Automated Multicohort Mobility Assessment with an Instrumented L-test (iL-test).

The L-test is a performance-based measure to assess balance and mobility. Currently, the primary outcome from this test is the time required to finish it. In this study we present the instrumented L-test (iL-test), an L-test wherein mobility is evaluated by means of a wearable inertial sensor worn at the lower back.

Walk Longer! Using Wearable Inertial Sensors to Uncover Which Gait Aspects Should Be Treated to Increase Walking Endurance in People with Multiple Sclerosis.

Reduced walking endurance is common in people with multiple sclerosis (PwMS), leading to reduced social participation and increased fall risk. This highlights the importance of identifying which gait aspects should be mostly targeted by rehabilitation to maintain/increase walking endurance in this population. A total of 56 PwMS and 24 healthy subjects (HSs) executed the 6 min walk test (6 MWT), a clinical measure of walking endurance, wearing three inertial sensors (IMUs) on their shanks and lower back.

Emotional auditory stimuli influence step initiation in Parkinson's disease with freezing of gait.

Freezing of gait (FOG) in Parkinson's disease (PD) can be triggered by sensomotor, cognitive or limbic factors. The limbic system's impact on FOG is attributed to elevated limbic load, characterized by aversive stimuli, potentially depleting cognitive resources for movement control, resulting in FOG episodes. However, to date, PD patients with and without FOG have not shown alterations of anticipatory postural adjustments during gait initiation after exposure to emotional images, possibly because visual stimuli are less immediately disruptive than auditory stimuli, which can more directly affect attention and the limbic system.

Discriminative ability of instrumented cognitive-motor assessments to distinguish fallers from non-fallers.

In older populations, sensitive fall risk assessment tools are important to timely intervene and prevent falls. Instrumented assessments have shown to be superior to standardized fall risk assessments such as the Timed Up and Go Test (TUG) and should capture both motor and cognitive functions. Therefore, the aim was to test novel instrumented assessments with and without a cognitive component.

Characterization of Walking in Mild Parkinson's Disease: Reliability, Validity and Discriminant Ability of the Six-Minute Walk Test Instrumented with a Single Inertial Sensor.

Although the 6-Minute Walk Test (6MWT) is among the recommended clinical tools to assess gait impairments in individuals with Parkinson's disease (PD), its standard clinical outcome consists only of the distance walked in 6 min. Integrating a single Inertial Measurement Unit (IMU) could provide additional quantitative and objective information about gait quality complementing standard clinical outcome. This study aims to evaluate the test-retest reliability, validity and discriminant ability of gait parameters obtained by a single IMU during the 6MWT in subjects with mild PD.

A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study.

Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs).

Uncovering Subtle Gait Deterioration in People with Early-Stage Multiple Sclerosis Using Inertial Sensors: A 2-Year Multicenter Longitudinal Study.

Limited longitudinal studies have been conducted on gait impairment progression overtime in non-disabled people with multiple sclerosis (PwMS). Therefore, a deeper understanding of gait changes with the progression of the disease is essential. The objective of the present study was to describe changes in gait quality in PwMS with a disease duration ≤ 5 years, and to verify whether a change in gait quality is associated with a change in disability and perception of gait deterioration.

Feasibility and Effectiveness of a Personalized Home-Based Motor-Cognitive Training Program in Community-Dwelling Older Adults: Protocol for a Pragmatic Pilot Randomized Controlled Trial.

Background: Exergame-based motor-cognitive training in older adults has been associated with improvements in physical, cognitive, and psychological functioning. The novel Cocare system (Dividat GmbH), developed through a user-centered design process, allows motor-cognitive training in a telerehabilitation setting. It includes (1) a stationary stepping platform for supervised exergame training (Dividat Senso; Dividat GmbH), (2) a home-based version (Dividat Senso Flex, which is a rollable pressure-sensitive mat; Dividat GmbH), (3) an assessment system (including motor-cognitive tests), and (4) a rehabilitation cockpit for remote training supervision and management.

