The SonicHand Protocol for Rehabilitation of Hand Motor Function: A Validation and Feasibility Study.

Musical sonification therapy is a new technique that can reinforce conventional rehabilitation treatments by increasing therapy intensity and engagement through challenging and motivating exercises. The aim of this paper is to evaluate the feasibility and validity of the SonicHand protocol, a new training and assessment method for the rehabilitation of hand function. The study was conducted in 15 healthy individuals and 15 stroke patients. The feasibility of implementation of the training protocol was tested in stroke patients only, who practiced a series of exercises concurrently to music sequences produced by specific movements. The assessment protocol evaluated hand motor performance during pronation/supination, wrist horizontal flexion/extension, and hand grasp without sonification. From hand position data, 15 quantitative parameters were computed evaluating mean velocity, movement smoothness, and angular excursions of hand/fingers. We validated this assessment in terms of its ability to discriminate between patients and healthy subjects, test-retest reliability and concurrent validity with the upper limb section of the Fugl-Meyer scale (FM), the functional independence measure (FIM), and the Box and Block Test (BBT). All patients showed a good understanding of the assigned tasks and were able to correctly execute the proposed training protocol, confirming its feasibility. A moderate-to-excellent intraclass correlation coefficient was found in 8/15 computed parameters. The moderate-to-strong correlation was found between the measured parameters and the clinical scales. The SonicHand training protocol is feasible and the assessment protocol showed good to excellent between-group discrimination ability, reliability, and concurrent validity, thus enabling the implementation of new personalized and motivating training programs employing sonification for the rehabilitation of hand function.

[Multidisciplinary protocol for work resumption after occupational osteoarticular injury: case record]. / Protocollo interdisciplinare per il reinserimento lavorativo dopo infortunio osteoarticolare sul lavoro: casistica clinica.

The results obtained with a protocol aimed at work resumption after occupational osteoarticular injury and subsequent rehabilitation are presented: 159 patients (102 males and 57 females: mean age 43.7 years) were evaluated by the physiatrist and the occupational physician, providing indications based on their functional capabilities and task features. After 6 months, 105 out of 130 subjects available for telephonic follow-up (80.7%) had returned to work (8 after changing tasks, 7 part-time). The mean time for work resumption was 9.4 days for those who resumed working completely, 31.4 days for the others. After 12 months, the percentage of working patients (76 out of 93: 81.7%) was superimposable, indicating that the rehabilitation beneficial effect is maximal in the short-medium period. On the whole, the data prove the efficacy of the multidisciplinary rehabilitative approach.

[Return to work after occupational osteoarticular injury: presentation of a multidisciplinary protocol and preliminary data]. / Reinserimento lavorativo dopo infortunio osteoarticolare sul lavoro: presentazione di un protocollo interdisciplinare e dati preliminari.

A protocol for work resumption after occupational osteoarticular injury and subsequent rehabilitation is presented: 97 patients (68 males and 29 females; mean age 42 years) were evaluated by the physiatrist and the occupational physician, providing indications based on their functional capabilities and task features. Up to date, 38 underwent follow-up at 6 months: 30 had returned to work (3 after changing tasks, 4 part-time). The mean time for work resumption was 15 days for the 26 subjects who resumed working completely, 1 month for the 4 who resumed partially. These data are encouraging, and highlight the importance of a multidisciplinary rehabilitative approach to facilitate return to work after occupational injuries.

[Risks of awkward posture]. / Rischi do posture incongrue.

For posture we mean the position of the body in the space and the relationship with its segments. The correct posture is determined by neurophysiological, biomechanical, emotional, psychological and relation factors, enabling us to perform daily and working activities with the lowest energy expenditure. When possible we suggest during posture variation, a preventive measure where there are prolonged fixed activities.

[Model Foundation S. Maugeri-IRCCS]. / Il modello Fondazione Salvatore Maugeri-IRCCS.

