Azure Kinect performance evaluation for human motion and upper limb biomechanical analysis.

Human motion tracking is a valuable task for many medical applications. Marker-based optoelectronic systems are considered the gold standard in human motion tracking. However, their use is not always feasible in clinics and industrial environments. On the other hand, marker-less sensors became valuable tools, as they are inexpensive, noninvasive and easy to use. However, their accuracy can depend on many factors including sensor positioning, light conditions and body occlusions. In this study, following previous works on the feasibility of marker-less systems for human motion monitoring, we investigate the performance of the Microsoft Azure Kinect sensor in computing kinematic and dynamic measurements of static postures and dynamic movements. According to our knowledge, it is the first time that this sensor is compared with a Vicon marker-based system to assess the best camera positioning while observing the upper body part movements of people performing several tasks. Twenty-five healthy volunteers were monitored to evaluate the effects of the several testing conditions, including the Azure Kinect positions, the light conditions, and lower limbs occlusions, on the tracking accuracy of kinematic, dynamic, and motor control parameters. From the statistical analysis of the performed measurements, the camera in the frontal position was the most reliable, the lighting conditions had almost no effects on the tracking accuracy, while the lower limbs occlusion worsened the accuracy of the upper limbs. The assessment of human static postures and dynamic movements based on experimental data proves the feasibility of applying the Azure Kinect to the biomechanical monitoring of human motion in several fields.

Data from the European registry for patients with McArdle disease (EUROMAC): functional status and social participation.

BACKGROUND: The European registry for individuals with GSD5 and other muscle glycogenosis (EUROMAC) was launched to register rare muscle glycogenosis in Europe, to facilitate recruitment for research trials and to learn about the phenotypes and disseminate knowledge about the diseases. A network of twenty collaborating partners from eight European countries and the US contributed data on rare muscle glycogenosis in the EUROMAC registry. METHODS: Following the initial report on demographics, neuromuscular features and comorbidity (2020), we here present the data on social participation, previous and current treatments (medication, supplements, diet and rehabilitation) and limitations. Furthermore, the following questionnaires were used: Fatigue severity scale (FSS), WHO Disability Assessment Scale (DAS 2.0), health related quality of life (SF36) and International Physical Activity Questionnaire (IPAQ). RESULTS: Of 282 participants with confirmed diagnoses of muscle glycogenosis, 269 had GSD5. Of them 196 (73%) completed all questionnaires; for the others, the data were incomplete. The majority, 180 (67%) were currently working. Previous medical treatments included pain medication (23%) and rehabilitation treatment (60%). The carbohydrate-rich diet was reported to be beneficial for 68%, the low sucrose diet for 76% and the ketogenic diet for 88%. Almost all participants (93%) reported difficulties climbing stairs. The median FSS score was 5.22, indicating severe fatigue. The data from the WHODAS and IPAQ was not of sufficient quality to be interpreted. CONCLUSIONS: The EUROMAC registry have provided insight into the functional and social status of participants with GSD5: most participants are socially active despite limitations in physical and daily life activities. Regular physical activity and different dietary approaches may alleviate fatigue and pain.

Biomechanical Assessments of the Upper Limb for Determining Fatigue, Strain and Effort from the Laboratory to the Industrial Working Place: A Systematic Review.

Recent human-centered developments in the industrial field (Industry 5.0) lead companies and stakeholders to ensure the wellbeing of their workers with assessments of upper limb performance in the workplace, with the aim of reducing work-related diseases and improving awareness of the physical status of workers, by assessing motor performance, fatigue, strain and effort. Such approaches are usually developed in laboratories and only at times they are translated to on-field applications; few studies summarized common practices for the assessments. Therefore, our aim is to review the current state-of-the-art approaches used for the assessment of fatigue, strain and effort in working scenarios and to analyze in detail the differences between studies that take place in the laboratory and in the workplace, in order to give insights on future trends and directions. A systematic review of the studies aimed at evaluating the motor performance, fatigue, strain and effort of the upper limb targeting working scenarios is presented. A total of 1375 articles were found in scientific databases and 288 were analyzed. About half of the scientific articles are focused on laboratory pilot studies investigating effort and fatigue in laboratories, while the other half are set in working places. Our results showed that assessing upper limb biomechanics is quite common in the field, but it is mostly performed with instrumental assessments in laboratory studies, while questionnaires and scales are preferred in working places. Future directions may be oriented towards multi-domain approaches able to exploit the potential of combined analyses, exploitation of instrumental approaches in workplace, targeting a wider range of people and implementing more structured trials to translate pilot studies to real practice.