Surface-Electromyography-Based Co-Contraction Index for Monitoring Upper Limb Improvements in Post-Stroke Rehabilitation: A Pilot Randomized Controlled Trial Secondary Analysis.

Persons post-stroke experience excessive muscle co-contraction, and consequently the arm functions are compromised during the activities of daily living. Therefore, identifying instrumental outcome measures able to detect the motor strategy adopted after a stroke is a primary clinical goal. Accordingly, this study aims at verifying whether the surface electromyography (sEMG)-based co-contraction index () could be a new clinically feasible approach for assessing and monitoring patients' motor performance.

Machine learning based estimation of dynamic balance and gait adaptability in persons with neurological diseases using inertial sensors.

Poor dynamic balance and impaired gait adaptation to different contexts are hallmarks of people with neurological disorders (PwND), leading to difficulties in daily life and increased fall risk. Frequent assessment of dynamic balance and gait adaptability is therefore essential for monitoring the evolution of these impairments and/or the long-term effects of rehabilitation. The modified dynamic gait index (mDGI) is a validated clinical test specifically devoted to evaluating gait facets in clinical settings under a physiotherapist's supervision.

Association of 7-Day Profiles of Motor Activity in Marital Dyads with One Component Affected by Parkinson's Disease.

(1) Background: A noticeable association between the motor activity (MA) profiles of persons living together has been found in previous studies. Social actigraphy methods have shown that this association, in marital dyads composed of healthy individuals, is greater than that of a single person compared to itself. This study aims at verifying the association of MA profiles in dyads where one component is affected by Parkinson's disease (PD).

Dynamic balance during walking in people with multiple sclerosis: A cross-sectional study.

Dynamic balance disorders are common impairments in People with Multiple Sclerosis (PwMS) leading to gait disorders and a higher risk of falling. However, the assessment of dynamic balance is still challenging and instrumented indexes provide objective and quantitative data of CoM movement and Base of Support, which are considered that are two key factors describing dynamic balance. This study aims at validating recent instrumented indexes based on the inverted pendulum model and characterizing dynamic balance disorders in PwMS.

Older adults' needs and requirements for a comprehensive exergame-based telerehabilitation system: A focus group study.

Introduction: Telerehabilitation in older adults using information and communication technologies (ICTs) provides therapy, which is potentially equally effective as traditional rehabilitation, yet more accessible. This study aimed to analyze the needs and requirements of older adults (OA) and healthcare-professionals (HP) toward ICTs and telerehabilitation in general as well as toward a specific novel exergame-based telerehabilitation system (COCARE system, Dividat).

Materials And Methods: The COCARE telerehabilitation system enables individual training based on exergames, as well as an assessment system and a digital centralized case management.

Balance Impairments in People with Early-Stage Multiple Sclerosis: Boosting the Integration of Instrumented Assessment in Clinical Practice.

The balance of people with multiple sclerosis (PwMS) is commonly assessed during neurological examinations through clinical Romberg and tandem gait tests that are often not sensitive enough to unravel subtle deficits in early-stage PwMS. Inertial sensors (IMUs) could overcome this drawback. Nevertheless, IMUs are not yet fully integrated into clinical practice due to issues including the difficulty to understand/interpret the big number of parameters provided and the lack of cut-off values to identify possible abnormalities.

Physical activity in non-disabled people with early multiple sclerosis: A multicenter cross-sectional study.

Background: People with Multiple Sclerosis (PwMS) show low levels of physical activity (PA), however there has been limited research on PA in early diagnosed and no/minimally impaired (<5 years, EDSS≤ 2.5) PwMS. The aims of the study were to objectively quantify PA levels in non-disabled PwMS, to compare the time spent daily at different PA levels (No activity (NPA), Light PA (LPA), Moderate PA (MPA), and Vigorous PA (VPA)) with healthy subjects (HS), and to examine the association of PA with disability, and clinical measures in PwMS.

Events Detection of Anticipatory Postural Adjustments through a Wearable Accelerometer Sensor Is Comparable to That Measured by the Force Platform in Subjects with Parkinson's Disease.

