SISTINE 3.0: Wearable System for Remote Functional Assessment of Phlebopathics.

Phlebopathic diseases are chronic conditions that impact the health status and affect functional capacity. We developed SISTINE 3.0, a wearable system for remote monitoring of patients, and the aim of the study is to evaluate whether it can detect differences between participants with phlebology and healthy ones. Twelve patients and five healthy subjects performed a 3-metres Timed-Up-Go wearing SISTINE 3.0 system. The results support the system's potential to discriminate participants, especially based on the linear walking and turning angular velocity.

A functional calibration protocol for ankle plantar-dorsiflexion estimate using magnetic and inertial measurement units: Repeatability and reliability assessment.

The ankle joint complex presents a tangled functional anatomy, which understanding is fundamental to effectively estimate its kinematics on the sagittal plane. Protocols based on the use of magnetic and inertial measurement units (MIMUs) currently do not take in due account this factor. To this aim, a joint coordinate system for the ankle joint complex is proposed, along with a protocol to perform its anatomical calibration using MIMUs, consisting in a combination of anatomical functional calibrations of the tibiotalar axis and static acquisitions. Protocol repeatability and reliability were tested according to the metrics proposed in Schwartz et al. (2004) involving three different operators performing the protocol three times on ten participants, undergoing instrumented gait analysis through both stereophotogrammetry and MIMUs. Instrumental reliability was evaluated comparing the MIMU-derived kinematic traces with the stereophotogrammetric ones, obtained with the same protocol, through the linear fit method. A total of 270 gait cycles were considered. Results showed that the protocol was repeatable and reliable for what concerned the operators (0.4 ± 0.4 deg and 0.8 ± 0.5 deg, respectively). Instrumental reliability analysis showed a mean RMSD of 3.0 ± 1.3 deg, a mean offset of 9.4 ± 8.4 deg and a mean linear relationship strength of R2 = 0.88 ± 0.08. With due caution, the protocol can be considered both repeatable and reliable. Further studies should pay attention to the other ankle degrees of freedom as well as on the angular convention to compute them.

Experimental study protocol of the project "MOtor function and VItamin D: Toolkit for motor performance and risk Assessment (MOVIDA)".

Musculoskeletal injuries, a public health priority also in the military context, are ascribed to several risk factors, including: increased reaction forces; low/reduced muscle strength, endurance, body mass, Vitamin D level, and bone density; inadequate lifestyles and environment. The MOVIDA Project-funded by the Italian Ministry of Defence-aims at developing a transportable toolkit (assessment instrumentation, assessment protocols and reference/risk thresholds) which integrates motor function assessment with biological, environmental and behavioural factors to help characterizing the risk of stress fracture, stress injury or muscle fatigue due to mechanical overload. The MOVIDA study has been designed following the STROBE guidelines for observational cross-sectional studies addressing healthy adults, both militaries and civilians, with varying levels of physical fitness (sedentary people, recreational athletes, and competitive athletes). The protocol of the study has been designed and validated and is hereby reported. It allows to collect and analyse anamnestic, diagnostic and lifestyle-related data, environmental parameters, and functional parameters measured through portable and wearable instrumentation during adapted 6 minutes walking test. The t-test, one and two-way ANOVA with post-hoc corrections, and ANCOVA tests will be used to investigate relevant differences among the groups with respect to biomechanical parameters; non-parametric statistics will be rather used for non-normal continuous variables and for quantitative discrete variables. Generalized linear models will be used to account for risk and confounding factors.

Hopping skill in individuals with Down syndrome: A qualitative and quantitative assessment.

INTRODUCTION: Individuals with Down syndrome (DS) show a delayed acquisition of gross motor skills. Among gross motor skills, hopping is a particular form of jumping that can be performed using one leg. Despite its large use during play and physical activity, this skill in adults with DS has not received much attention so far. Here, we aim at investigating hopping skill in adults with DS both from a quantitative and qualitative point of view. METHODS: Center of mass and dominant leg kinematics during hopping over distance were recorded from 24 adult individuals with DS and from 21 typically developed adults (TD) using two inertial measurement units positioned on the posterior aspect of the lower back and on the lateral malleolus of the hopping leg. From linear acceleration and angular velocity signals, hopping frequency (HF), cycle, stance and flight duration (CD, SD, FD), vertical stiffness (KV) and peak to peak linear acceleration and angular velocities about the cranio-caudal, antero-posterior and medio-lateral axes were extracted. A qualitative process assessment of the hopping skill was carried out using the performance criteria of the test for gross motor development (TGMD-3). The extracted parameters were submitted to analysis of covariance, with stature as a covariate to rule-out possible confounding effects. RESULTS: The qualitative assessment highlighted a poorer hopping performance in the DS group compared to the TD group. DS participants showed higher HF and KV, shorter CD, SD, FD and lower angular velocity about the cranio-caudal axis compared to the TD group. Significant correlations between the temporal parameters of the quantitative assessment and the results of the qualitative assessment were observed. DISCUSSION: The poorer motor competence in hopping in individuals with DS compared to TD peers may be related to the shorter flight time and higher vertical stiffness observed in TD peers. The adopted instrumental approach, overcoming the limitations of subjective evaluations, represents a promising opportunity to quantify motor competence in hopping.

Overuse-Related Injuries of the Musculoskeletal System: Systematic Review and Quantitative Synthesis of Injuries, Locations, Risk Factors and Assessment Techniques.