Additive Manufacturing of Spinal Braces: Evaluation of Production Process and Postural Stability in Patients with Scoliosis.

Spinal orthoses produced using additive manufacturing show great potential for obtaining patient-specific solutions in clinical applications, reducing manual operations, time consumption, and material waste. This study was conducted to evaluate the production process of spinal orthoses produced by additive manufacturing, and to test the effects of 3D-printed braces on postural stability in patients with adolescent idiopathic scoliosis and osteogenesis imperfecta. Ten patients were recruited consecutively and were asked to wear a spinal orthosis produced by additive manufacturing for 2 weeks. The four phases of the production process for each brace were evaluated separately on a scale from 0 (not acceptable) to 3 (optimal). Postural stability in the unbraced and the two braced conditions (3D-printed and conventional) was assessed using validated metrics obtained from a wearable inertial sensor. The production process was evaluated as good in four cases, acceptable in five cases, and not acceptable in one case, due to problems in the printing phase. No statistically significant differences were observed in any of the postural balance metrics between the 3D-printed and conventional brace. On the other hand, postural balance metrics improved significantly with both types of braces with respect to the unbraced condition. Spinal orthoses produced with an innovative production process based on digital scans, CAD, and 3D printing are valid alternatives to conventionally produced orthoses, providing equivalent postural stability.

Optimal Biomechanical Performance in Upper-Limb Gestures Depends on Velocity and Carried Load.

In the last few years, there has been increased interest in the preservation of physical and mental health of workers that cooperate with robots in industrial contexts, such as in the framework of the European H2020 Mindbot Project. Since biomechanical analysis contributes to the characterization of the subject interacting with a robotic setup and platform, we tested different speed and loading conditions in a simulated environment to determine upper-limb optimal performance. The simulations were performed starting from laboratory data of people executing upper-limb frontal reaching movements, by scaling the motion law and imposing various carried loads at the hand. The simulated velocity ranged from 20% to 200% of the original natural speed, with step increments of 10%, while the hand loads were 0, 0.5, 1, and 2 kg, simulating carried objects. A 3D inverse kinematic and dynamic model was used to compute upper-limb kinematics and dynamics, including shoulder flexion, shoulder abduction, and elbow flexion. An optimal range of velocities was found in which the expended energy was lower. Interestingly, the optimal speed corresponding to lower exerted torque and energy decreased when the load applied increased. Lastly, we introduced a preliminary movement inefficiency index to evaluate the deviation of the power and expended energy for the shoulder flexion degree of freedom when not coinciding with the minimum energy condition. These results can be useful in human-robot collaboration to design minimum-fatigue collaborative tasks, tune setup parameters and robot behavior, and support physical and mental health for workers.

Respiratory Sinus Arrhythmia (RSA) stress response in preschool age varies by serotonin transporter polymorphism (5-HTTLPR): A preliminary report.

The serotonin transporter promoter region polymorphism (5-HTTLPR) has been implicated in stress regulation, with increased stress reactivity often being found in carriers of the low-expressing short (S) allele. Nevertheless, the role of the 5-HTTLPR in influencing parasympathetic stress reactivity, as indexed by Respiratory Sinus Arrhythmia (RSA), is still unknown. This study examined, for the first time, whether the 5-HTTLPR was associated with variations in RSA response to maternal separation in a sample of 69 healthy 5-year-old children. Preschoolers' RSA was measured during an age-adapted version of the Strange Situation Procedure (SSP). The 5-HTTLPR polymorphism was tested as a predictor of RSA dynamic response to the SSP through multilevel models. A significant interaction between 5-HTTLPR and SSP episodes was found. In particular, whereas a significant decrease in RSA levels was observed during the stranger episode in the whole sample, S allele carriers showed a significant decrease in RSA levels from the stranger episode to the first separation episode, followed by an increase for the rest of the procedure. Albeit preliminary, data support the view that the 5-HTTLPR may contribute to individual differences in RSA stress reactivity from preschool age.