Out-of-the-lab instrumented gait testing focuses on steady-state gait and usually does not include gait initiation (GI) measures. GI involves Anticipatory Postural Adjustments (APAs), which propel the center of mass (COM) forward and laterally before the first step. These movements are impaired in persons with Parkinson’s disease (PD), contributing to their pathological gait.

Smoothness of movement in idiopathic cervical dystonia.

Smoothness (i.e. non-intermittency) of movement is a clinically important property of the voluntary movement with accuracy and proper speed.

Walking With Horizontal Head Turns Is Impaired in Persons With Early-Stage Multiple Sclerosis Showing Normal Locomotion.

Background: Turning the head while walking (an action often required during daily living) is particularly challenging to maintain balance. It can therefore potentially reveal subtle impairments in early-stage people with multiple sclerosis who still show normal locomotion (NW-PwMS). This would help in identifying those subjects who can benefit from early preventive exercise aimed at slowing the MS-related functional decline.

The effect of music-induced emotion on visual-spatial learning in people with Parkinson's disease: A pilot study.

Introduction: Emotional states have been shown to influence cognitive processes including visual-spatial learning. Parkinson's Disease (PD), besides manifesting with the cardinal motor symptoms, presents cognitive and affective disturbances. Here we aimed at investigating whether manipulation of the emotional state by means of music was able to influence the performance of a visual-spatial learning task in a group of PD participants.

The Falls Efficacy Scale International is a valid measure to assess the concern about falling and its changes induced by treatments.

Objective: To test with the Rasch analysis the psychometric properties of the Falls Efficacy Scale International, a questionnaire for measuring concern about falling.

Design: Longitudinal observational study, before-after rehabilitation.

Setting: Inpatient rehabilitation.

Instrumentally assessed gait quality is more relevant than gait endurance and velocity to explain patient-reported walking ability in early-stage multiple sclerosis.

Background And Purpose: People with multiple sclerosis (PwMS) often report walking limitations even when the gold standard Expanded Disability Status Scale (EDSS) indicates normal walking endurance/autonomy. The present multicenter study on early-stage PwMS aims at analyzing which aspects are associated with patient-reported walking limitations measured with the 12-item Multiple Sclerosis Walking Scale (MSWS-12).

Methods: Eighty-two PwMS (EDSS ≤ 2.

A randomized controlled trial on the effects induced by robot-assisted and usual-care rehabilitation on upper limb muscle synergies in post-stroke subjects.

Muscle synergies are hypothesized to reflect connections among motoneurons in the spinal cord activated by central commands and sensory feedback. Robotic rehabilitation of upper limb in post-stroke subjects has shown promising results in terms of improvement of arm function and motor control achieved by reassembling muscle synergies into a set more similar to that of healthy people. However, in stroke survivors the potentially neurophysiological changes induced by robot-mediated learning versus usual care have not yet been investigated.

Prevalence and patterns of subclinical motor and cognitive impairments in non-disabled individuals with early multiple sclerosis: A multicenter cross-sectional study.

Background: Motor and cognitive disorders appear early in the course of multiple sclerosis (MS) and develop gradually over time.

Objective: To study the frequency and pattern of subtle functional disorders in people with MS (PwMS) with no overt signs of disability in an early phase of the disease and their association with walking impairments in daily activities.

Methods: In this cross-sectional study, we recruited PwMS with an Expanded Disability Status Scale (EDSS) score≤2.

Sequentially applied myoelectrically controlled FES in a task-oriented approach and robotic therapy for the recovery of upper limb in post-stroke patients: A randomized controlled pilot study.

Background: Functional recovery of the plegic upper limb in post-stroke patients may be enhanced by sequentially applying a myoelectrically controlled FES (MeCFES), which allows the patient to voluntarily control the muscle contraction during a functional movement, and robotic therapy which allows many repetitions of movements.

Objective: Evaluate the efficacy of MeCFES followed by robotic therapy compared to standard care arm rehabilitation for post-stroke patients.

Methods: Eighteen stroke subjects (onset ⩾ 3 months, age 60.