Gait transitions in simulated reduced gravity.

Gravity has a strong effect on gait and the speed of gait transitions. A gait has been defined as a pattern of locomotion that changes discontinuously at the transition to another gait. On Earth, during gradual speed changes, humans exhibit a sudden discontinuous switch from walking to running at a specific speed.

Methodological issues in monitoring health services and outcomes for stroke survivors: a case study.

Background: Obtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum of understanding between the NIH and the ISS (its Italian equivalent) to foster collaborative research on rehabilitation.

Objective: The purpose of this study was to pilot a methodology using administrative data to monitor and improve health outcomes for stroke survivors in Tuscany.

A web based health technology assessment in tele-echocardiography: the experience within an Italian project.

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA.

Measurement of physical quantities in upper-limb tele-rehabilitation.

A total of 50 patients (affected by traumatic brain injury, stroke or multiple sclerosis) were treated for one month using a rehabilitation protocol. Rehabilitation could be monitored using a Portable Unit (PU) which could be installed in a patient's home allowing the measurement of kinetic and kinematic variables during exercise. In a preliminary analysis, the variables related to four rehabilitation exercises were examined for two patients at baseline and at the end of the one-month treatment.

Community-based adaptive physical activity program for chronic stroke: feasibility, safety, and efficacy of the Empoli model.

Objective: To determine whether Adaptive Physical Activity (APA-stroke), a community-based exercise program for participants with hemiparetic stroke, improves function in the community.

Methods: Nonrandomized controlled study in Tuscany, Italy, of participants with mild to moderate hemiparesis at least 9 months after stroke. Forty-nine participants in a geographic health authority (Empoli) were offered APA-stroke (40 completed the study).

A home-care system for the telemonitoring and telerehabilitation of the hand incorporating interactive biofeedback.

We have designed and constructed force measurement equipment to assess hand-finger function in pressing tasks. The equipment was used for monitoring the follow-up of five hand-transplanted subjects. Interactive software was integrated into the instrument to monitor the functionality of the hand and fingers during exercises in realtime.

A novel, user-friendly step counter for home telemonitoring of physical activity.

Step counting is an important index of motion in telemonitoring. We have developed a wearable system based on a device with a force-sensing resistor. This is affixed at the calf gastrocnemius level to monitor the muscular expansion related to the gait.

Clinical assessment of the HELLODOC tele-rehabilitation service.

Within the EU project HELLODOC, the clinical effectiveness was investigated of the home care activity desk (H-CAD). Eighty-one patients with chronic stroke, traumatic brain injury (TBI) and multiple sclerosis (MS) were recruited; 50 out of 81 received 1 month of H-CAD intervention, with one training session a day lasting 30 minutes for 5 days a week. The overall satisfaction of both patients and therapists was high.

Tele-rehabilitation and e-learning: the HELLODOC educational experience.

A web-based learning activity in the field of tele-rehabilitation was conducted by Istituto Superiore di Sanità (ISS), the Italian National Institute of Health, within the EU project HELLODOC. The activity aimed at training professionals to effectively manage the tele-rehabilitation service. ISS adapted the Moodle e-learning platform and implemented the problem-based learning (PBL) methodology.

Technical assessment of the HELLODOC service.

A technical assessment activity has been conducted by Istituto Superiore di Sanità (ISS) in the European project HELLODOC (Healthcare service linking tele-rehabilitation to disabled people and clinicians) for evaluating the tele-rehabilitation service. The activity was mainly focussed on architectural aspects and a step by step monitoring of the service. It was mainly related to the following aspects: service implementation, service performances, service integration and fault management.

Tele-rehabilitation: present and future.

During the last decade we assisted to relevant progress in rehabilitation studies and in technological development. From the combination of these issues rises the tele-rehabilitation--a subfield of telemedicine consisting of a system to control rehabilitation "at distance"--as an actual possibility of application and a promising development in the future. The present paper offers a short review of the state of the art in the field of tele-rehabilitation, with a special focus on upper limb tele-rehabilitation.

Muscle performance and ankle joint mobility in long-term patients with diabetes.

Background: Long-term patients with diabetes and peripheral neuropathy show altered foot biomechanics and abnormal foot loading. This study aimed at assessing muscle performance and ankle mobility in such patients under controlled conditions.

Methods: Forty six long-term diabetes patients with (DN) and without (D) peripheral neuropathy, and 21 controls (C) were examined.

Adaptive physical activity improves mobility function and quality of life in chronic hemiparesis.

This study investigated the effects of an adaptive physical activity (APA) program on mobility function and quality of life (QOL) in chronic stroke patients. Twenty subjects with chronic hemiparesis completed a 2-month, combined group, class-home exercise regimen that emphasized mobility training. APA improved Berg Balance Scale scores (35 +/- 2 vs 45 +/- 2, p = 0.