Engagement of Families Attending Early Childhood Services During 5-Month School Closure Due to COVID-19: An Italian Experience.

During the COVID-19 outbreak, we experienced the suspension of both work-related and spare activities, with the closure of shops, companies, services, as well as schools. Children probably are the ones who have suffered the most from this situation, due to the limited socialization with peers and boredom experienced at home. In this context, schools and childhood services tried to relieve the negative effects brought by the pandemic through actions aimed at actively engaging students and their parents in promoting child development and wellbeing. Therefore, several worldwide actions have been implemented to guarantee educational continuity. However, most of these actions targeted 3-18years old children/adolescents, while the subgroup 0-3 was rarely included. Cooperativa Sociale Aeris, a social enterprise based in northern Italy that deals with socio-educational and welfare services, took several measures to overcome problems resulting from the closure of its services dedicated to 0-3 aged children. In this manuscript, we depict how Aeris kept engaged children and their parents, reporting families' evaluation on the actions taken. For assessing their proposed activities, Aeris promptly distributed an on-line survey to the families in May 2020. The answers showed that the organized activities had a positive impact on both children and parents, diminishing the sense of loneliness and boredom for the former, and acting as an important support for the latter. Therefore, this manuscript could work as a reference for policy-makers and managers of educational services in implementing activities and initiatives during home schooling.

The Effect of Baseline on Toddler Event-Related Mu-Rhythm Modulation.

Event-related mu-rhythm activity has become a common tool for the investigation of different socio-cognitive processes in pediatric populations. The estimation of the mu-rhythm desynchronization/synchronization (mu-ERD/ERS) in a specific task is usually computed in relation to a baseline condition. In the present study, we investigated the effect that different types of baseline might have on toddler mu-ERD/ERS related to an action observation (AO) and action execution (AE) task. Specifically, we compared mu-ERD/ERS values computed using as a baseline: (1) the observation of a static image (BL1) and (2) a period of stillness (BL2). Our results showed that the majority of the subjects suppressed the mu-rhythm in response to the task and presented a greater mu-ERD for one of the two baselines. In some cases, one of the two baselines was not even able to produce a significant mu-ERD, and the preferred baseline varied among subjects even if most of them were more sensitive to the BL1, thus suggesting that this could be a good baseline to elicit mu-rhythm modulations in toddlers. These results recommended some considerations for the design and analysis of mu-rhythm studies involving pediatric subjects: in particular, the importance of verifying the mu-rhythm activity during baseline, the relevance of single-subject analysis, the possibility of including more than one baseline condition, and caution in the choice of the baseline and in the interpretation of the results of studies investigating mu-rhythm activity in pediatric populations.

Stress symptoms and resilience factors in children with neurodevelopmental disabilities and their parents during the COVID-19 pandemic.