A multidisciplinary (physiatrist, occupational physician, neurophysiologist, radiologist, etc.) and multiprofessional (occupational therapist, physiotherapist, ergonomist) strategy for rehabilitation and re-introduction of people with work-related injuries was tested at the "Fondazione Maugeri" Scientific Institue (Pavia, Italy). This process of re-introduction to work has several stages including increasing strength and resistance, specific occupational therapy activities to recover working functions and movements, aerobic training, prescription and allocation of any auxiliaries necessary, and inspections of the home and workplace. One particular feature is the final functional evaluation, whose aims are: to study the subject's "residual capacities" and "sustainable capacities", to supply useful information to the occupational physician in view of the verifying the patient's suitability for work, to contribute to "targeted" re-introduction, and to offer parameters useful for prevention and ergonomic planning. The main features of the disabled person which are studied are: degree of disability, motor capacity (joint movements, strength, resistance), cognitive-verbal functions, sensitivity and sensory functions, psychological and emotional components, need for auxiliaries, educational-professional aspects, possibility of autonomous transport, and motivation.

[Tests of hand functionality in upper limb amputation with prosthesis]. / I test di funzionalità della mano in amputati di arto superiore con protesi.

The need for standardized instruments for clinical measurements has become pressing in the fields of occupational rehabilitation and ergonomics. This is particularly the case for instruments that allow a quantitative evaluation of upper limb function, and especially hand function in patients who have undergone an amputation and then application of an upper limb prosthesis. This study presents a review of the main tests used to evaluate hand function, with a critical analysis of their use in subjects with an upper limb prosthesis. The tests are divided into: tests to evaluate strength, tests to evaluate co-ordination and dexterity, tests of global or overall function, and tests proposed specifically for subjects with an upper limb prosthesis. Of the various tests presented, the authors give their preference to the Bimanual Functional Assessment, Abilhand and/or the ADL Questionnaire, because of the practical usefulness, clinimetric features, simplicity and ease of administration of these tests.

[Industrial manufacturing of the wool: pathology secondary to the biomechanical involvement of the upper limbs and the course in relation to work tasks]. / Lavorazione industriale dello lana: patologie secondarie all'impegno biomeccanico degli arti superiori (UEWMSDS) e loro evoluzione in relazione alla mansione lavorativa.

In years 2003-2005, 1248 laborers of Zegna Baruffa - Lane Borgosesia Company (establishment of Borgosesia and Vallemosso) have been visited and we selected 102 cases of pathology from upper extremity work-related musculoskeletal disorders in the units with working risk. Subsequently from April 2005 to May 2006 we have controlled the clinical evolution of the enlisted laborers and we noted that in 54% of the cases the clinical symptomatology has been resolved with a rest works and a correct therapy. The diagnosis, the treatment and the change of working duty can resolve a meaningful number of clinical cases.

[Industrial processing of wool: biomechanics and ergonomic aspects]. / Lavorazione industriale della lana: impegno biomeccanico ed aspetti ergonomici.

Workers in a wool processing industry were analyzed for risk factors in development of musculoskeletal disorders from specific repetitive movements that they executed, in all phases of the preparation of wool products ("tintoria", "mescolanza", "finitura", "filatura", "riroccatura", "ritorcitura", "confezionamento"). The evaluation revealed nonergonomic work situations, due to both repetitive movements of the upper extremities as well as prolonged asymmetrical postures of the trunk while moving loads; both of these problems were due to suboptimal interface between the anthropomorphic characteristics of the operators and the technical movements required at the machines. The risk analysis was performed both for cumulative trauma disorders as well as for low back pain, based on formulas in the exisiting literature. Ergonomic interventions were implemented and evaluated for the most stressful situations.

[Assessment of function recovery in patients with total knee prosthesis]. / Valutazione della ripresa funzionale nei pazienti sottoposti ad intervento di protesi totale di ginocchio.