New neural network classifier of fall-risk based on the Mahalanobis distance and kinematic parameters assessed by a wearable device.

Fall prevention lacks easy, quantitative and wearable methods for the classification of fall-risk (FR). Efforts must be thus devoted to the choice of an ad hoc classifier both to reduce the size of the sample used to train the classifier and to improve performances. A new methodology that uses a neural network (NN) and a wearable device are hereby proposed for this purpose.

Telemonitoring and telerehabilitation of patients with Parkinson's disease: health technology assessment of a novel wearable step counter.

Step counting is an important index of motion in telemonitoring. One of the most diffused wearable systems, designed for this purpose, is the pedometer. The accuracy of commercial pedometers has been reported in the literature.

Health technology assessment of a homecare device for telemonitoring and telerehabilitation for patients after hand transplantation.

Hand rehabilitation requires continuous and frequent monitoring of the functionality in order to assess therapy and/or refine it. In order to contain costs for the rehabilitation program, a telehomecare rehabilitation system is suitable. The purpose of this paper was to describe the setup and configuration of a homecare device for telemonitoring/telerehabilitation of patients who underwent hand transplant.

Assessment of fall risk using a pneumatic pattern generator.

This paper describes the design and construction of a new equipment for the fall risk investigation. It comprehends a portable device including 3 mono-axial accelerometers and 3 rate-gyroscopes which assesses the trunk sway and provides (Giansanti et al 2005 IEEE Trans. Biomed.

Design and construction of step counters for disable people: preliminary experience at the Italian Institute of Health.

Step counting is an important index of motion One of the most diffused wearable systems, designed for this purpose, is the pedometer. The accuracy of commercial pedometers has been tested in literature. Several limits have been found in many commercial systems both in healthy subjects and in disable people.

Validation of a tele-home-care for hand-telerehabilitation.

The hand rehabilitation process needs a continuous and frequent monitoring of the patient's functionality in order to test the delivered therapy and/or adapt it to the patient's progress. In order to contain costs for the rehabilitation program, a tele-homecare rehabilitation system is suitable. We have proposed a tele-home-care allowing the assessment of the hand fingers' dynamics and kinematics by integrating with a dedicated software two particular devices: the first was a commercial glove, the HumanGlove by Humanware (Pisa, Italy) and the second was a set of instruments for the measurement of the hand fingers' force comprehending an Instrumented Keyboard (IK) and an Instrumented Mouse-Like (IML) device.

Guidelines for calibration and drift compensation of a wearable device with rate-gyroscopes and accelerometers.

The technical note describes a methodology for the calibration and the drift compensation of a device with accelerometers and rate-gyroscopes. The methodology is based on a step-wise-motor approach and a simulation environment with the device simulation model for optimisation of the calibration parameters. The validation on a wide range of locomotion tasks performed by 30 subjects with some unbalance problems showed the feasibility of the methodology.

Towards the investigation of kinematic parameters from an integrated measurement unit for the classification of the rising from the chair.

In this paper we introduce a new method to evaluate the ability to rise from a chair by means of the sit-to-stand locomotion task. It is based on the analysis of the vertical acceleration peaks and the timing as assessed by an our designed device. Preliminary results indicate the feasibility of discriminating the rising from a chair fixed to different heights and the discrimination by pathological and non pathological Parkinsonian subjects.

A protocol for the assessment of diagnostic accuracy in tele-echocardiography imaging.

Tele-echocardiography could be a useful means for investigating heart pathologies on remotely-located patients. At present, the main drawback with tele-echocardiography is the lack of a thorough protocol for the assessment of the diagnostic accuracy of the transmitted images. Diagnostic accuracy in tele-echocardiography is not only a function of quantitative parameters but also of the subjective decision of the operator depending on his/her a priori knowledge based on complex internal models.

Inertial measurement units furnish accurate trunk trajectory reconstruction of the sit-to-stand manoeuvre in healthy subjects.

A simple inertial measurement unit (IMU) incorporating rate gyroscopes and accelerometers has been tested to investigate the trunk kinematics during the sit-to-stand. It was affixed at trunk L5 level and used for sit-to-stand position and orientation reconstruction. The method was validated with standard optoelectronic equipment and results were also compared to the ones obtained by means of a Fast Video Camera.

Assessment of fall-risk by means of a neural network based on parameters assessed by a wearable device during posturography.

We have investigated the use of an Artificial Neural Network (ANN) for the assessment of fall-risk (FR) in patients with different neural pathologies. The assessment integrates a clinical tool based on a wearable device (WD) with accelerometers (ACCs) and rate gyroscopes (GYROs) properly suited to identify trunk kinematic parameters that can be measured during a posturography test with different constraints. Our ANN--a Multi Layer Perceptron Neural Network with four layers and 272 neurones--shows to be able to classify patients in three well-known fall-risk levels.