Greater brain response to emotional expressions of their own children in mothers of preterm infants: an fMRI study.

OBJECTIVE: The birth of a preterm infant and Neonatal Intensive Care Unit hospitalization constitute a potentially traumatic experience for mothers. Although behavioral studies investigated the parenting stress in preterm mothers, no study focused on the underlying neural mechanisms. We examined the effect of preterm births in mothers, by comparing brain activation in mothers of preterm and full-term infants. STUDY DESIGN: We used functional magnetic resonance imaging to measure the cerebral response of 10 first-time mothers of preterm infants (gestational age <32 weeks and/or birth weight <1500) and 11 mothers of full-term infants, viewing happy-, neutral- and distress-face images of their own infant, along with a matched unknown infant. RESULTS: While viewing own infant's face preterm mothers showed increased activation in emotional processing area (i.e., inferior frontal gyrus) and social cognition (i.e., supramarginal gyrus) and affiliative behavior (i.e., insula). CONCLUSION: Differential brain activation patterns in mothers appears to be a function of the atypical parenthood transition related to prematurity.

Quantitative Evaluation of Performance during Robot-assisted Treatment.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Methodologies, Models and Algorithms for Patients Rehabilitation". OBJECTIVES: The great potential of robots in extracting quantitative and meaningful data is not always exploited in clinical practice. The aim of the present work is to describe a simple parameter to assess the performance of subjects during upper limb robotic training exploiting data automatically recorded by the robot, with no additional effort for patients and clinicians. METHODS: Fourteen children affected by cerebral palsy (CP) performed a training with Armeo®Spring. Each session was evaluated with P, a simple parameter that depends on the overall performance recorded, and median and interquartile values were computed to perform a group analysis. RESULTS: Median (interquartile) values of P significantly increased from 0.27 (0.21) at T0 to 0.55 (0.27) at T1 . This improvement was functionally validated by a significant increase of the Melbourne Assessment of Unilateral Upper Limb Function. CONCLUSIONS: The parameter described here was able to show variations in performance over time and enabled a quantitative evaluation of motion abilities in a way that is reliable with respect to a well-known clinical scale.

An ecological evaluation of the metabolic benefits due to robot-assisted gait training.

Cerebral palsy (CP), one of the most common neurological disorders in childhood, features affected individual's motor skills and muscle actions. This results in elevated heart rate and rate of oxygen uptake during sub-maximal exercise, thus indicating a mean energy expenditure higher than healthy subjects. Rehabilitation, currently involving also robot-based devices, may have an impact also on these aspects. In this study, an ecological setting has been proposed to evaluate the energy expenditure of 4 children with CP before and after a robot-assisted gait training. Even if the small sample size makes it difficult to give general indications, results presented here are promising. Indeed, children showed an increasing trend of the energy expenditure per minute and a decreasing trend of the energy expenditure per step, in accordance to the control group. These data suggest a metabolic benefit of the treatment that may increase the locomotion efficiency of disabled children.

Gait rehabilitation with a high tech platform based on virtual reality conveys improvements in walking ability of children suffering from acquired brain injury.

The Gait Real-time Analysis Interactive Lab (GRAIL) is an instrumented multi-sensor platform based on immersive virtual reality for gait training and rehabilitation. Few studies have been included GRAIL to evaluate gait patterns in normal and disabled people and to improve gait in adults, while at our knowledge no evidence on its use for the rehabilitation of children is available. In this study, 4 children suffering from acquired brain injury (ABI) underwent a 5 session treatment with GRAIL, to improve walking and balance ability in engaging VR environments. The first and the last sessions were partially dedicated to gait evaluation. Results are promising: improvements were recorded at the ankle level, selectively at the affected side, and at the pelvic level, while small changes were measured at the hip and knee joints, which were already comparable to healthy subjects. All these changes also conveyed advances in the symmetry of the walking pattern. In the next future, a longer intervention will be proposed and more children will be enrolled to strongly prove the effectiveness of GRAIL in the rehabilitation of children with ABI.

ERP and Adaptive Autoregressive identification with spectral power decomposition to study rapid auditory processing in infants.

The ability to process rapidly-occurring auditory stimuli plays an important role in the mechanisms of language acquisition. For this reason, the research community has begun to investigate infant auditory processing, particularly using the Event Related Potentials (ERP) technique. In this paper we approach this issue by means of time domain and time-frequency domain analysis. For the latter, we propose the use of Adaptive Autoregressive (AAR) identification with spectral power decomposition. Results show EEG delta-theta oscillation enhancement related to the processing of acoustic frequency and duration changes, suggesting that, as expected, power modulation encodes rapid auditory processing (RAP) in infants and that the time-frequency analysis method proposed is able to identify this modulation.

Coupling of fMRI and NIRS measurements in the study of negative BOLD response to intermittent photic stimulation.

Functional Magnetic Resonance Imaging (fMRI) in combination with Near Infrared Spectroscopy (NIRS) is finding widespread use in the analysis of brain function. While most of the studies deal with the detection of positive responses, here we focus on negative responses to visual stimulation. In a group fMRI study on Intermittent Photic Stimulation (IPS) we detected a sustained Negative BOLD Response (NBR) in the extrastriate visual cortex. To confirm and better characterize NBR, we repeated the same protocol during NIRS recordings. In this paper we show fMRI results and demonstrate the NBR on the basis of NIRS findings.

A new device for the care of Congenital Central Hypoventilation Syndrome patients during sleep.

Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disease that causes an autonomous nervous system dysregulation. Patients are unable to have a correct ventilation, especially during sleep, facing risk of death. Therefore, most of them are mechanically ventilated during night and their blood oxygenation is monitored, while a supervisor keeps watch over them. If low oxygen levels are detected by the pulse-oximeter, an alarm fires; the supervisor deals with the situation and, if there is neither a technical problem nor a false alarm, wakes the subject, as CCHS patients usually recover from hypoxia when roused from sleep. During a single night multiple alarms may occur, causing fractioned sleep for the subject and a lasting state of anxiety for supervisors.

Quantitative evaluation protocol for upper limb motor coordination analysis in patients with ataxia.

Objective and quantitative measurement is crucial in the definition of functional impairment and in the tracking of disease progress over time of patients affected by progressive pathologies, such as ataxia. A new experimental procedure for the quantitative description of upper limb movement and coordination analysis was developed by the integration of an optoelectronic system and dedicated electronic board with four visual and pressure stimuli. 20 passive retroreflective markers were placed on the subject's body and two types pointing tests were defined: in the first one, the subjects were asked to reach with the index finger five consecutive times each of the three targets ("repetitive test"), and in the second one, the subjects were asked to randomly reach the targets with the index finger ("random test"). The preliminary results showed that patients affected by ataxia took more time with a less smooth finger tip movement to perform the reaching tests when compared to healthy subjects. The velocity was lower and its profile was more irregular in ataxic subjects. The new developed experimental procedure seems to be very promising in the quantitative description of upper limb movements of pathological and healthy subjects and it seems to be able to distinguish the impairments due to different levels of ataxia.

Design of a 3D surface scanner prototype suitable for MR.

The detection of body movements during MR examination could help in reducing motion artifacts or to get patient responses during functional magnetic resonance. It can be supported by a slit scanner, that combines a camera with a light stripe projector to obtain 3D coordinates of points forming the external surface of the body. In this work we propose a slit scanner prototype based on a miniaturized projector without moving parts. Just small sized hardware is required to analyze the video signal, operating in time domain instead of spatial domain. To accomplish this, the camera is placed with its pixel columns as more parallel as possible to the projected light stripes and the camera video signal is analyzed by a resistor transistor logic after analog processing.

Active monitoring insole: a wearable device for monitoring foot load distribution in home-care context.

Post surgical patients need to resume a correct load distribution over both legs in order to facilitate bone osteogenesis. We propose a device for continuously monitoring lower limbs loads. It can be used by the patient to be aware of his loading conditions, by the physician or physical therapist to perform a quantitative analysis of applied loads. We tested the device on two subjects and verified its capability to detect reduced loads on the affected limb and its usefulness in helping to recognize in which walking phases.

Integrating telemonitoring with clinical information systems: a case study.

Current health scenarios have witnessed increased attention for home care as a way to enhance the quality of service provision and reduce costs. In recent times, clinical information systems (CISs) have undergone significant development and they now include useful applications for doctors, nurses and other health professionals. The present work investigates the possible integration of a home-based telemonitoring system within a CIS to enhance its potentials. Test results showed a smooth integration and highlighted multiple advantages such as use of a single interface for the management of several data types, inclusion of health-related data about in-hospital and home periods, workflow creation and check points during home care provision, use of consistent criteria for data security and privacy protection.

A wearable device for a fully automated in-hospital staff and patient identification.

In the health care context, devices for automated staff / patient identification provide multiple benefits, including error reduction in drug administration, an easier and faster use of the Electronic Health Record, enhanced security and control features when accessing confidential data, etc. Current identification systems (e.g. smartcards, bar codes) are not completely seamless to users and require mechanical operations that sometimes are difficult to perform for impaired subjects. Emerging wireless RFID technologies are encouraging, but cannot still be introduced in health care environments due to their electromagnetic emissions and the need for large size antenna to operate at reasonable distances. The present work describes a prototype of wearable device for automated staff and patient identification which is small in size and complies with the in-hospital electromagnetic requirements. This prototype also implements an anti-counterfeit option. Its experimental application allowed the introduction of some security functions for confidential data management.

TANCLICO: tools for the analysis of inter-departmental clinical communications.

Patient care management provided by healthcare organizations is complex, involving many different care providers. The information exchange between providers concerns a varying and considerable number of actors and a high transmission load. Based on models, used to characterize specific features of work processes, we propose a new method able to analyze and represent clinical communications inside hospitals. Software has been developed, providing tools for storing and retrieving information resulting from clinical communications. The method, together with data collected in actual situations, may constitute useful tools for health information systems developers.

Homonymous bilateral hemianopsia: electrophysiological study of a case.

Described is a case of bilateral homonymous hemianopsia with macular sparing, resulting from head trauma. The case presented lesions of the occipital visual areas which involved entirely the left hemisphere and only partially the right hemisphere. VEP were obtainable only from electrodes placed on the right hemisphere with both right eye and left eye stimulation. VEP mapping showed that each eye projects macular fibres towards functional areas of the right occipital hemisphere. Electrophysiological examination confirmed objectively and for the first time in man the theory of "double cortical macular representation". Clinical implications of this finding are discussed.

Single-sweep analysis using an autoregressive with exogenous input (ARX) model.

Single-sweep visual evoked potential analysis would be useful in clinical electrophysiology practice because it would make possible the evaluation of transient phenomena, but recording single-sweep visual evoked potentials is difficult because of the low signal-noise ratio. To increase this ratio we used a filter based on an autoregressive with exogenous input model. We studied a group of 12 diabetic patients matched with a control group of 14 normal subjects. The model, in most cases, allowed us to extrapolate the P100 component from each single sweep of visual evoked potential. The visual evoked potential values obtained by means of averaging were not significantly different in the groups studied, but single-sweep analysis showed different distribution of the P100 component amplitude. The preliminary results of our study evidenced differences in the amplitude and latency distribution of normal and diabetic subjects, thus confirming the power of this new technique and its ability to obtain some information that is masked by the averaging method.