Overuse-related musculoskeletal injuries mostly affect athletes, especially if involved in preseason conditioning, and military populations; they may also occur, however, when pathological or biological conditions render the musculoskeletal system inadequate to cope with a mechanical load, even if moderate. Within the MOVIDA (Motor function and Vitamin D: toolkit for risk Assessment and prediction) Project, funded by the Italian Ministry of Defence, a systematic review of the literature was conducted to support the development of a transportable toolkit (instrumentation, protocols and reference/risk thresholds) to help characterize the risk of overuse-related musculoskeletal injury. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach was used to analyze Review papers indexed in PubMed and published in the period 2010 to 2020. The search focused on stress (overuse) fracture or injuries, and muscle fatigue in the lower limbs in association with functional (biomechanical) or biological biomarkers. A total of 225 Review papers were retrieved: 115 were found eligible for full text analysis and led to another 141 research papers derived from a second-level search. A total of 183 papers were finally chosen for analysis: 74 were classified as introductory to the topics, 109 were analyzed in depth. Qualitative and, wherever possible, quantitative syntheses were carried out with respect to the literature review process and quality, injury epidemiology (type and location of injuries, and investigated populations), risk factors, assessment techniques and assessment protocols.

A wearable gait analysis protocol to support the choice of the appropriate ankle-foot orthosis: A comparative assessment in children with Cerebral Palsy.

BACKGROUND: Cerebral Palsy is, nowadays, the most common cause of pediatric disabilities, particularly debilitating for daily living activities. While the adoption of ankle-foot orthoses is very well established as gait treatment, the choice of the most appropriate orthotic configuration is not strongly supported by scientific evidence. The aim of this study was to develop an instrumented assessment protocol based on wearable gait analysis to support clinicians in ankle-foot orthoses configuration selection. METHODS: Ten children with spastic diplegic Cerebral Palsy were assessed (7 males, aged 4 to 11 years; all functionally classified as Gross Motor Function Classification System I or II, with clinical indication of conservative treatment through use of ankle-foot orthoses). They performed a 10Meter Walk Test in three conditions: barefoot and wearing alternatively a polypropylene hinged and solid ankle-foot orthosis accommodated in the same off-the-shelf shoe model, after 20 days of daily use of each configuration. An instrumented assessment protocol based on body-mounted magneto-inertial sensors was devised to derive spatio-temporal, gait stability and symmetry biomechanical parameters within an observational pre and post cross over design. FINDINGS: The analysis at the individual level quantitatively revealed how different patients benefited differently from the two orthoses. No general indications were obtained in favour of or against a specific configuration for the sample as a whole. INTERPRETATION: The proposed instrumented protocol represents a quantitative and useful tool to support the clinical selection of an appropriate orthotic treatment and, potentially, in evaluating its effectiveness.

Countermovement jump performance assessment using a wearable 3D inertial measurement unit.

The aim of this study was to validate a wearable inertial measurement unit (IMU), containing a 3D accelerometer and gyroscope, for the estimation of countermovement jump height. The absolute vertical acceleration of the IMU positioned on the back of the participant at L5 level, compensated for trunk rotations, was used to obtain jump height by applying the equation of free-fall to the motion of the IMU. The methodology was tested on 28 participants performing five countermovement jumps each. A reference value for this quantity was obtained using stereophotogrammetry (35.4 cm, s = 4.9). Jump height scores obtained using the proposed methodology (35.9 cm, s = 5.5) presented no significant difference with respect to stereophotogrammetry (P = 0.61). A low bias of 0.6 cm confirmed the accuracy of the estimate, which also showed a high (r = 0.87) and significant (P < 0.0001) correlation with reference values. Furthermore, without compensating accelerations for trunk rotation, jump height was largely underestimated (P < 0.0001) (bias: -12.7 cm) and poorly associated (r = 0.31) with stereophotogrammetry. The results of this study show that the estimation of jump height using inertial sensors leads to accurate results when the measured accelerations are corrected for trunk rotations.

Non-invasive assessment of superficial soft tissue local displacements during movement: a feasibility study.

In the movement analysts community, the assessment of the displacement of skin photogrammetric markers relative to the underlying bone (soft tissue displacement, STD) is considered to be a priority. The aim of this study is to present a non-invasive method that allows for the characterization of STD for any marker location, subject, and motor task. In particular, this method provides an estimate of the STD vector in a bone-embedded frame. The body segment under analysis is endowed with the largest possible number of skin markers located over all areas of interest. Any given STD vector is observed from all the marker cluster frames that can be built by suitably combining all the available markers. A subset of the latter frames is identified that is made of frames endowed with uncorrelated local movements. The estimate of a given STD vector is determined through the coherent average of the vectors reconstructed using the above-mentioned independent frames. This estimate is affected by a 180 degrees phase indeterminacy. The proposed method and the underlying hypotheses were validated using markers located on the thighs of two female subjects treated for a total knee replacement. The relevant STD estimates, STDm, were compared with those directly observed using photogrammetry combined with 2D fluoroscopic projections and the prosthesis CAD model (STDf). Recordings were made while the volunteers performed step up/down motor tasks. The root mean square value of STDm was found in the range 2.5-23.0 mm and was consistent with the RMS values of STDf and with other results reported in the literature and obtained in similarly unconstrained conditions. Moreover, STDm and STDf showed a pattern similarity measured by a correlation coefficient equal to 0.83 (+/-0.13) and by a normalised root mean square distance equal to 27% (+/-16%). The described estimate of the STD pattern and magnitude, even with the above-mentioned indeterminacies, constitutes valuable information when aiming at optimal marker placement and is an indispensable prerequisite for bone pose estimator design and assessment.