Use of Lower Limb Exoskeletons as an Assessment Tool for Human Motor Performance: A Systematic Review.

Exoskeletons are a promising tool to support individuals with a decreased level of motor performance. Due to their built-in sensors, exoskeletons offer the possibility of continuously recording and assessing user data, for example, related to motor performance. The aim of this article is to provide an overview of studies that rely on using exoskeletons to measure motor performance. Therefore, we conducted a systematic literature review, following the PRISMA Statement guidelines. A total of 49 studies using lower limb exoskeletons for the assessment of human motor performance were included. Of these, 19 studies were validity studies, and six were reliability studies. We found 33 different exoskeletons; seven can be considered stationary, and 26 were mobile exoskeletons. The majority of the studies measured parameters such as range of motion, muscle strength, gait parameters, spasticity, and proprioception. We conclude that exoskeletons can be used to measure a wide range of motor performance parameters through built-in sensors, and seem to be more objective and specific than manual test procedures. However, since these parameters are usually estimated from built-in sensor data, the quality and specificity of an exoskeleton to assess certain motor performance parameters must be examined before an exoskeleton can be used, for example, in a research or clinical setting.

Effects of Upper-Limb Exoskeletons Designed for Use in the Working Environment-A Literature Review.

Introduction: Many employees report high physical strain from overhead work and resulting musculoskeletal disorders. The consequences of these conditions extend far beyond everyday working life and can severely limit the quality of life of those affected. One solution to this problem may be the use of upper-limb exoskeletons, which are supposed to relieve the shoulder joint in particular. The aim of this literature review was to provide an overview of the use and efficacy of exoskeletons for upper extremities in the working environment. Methods: A literature review was conducted using the PICO scheme and the PRISMA statement. To this end, a systematic search was performed in the PubMed, Web of Science and Scopus databases in May 2020 and updated in February 2022. The obtained studies were screened using previously defined inclusion and exclusion criteria and assessed for quality. Pertinent data were then extracted from the publications and analyzed with regard to type of exoskeleton used as well as efficacy of exoskeleton use. Results: 35 suitable studies were included in the review. 18 different exoskeletons were examined. The majority of the exoskeletons only supported the shoulder joint and were used to assist individuals working at or above shoulder level. The main focus of the studies was the reduction of muscle activity in the shoulder area. Indeed, 16 studies showed a reduced activity in the deltoid and trapezius muscles after exoskeleton use. Kinematically, a deviation of the movement behavior could be determined in some models. In addition, study participants reported perceived reduction in exertion and discomfort. Discussion: Exoskeletons for upper extremities may generate significant relief for the intended tasks, but the effects in the field (i.e., working environment) are less pronounced than in the laboratory setting. This may be due to the fact that not only overhead tasks but also secondary tasks have to be performed in the field. In addition, currently available exoskeletons do not seem to be suitable for all overhead workplaces and should always be assessed in the human-workplace context. Further studies in various settings are required that should also include more females and older people.

NFκB- and MAP-Kinase Signaling Contribute to the Activation of Murine Myeloid Dendritic Cells by a Flagellin A:Allergen Fusion Protein.

Fusion proteins incorporating the TLR5-ligand flagellin are currently undergoing clinical trials as vaccine candidates for many diseases. We recently reported a flagellin:allergen fusion protein containing the TLR5-ligand flagellin A (FlaA) from Listeriamonocytogenes and the major birch pollen allergen Bet v 1 (rFlaA:Betv1) to prevent allergic sensitization in an experimental mouse model. This study analyzes the signaling pathways contributing to rFlaA:Betv1-mediated pro- and anti-inflammatory cytokine secretion and cell metabolism in myeloid dendritic cells (mDCs) in vitro. The influence of mammalian target of rapamycin (mTOR)-, NF?B-, and MAP kinase (MAPK)-signaling on cytokine secretion and metabolic activity of bone marrow (BM)-derived mDCs stimulated with rFlaA:Betv1 were investigated by pre-treatment with either mTOR- (rapamycin), NF?B- (dexamethason, BMS-345541, TPCA-1, triptolide, or BAY-11) or MAPK- (SP600125, U0126, or SB202190) inhibitors, respectively. rFlaA:Betv1-mediated IL-10 secretion as well as activation of mDC metabolism, rather than pro-inflammatory cytokine secretion, were inhibited by rapamycin. Inhibition of NFκB-signaling suppressed rFlaA:Betv1-induced IL-12, while inhibition of MAPK-signaling dose-dependently suppressed rFlaA:Betv1-induced IL-10 as well as pro-inflammatory IL-6 and TNF-α production. Notably, with the exception of a partial JNK-dependency, rFlaA:Betv1-mediated effects on mDC metabolism were mostly NF?B- and MAPK-independent. Therefore, MAPK-mediated activation of both NFκB- and mTOR-signaling likely is a key pathway for the production of pro- and anti-inflammatory cytokines by flagellin fusion protein vaccines.

Reliable manual segmentation of the frontal, parietal, temporal, and occipital lobes on magnetic resonance images of healthy subjects.

BACKGROUND: It is a challenge to reliably measure the lobar volumes from magnetic resonance imaging (MRI) data. OBJECTIVE: Description of a landmark-based method for volumetric segmentation of the brain into the four cerebral lobes from MR images. METHOD: The segmentation method relies on a combination of anatomical landmarks and geometrical definitions. The first step, described previously, is a segmentation of the four lobes on the surface of the brain. The internal borders between the lobes are defined on the axial slices of the brain. The intra- and inter- rater reliability was determined from the MRI scans of a group of 10 healthy control subjects measured by 2 independent raters. RESULTS: The intra-rater relative error (and intra-class correlation coefficient) of the lobar volume measures ranged from 0.81% to 3.85% (from 0.97 to 0.99). The inter-rater relative error (and intra-class correlation coefficient) ranged from 0.55% to 3.09% (from 0.94 to 0.99). CONCLUSION: This technique has been shown to have high intra- and inter-rater reliability. The current method provides a method to obtain volumetric estimates of the 4 cerebral lobes.