Enhancing Heart Rate-Based Estimation of Energy Expenditure and Exercise Intensity in Patients Post Stroke.

Background: Indirect calorimetry is the gold standard field-testing technique for measuring energy expenditure and exercise intensity based on the volume of oxygen consumed (VO, mL O/min). Although heart rate is often used as a proxy for VO, heart rate-based estimates of VO may be inaccurate after stroke due to changes in the heart rate-VO relationship. Our objective was to evaluate in people post stroke the accuracy of using heart rate to estimate relative walking VO (wVO) and classify exercise intensity.

Microsurgical training using an model: microscope 3D exoscope.

Objective: The aim of this study is to evaluate the feasibility of the 3D exoscope in a microvascular anastomosis training setting and compare it with the gold-standard technique using the operating microscope (OM).

Methods: Participants were recruited among otorhinolaryngology head and neck surgery (OHNS) residents of two tertiary care hospitals. Trainees were asked to complete 4 microvascular end-to-end anastomoses on chicken thighs with the OM and VITOM 3D exoscope.

Estimation of Walking Speed and Its Spatiotemporal Determinants Using a Single Inertial Sensor Worn on the Thigh: From Healthy to Hemiparetic Walking.

We present the use of a single inertial measurement unit (IMU) worn on the thigh to produce stride-by-stride estimates of walking speed and its spatiotemporal determinants (i.e., stride time and stride length).

Indirect measurement of anterior-posterior ground reaction forces using a minimal set of wearable inertial sensors: from healthy to hemiparetic walking.

Background: The anterior-posterior ground reaction force (AP-GRF) and propulsion and braking point metrics derived from the AP-GRF time series are indicators of locomotor function across healthy and neurological diagnostic groups. In this paper, we describe the use of a minimal set of wearable inertial measurement units (IMUs) to indirectly measure the AP-GRFs generated during healthy and hemiparetic walking.

Methods: Ten healthy individuals and five individuals with chronic post-stroke hemiparesis completed a 6-minute walk test over a walking track instrumented with six forceplates while wearing three IMUs securely attached to the pelvis, thigh, and shank.

Endoscopic Endonasal Surgery of Clival Chordomas: Preliminary Results.

Chordomas are rare malignant tumors, often affecting the clival region. Traditionally, they are removed via craniotomic approach but the introduction of the endoscopic endonasal technique (EEA) allowed to control this area. This article shows a series of patients affected by clival chordomas treated with endoscopic approach.

The Management of Tympanic Membrane Perforation With Endoscopic Type I Tympanoplasty.

Objective: The objective of this study is to describe what we consider to be the state-of-the-art procedure for the treatment of tympanic membrane perforations, and to present the results attained in our institution.

Study Design: A retrospective cohort study, using data of Verona University Hospital, Italy. This medical record includes the data of 98 patients who underwent 100 transcanal endoscopic type I tympanoplasties from November 2014 to October 2017.

Endoscopic stapedotomy: safety and audiological results in 150 patients.

Objective: The most widely accepted treatment for otosclerosis is currently microscopic stapes surgery under either local or general anesthesia. The aim of the study is to describe the surgical steps in endoscopic stapes surgery and to evaluate the audiologic and surgical outcomes.

Materials And Methods: All patients who underwent exclusive endoscopic stapes surgery or revision surgery for previous stapedotomy between November 2014 and September 2018 were enrolled in this study.

Intralabyrinthine schwannomas: a new surgical treatment.

Objective: To define a new surgical option, with lower morbidity, for the treatment of intralabyrinthine schwannomas.

Study Design: Retrospective case review.

Setting: Tertiary referral centers.

Endoscopic transnasal surgery of clival lesions: our experience.

Background: The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions.

Transcanal Transpromontorial Acoustic Neuroma Surgery: Results and Facial Nerve Outcomes.

Background: Recently, the transcanal approach for the removal of acoustic neuromas has been introduced. Facial nerve (FN) preservation is one of the main challenges of this kind of surgery.

Objective: To describe our experience in the surgical treatment of acoustic neuromas, focusing on the functional results of FN preservation after a transcanal approach.

A soft robotic exosuit improves walking in patients after stroke.

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite-and perhaps because of-their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb's residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke.

