP) and lateral (LCP) condyle contact
points. MCP and LCP antero-posterior translations were also
calculated and reported in % of tibial base-plate length.
Results: Postoperative knee and functional IKSS scores in group
A were 78±20 and 80±23, worst than in group B, respectively
91±12 and 90±15. Knee motion patterns were much more consistent
over patients in group B than A. In both groups, normal
ranges were found for FE, IE and AA, the latter being generally
smaller than 3◦. Average IE ranges in the three motor tasks were
respectively 8.2±3.2◦, 10.1±3.9◦ and 7.9±4.0◦ in group A, and
6.6±4.0◦, 10.5±2.5◦ and 11.0±3.9◦ in group B. Corresponding
MCP translations were 13.8±5.6% anterior, 17.0±6.6% posterior
and 15.4±6.9% posterior in group A, and 13.0±3.4%, 16.6±5.3%
and 16.6±5.6% all posterior in group B; LCP values were all posterior,
i.e. 9.5±3.6%, 11.1±4.3% and 8.7±2.6% in group A, and
10.2±2.1%, 13.7±8.6% and 14.6±9.8% in group B. Relevant CLRs were 8.2±3.2◦, 10.2±3.7◦ and 8.8±5.3◦ in group A, and 7.3±3.5◦,
12.6±2.6◦ and 12.5±4.2◦ in group B. EMG analysis revealed prolonged
activation of the medial/lateral vasti muscles in group
A. Such muscle co-contraction was not generally observed in all
patients in group B, this being proving more stability in the knee
joint after TKA according KA.
Discussion: These results reveal that better function occurs
usingKAthanNMAin TKR. Though small differences were observed
between TKR groups in terms of motion data, the higher data
consistency and the less prolonged muscle activations identified
using KA support the claim of a more natural soft tissue balance
in corresponding knees. More patients are needed to establish the
superiority of KA.
Reference
[1] Eckhoff DG, et al. J Bone Joint Surg Am 2005;87(Suppl. 2):71–80
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