The aim of this study was to analyse the evolution of motor performance in a group of patients who underwent surgical knee replacement. We also assessed patient satisfaction at 3 and 9 months after the operation. Sixty-two patients (40 women, 22 men, mean age 72.4 years) underwent isokinetic evaluation associated with surface EMG. All the patients had undergone a total prosthetic knee joint replacement for arthrosis, and had followed a standardised 30-day rehabilitation program at our centre for recovery of knee joint function, strengthening of the flexor-extensor muscles and restoration of ambulation as best as possible. Each of these patients underwent isokinetic evaluations 3 months and 9-10 months after their operation. The isokinetic test consisted of carrying out 5 flexion-extensions of the knee at an angular velocity of 60 degrees/second, followed by an endurance test of 30 repetitions of flexion-extension of the knee at 120 degrees/second. This isokinetic test provided data on extensor strength and flexor strength; furthermore, specifically designed software allowed simultaneous visualisation of the surface EMG tracing, torque and joint excursion. The first analysis showed a macroscopic decrease in the strength of the flexor-extensor muscles of the knee. This muscle weakness was clearly evident 3 months after the operation and was particularly pronounced for the extensor muscles of the operated limb compared with the muscles of contralateral, unoperated limb. Muscle weakness was still present 9 months after the operation although there had been a considerable improvement compared with 6 months previously; the imbalance in the flexor/extensor ratio, which differed from that in the contralateral, unoperated limb, was noted to be still present. The surface EMG demonstrated persistent myoelectrical activity in the flexors even when the extensor activity was predominant: this is an expression of imbalance between agonists-antagonists. A questionnaire administered to the patients about their satisfaction with the operation revealed that 9 months after the surgery 23 patients still complained of continuous joint pain with increased loads, 27 complained of frequent pain with load-bearing and only 12 no longer complained of any disturbance, manifesting full satisfaction with the operation. Total knee replacement is thus a valid treatment in those cases in which degenerative joint disease necessitates a radical solution. Nevertheless, dissatisfaction with the operation is common, and may be due to persistence of joint pain and incomplete joint recovery of joint function or muscle strength. In our series of patients, we found that although there was progressive recovery of strength of both the flexor and extensor muscles, a considerable imbalance remained between the operated and unoperated limbs; this finding was also confirmed by the surface EMG investigation.

[The Italian version of "OREGE" (Outil de Repérage et d'Evaluation des Gestes) of the INRS (Institut national de recherche et de sécurité) for the assessment of musculoskeletal disorders of the upper limb]. / La versione italiana "OREGE" (Outil de Repérage et d'Evaluation des Gestes) dell'INRS (Institut national de recherche et de sécurité) per la valutazione dei disturbi muscolo-scheletrici dell'arto superiore.

The upper extremity work-related musculoskeletal disorders (UEWMSDs) are a heterogeneous group of disorders not yet standardised mainly epidemiological criteria for case definition. They are multifactorial, often they are work related even if sometimes they show an individual origin. In recent years they show a rapid increase but it's worth noting that this trend is also affected by a more widespread and easy recognition as work related diseases. There are many ergonomic analysis tools, currently available, that claim to accurately measure variables associated with UEWMSDs. They are essentially based on biomechanical, epidemiological and physiological approaches and identify work activities at risk of developing: OSHA's checklist, Strain Index, OCRA Index, ACGIH (Hand Activity Level). A method for the study of musculoskeletal disorders of the upper limb has been proposed by French INRS (National de Recherche et de Sécurité). It is defined as a project based on ergonomics applied to occupational medicine and it includes: (1) OSHA's checklist as a screening tool; (2) MSDs questionnaire for standardised record of symptoms and of worker's opinions (3) OREGE, (Outil de Repérage et d'Evaluation des Gestes) a exhaustive evaluation tool to be used by ergonomics-trained personnel, aimed to identify risk factors to be considered for preventive and corrective actions. OREGE includes: force evaluation through Latko's scale (which take into account: weight of objects and tools, kind of hold, pressure, vibration, temperature, use of gloves), articular position analysis, repetition analysis, synthesis of the different biomechanical risk factors, calculation of an index of risk. The authors have considered of interest to provide occupational physicians and ergonomic professionals with an Italian version of OREGE. The expected results are: a critical review of the method, a comparison with the other most known evaluation methods and the selection of the best method for specific work activity.

[Cost assessment of one-day stay in the Day Hospital system for motor rehabilitation]. / Determinazione del costo di una giornata di degenza in regime di Day Hospital per un reparto di riabilitazione motoria.