Biomechanical and Physiological Evaluation of Multi-Joint Assistance With Soft Exosuits.

To understand the effects of soft exosuits on human loaded walking, we developed a reconfigurable multi-joint actuation platform that can provide synchronized forces to the ankle and hip joints. Two different assistive strategies were evaluated on eight subjects walking on a treadmill at a speed of 1.25 m/s with a 23.

A wireless flexible sensorized insole for gait analysis.

This paper introduces the design and development of a novel pressure-sensitive foot insole for real-time monitoring of plantar pressure distribution during walking. The device consists of a flexible insole with 64 pressure-sensitive elements and an integrated electronic board for high-frequency data acquisition, pre-filtering, and wireless transmission to a remote data computing/storing unit. The pressure-sensitive technology is based on an optoelectronic technology developed at Scuola Superiore Sant'Anna.

Kinematics and design of a portable and wearable exoskeleton for hand rehabilitation.

We present the kinematic design and actuation mechanics of a wearable exoskeleton for hand rehabilitation of post-stroke. Our design method is focused on achieving maximum safety, comfort and reliability in the interaction, and allowing different users to wear the device with no manual regulations. In particular, we propose a kinematic and actuation solution for the index finger flexion/extension, which leaves full movement freedom on the abduction-adduction plane.

Automated detection of gait initiation and termination using wearable sensors.

This paper presents algorithms for detection of gait initiation and termination using wearable inertial measurement units and pressure-sensitive insoles. Body joint angles, joint angular velocities, ground reaction force and center of plantar pressure of each foot are obtained from these sensors and input into supervised machine learning algorithms. The proposed initiation detection method recognizes two events: gait onset (an anticipatory movement preceding foot lifting) and toe-off.

On the design of ergonomic wearable robotic devices for motion assistance and rehabilitation.

The appropriate ergonomic design of a wearable robotic device is critical for the effectiveness of the device itself. In this paper we identified two key requirements for a structural ergonomics: the correct kinematic compatibility with the human limb and a comfortable and adaptable physical human-robot interface. We then show how the aforementioned requirements have been faced and implemented in the mechanical design of two wearable devices for elbow and hand rehabilitation, both developed at The BioRobotics Institute of Scuola Superiore Sant' Anna.

A flexible sensor technology for the distributed measurement of interaction pressure.

We present a sensor technology for the measure of the physical human-robot interaction pressure developed in the last years at Scuola Superiore Sant'Anna. The system is composed of flexible matrices of opto-electronic sensors covered by a soft silicone cover. This sensory system is completely modular and scalable, allowing one to cover areas of any sizes and shapes, and to measure different pressure ranges.

Sensing pressure distribution on a lower-limb exoskeleton physical human-machine interface.

A sensory apparatus to monitor pressure distribution on the physical human-robot interface of lower-limb exoskeletons is presented. We propose a distributed measure of the interaction pressure over the whole contact area between the user and the machine as an alternative measurement method of human-robot interaction. To obtain this measure, an array of newly-developed soft silicone pressure sensors is inserted between the limb and the mechanical interface that connects the robot to the user, in direct contact with the wearer's skin.

Oscillator-based walking assistance: a model-free approach.

In this paper, we further develop our framework to design new assistance and rehabilitation protocols based on motor primitives. In particular, we extend our recent results of oscillator-based assistance to the case of walking. The adaptive oscillator used in this paper is capable of predicting the angular position of the user's joints in the future, based on the pattern learned during preceding cycles.

Oscillator-based assistance of cyclical movements: model-based and model-free approaches.

In this article, we propose a new method for providing assistance during cyclical movements. This method is trajectory-free, in the sense that it provides user assistance irrespective of the performed movement, and requires no other sensing than the assisting robot's own encoders. The approach is based on adaptive oscillators, i.

The neuro-robotics paradigm: NEURARM, NEUROExos, HANDEXOS.

This work describes the neuro-robotics paradigm: the fusion of neuroscience and robotics. The fusion of neuroscience and robotics, called neuro-robotics, is fundamental to develop robotic systems to be used in functional support, personal assistance and neuro-rehabilitation. While usually the robotic device is considered as a "tool" for neuroscientific studies, a breakthrough is obtained if the two scientific competences and methodologies converge to develop innovative platforms to go beyond robotics by including novel models to design better robots.