This study develops a model for determining the standard cost of a day's admission to a Day Hospital in a rehabilitation unit. The task is carried out by analysing the costs in a single hospital. The method chosen to determine the standard cost of a day's admission to the Day Hospital was to evaluate the patient's management course. The analysis was limited to the period between the moment the patient is contacted for Day Hospital treatment up to end of the day spent in the Day Hospital. The work has four stages: 1. definition of the patient's management course; 2. identification of all the activities carried out and all the resources involved in the different stages of the management course; 3. evaluation of the resources used by the activities identified, 4. analysis of the clinical records to verify that the management actually provided did not differ from the defined one in order to determine the standard cost.

[Anatomo-functional aspects and diagnostic algorithm (of the upper limb pathologies secondary to repeated trauma)]. / Aspetti anatomo-funzionali ed inquadramento diagnostico (delle patologie da traumi ripetuti agli arti superiori).

The epidemiology of work-related musculo-skeletal pathologies of the upper limbs has become significantly relevant in the last years, and a sharp increasing trend can be observed. This paper mainly focuses on the chronic inflammatory and degenerative conditions, which are more complex and difficult to accurately diagnose and treat. A synthesis of the diagnostic picture of the different types, involving the joints, muscles and tendons, and peripheral nerves is provided, with mention of the sensitivity and specificity of the main diagnostic tests. The possible entrapments of the radial, median and ulnar nerves are described in detail. Finally, a brief critical review on the principal movements of the upper limbs which are responsible of the onset of such conditions is presented.

[Evaluation of the risk related to repetitive work activities: testing of several methods proposed in the literature]. / La valutazione del rischio connesso ad attività lavorative ripetitive: sperimentazione di diversi metodi proposti dalla letteratura.

Pathologies due to the repetitive activity of the upper limbs constitutes a growing part of the work-related musculo-skeletal disorders. At the moment, there are no universally accepted and validated methods for the description and assessment of the work-related risks. Yet, the criteria fundamentally characterizing the exposure are rather clear and even. This study reports a practical example of the application of some recent risk assessment methods proposed in the literature, combining objective and subjective measures obtained on the field, with the traditional activity analysis.

[Multifactorial ergonomic evaluation of the hospital nursing activity in assisting not self-sufficient patients]. / Valutazione ergonomica multifattoriale dell'attività infermieristica ospedaliera, nell'assistenza ad ammalati non autosufficienti.

8 Institutes of Health Care and Research of Northern-Central Italy participated in the study, which consisted of on-site investigations, interviews with the chief-nurse, and monitoring of physiological and subjective variables. We studied the most critical phases in the laboratory, by means of video-graphical systems for biomechanical and postural analysis. The outlined profile shows a demanding activity, yielding important risk factors relative to musculoskeletal lesions. The preventive attitude (education, training) must be implemented by ergonomic interventions, aimed to minimize the risk related to manual handling.

[An ergonomic study of postures of toll collectors]. / Indagine ergonomica nelle postazioni di "esattori pedaggio".

The working activities of operators in the workstations along the italian motor ways involve repetitive movements of upper limbs and neck with asymmetric postures of the trunk. The tasks examined are characterized by factors potentially dangerous for developing musculo-skeletal disorders, such as repetitivity, and prolonged constrained postures. It is therefore crucial that dimensional and structural characteristics of the workplace are adequately designed, with regard to the anthropometric parameters and the type of activity performed. The results of our "on-site" investigation, using an observational method (OCRA), dedicated computerized modules for postural analysis (software "Vision 3000", Promatek, Ltd.), and recordings of myoelectrical activity (surface EMG) in the muscles of the shoulder girdle, have shown the need of a partial re-designing of the man-workstation system under investigation.

[Evaluation of the capacity of work using upper limbs after radical latero-cervical surgery]. / La valutazione della capacità lavorativa con gli arti superiori dopo intervento di svuotamento latero-cervicale.

Evaluation of arm work capacity after radical neck surgery. The aim of this paper is to describe an approach for the assessment of work capacity in patients who underwent radical neck surgery, including those treated with radiation therapy. Nine male patients, who underwent radical neck surgery 2 months before being referred to our Unit, participated in the study. In addition to manual muscle strength test, we performed the following functional evaluations: 0-100 Constant scale for shoulder function; maximal shoulder strength in adduction/abduction and intrarotation/extrarotation; instrumental. We measured maximal isokinetic strength (10 repetitions) with a computerized dynamometer (Lido WorkSET) set at 100 degrees/sec. During the rehabilitation phase, the patients' mechanical parameters, the perception of effort, pain or discomfort, and the range of movement were monitored while performing daily/occupational task individually chosen on the simulator (Lido WorkSET) under isotonic conditions. On this basis, patients were encouraged to return to levels of daily physical activities compatible with the individual tolerable work load. The second evaluation at 2 month confirmed that the integrated rehabilitation protocol successfully increased patients' capacities and "trust" in their physical capacity. According to the literature, the use of isokinetic and isotonic exercise programs appears to decrease shoulder rehabilitation time. In our experience an excellent compliance has been noted. One of the advantages of the method proposed is to provide quantitative reports of the functional capacity and therefore to facilitate return-to-work of patients who underwent radical neck surgery.

[Standard parameters in gait analysis in an Italian multicenter case study]. / Parametri normativi dell'analisi del cammino in una casistica multicentrica italiana.

The study reports the results of a group who, in a multicentric trial, using a gait analysis laboratory Italian made, and a standard procedure, examined 127 normal subjects. The gait laboratory is composed of contacts to relieve the support on the ground, goniometric transducers with an articulated parallelogram, active sensors for cutaneous electromyography, patient unit for data collection and transmission, interface modules for signal reconstruction, software for data elaboration. All data was elaborated in order to give normative data for Italian population. There were no differences between right and left side, nor between male and female subjects. Values of the present study was compared with previous foreign literature and a critical comment is proposed.

Tolerability to prolonged lifting tasks. A validation of the recommended limits.

Prolonged physical exertion is subjectively regulated by the perception of effort. This preliminary study was conducted to validate the use of subjective perceptions of effort in assessing objectively tolerable workloads for prolonged lifting tasks. Ten healthy male subjects tested their maximal lifting capacity (MLC) on a lift dynamometer (LidoLift, Loredan Biomed., West Sacramento, CA) and underwent incremental and 30-minute endurance lifting tests. Cardiorespiratory parameters were monitored with an oxygen uptake analyzer, mechanical parameters were calculated using a computerized dynamometer. Ratings of perceived exertion were given on Borg's 10-point scale. Physiological responses to repetitive lifting were matched with subjective perceptions. A single-variable statistical regression for power functions was performed to obtain the individual "iso-perception" curves as functions of the mechanical work exerted. We found that the "iso-perception" curve corresponding to a "moderate" perception of effort may represent the individual "tolerance threshold" for prolonged lifting tasks, since physiological responses at this level of intensity did not change significantly and the respiratory exchange ratio was less than one. The individually tolerable weight for lifting tasks lasting 30 min has been expressed as a percentage of the isoinertial MLC value and compared with the currently recommended limits for prolonged lifting tasks (Italian legislation D.L. 626/94). On the basis of our preliminary results a "tolerance threshold" of 20% MLC has been proposed for prolonged lifting tasks.

A field methodology for ergonomic analysis in occupational manual materials handling.

A methodology is presented for the 'on-site' evaluation of work-related physical activities. In a first session, video recordings were made of six industrial plant workers during their routine occupational tasks. Heart rate (HR) and subjective perception of effort were monitored. The video recordings were then analysed with appropriate software to determine the musculo-skeletal load ('Vision 3000', Promatek, Montreal) and to evaluate energy expenditure ('Energy', University of Michigan). The indirect estimates of energy expenditure were validated in a second session by monitoring the six subjects' oxygen consumption (VO2) during the same activities with a portable telemetric oxygen uptake analyser (Cosmed 'K2', Rome). No statistically significant differences were found between direct measurements of VO2 and the computerised estimates of energy expenditure. Biomechanical parameters obtained in the two sessions did not differ. Therefore, we conclude that the 'Energy' programme and the 'Vision 3000' program provide a fast and reliable profile of job requirements.