OBJECTIVE: This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic in Italy by specifically looking at the psychosocial response of children/adolescents with neurodevelopmental disabilities (NDD) and their parents, and explored which factors could potentially contribute to increasing or mitigating stress-related behaviors in children/adolescents as well as their parents' stress. METHOD: An online anonymous survey was designed to investigate family demographic characteristics, COVID-19 outbreak and restriction-related variables, children/adolescents' behavioral regulation problems, parental stress, and resilience. Data were collected from 1,472 parents (83.1% mothers) of 1632 NDD children/adolescents (33.7% females). RESULTS: Compared to pre-emergency, parents reported a significant increase in their children's behavioral regulation problems: Anxious/depressed behavior, Attention problems, and Aggressive behavior (p < .001), and they reported feeling more Overwhelmed and Burdened (p < .001) as parents but less Unfulfilled, Numbness, Devastated, and Angry (p < .001). A hierarchical stepwise regression analysis revealed that both behavioral regulation problems in NDD children/adolescents and parental stress are-at least partially-buffered by resilience factors in parents (Perception of self, Planned future, Family cohesion). CONCLUSIONS: Results showed that behavioral regulation problems in children/adolescents with NDD and parental stress increased. However, parental resilience can act as a protective factor, counterbalancing parental difficulties in the care of their NDD children during the emergency. Identifying risk and protective factors impacting the psychosocial response ofchildren/adolescents with NDD and their parents is essential to implement appropriate support interventions both for parents and children/adolescents with NDD during the COVID-19 pandemic. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Assessing stress variations in children during the strange situation procedure: comparison of three widely used respiratory sinus arrhythmia estimation methods.

Objective.The respiratory sinus arrhythmia (RSA) is a well-known marker of vagal activity that can be exploited to measure stress changes. RSA is usually estimated from heart rate variability (HRV). This study aims to compare the RSA obtained with three widely adopted methods showing their strengths and potential pitfalls.Approach.The three methods are tested on 69 healthy preschoolers undergoing a stressful protocol, the strange situation procedure (SSP). We compare the RSA estimated by the Porges method, the univariate autoregressive (AR) spectral analysis of the HRV signal, and the bivariate AR spectral analysis of HRV and respirogram signals. We examine RSA differences detected across the SSP episodes and correlation between the estimates provided by each method.Main results.The Porges and the bivariate AR approaches both detected significant differences (i.e. stress variations) in the RSA measured across the SSP. However, the latter method showed higher sensitivity to stress changes induced by the procedure, with the mean RSA variation between baseline and first separation from the mother (the most stressful condition) being significantly different among methods: Porges, -17.5%; univariate AR, -18.3%; bivariate AR, -23.7%. Moreover, the performances of the Porges algorithm were found strictly dependent on the applied preprocessing.Significance.Our findings confirm the bivariate AR analysis of the HRV and respiratory signals as a robust stress assessment tool that does not require any population-specific preprocessing of the signals and warn about using RSA estimates that neglect breath information in more natural experiments, such as those involving children, in which respiratory frequency changes are extremely likely.

Mother-Infant Interaction Kinect Analysis (MIIKA): An automatic kinematic-based methodology for the investigation of interpersonal distance during early exchanges.

Interpersonal distance is a core aspect of mother-child interaction. While conventional measures based on human coders do not fully capture the dynamics of this feature, computational methods provide automatic measures which can detect even small changes and more accurate estimates both spatially and temporally. Using RGB-D sensors (Microsoft Kinect V2), the present study describes a setup to automatically examine interpersonal distance during mother-child interactions, termed Mother-Infant Interaction Kinect Analysis (MIIKA). First, the laboratory setting and the data extraction method are described. By using an ad-hoc algorithm for kinematic data extraction, MIIKA returns three metrics: barycenter position (distance and velocity of approach and separation), movements (number of small, medium and large approaches and separations) and contributions (proportional contributions of mother and child to approaches and separations). Secondly, preliminary MIIKA metrics are described for a non-clinical mother-child dyad as an exemplification of the protocol. As interpersonal distance can be affected by contingent situations, we detected mother-infant full skeleton during three interactional contexts characterized by different kinds of dyadic exchanges: a free play session, a task-oriented activity and an emotionally arousing condition. Results highlighted similarities and differences between the three interactional contexts. MIIKA appears to be a promising setup to automatically examine interpersonal distance in early mother-child interactions.

Data from the European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC).

BACKGROUND: The European registry for patients with McArdle disease and other muscle glycogenoses (EUROMAC) was launched to register rare muscle glycogenoses in Europe, to facilitate recruitment for research trials and to learn about the phenotypes and disseminate knowledge about the diseases through workshops and websites. A network of twenty full and collaborating partners from eight European countries and the US contributed data on rare muscle glycogenosis in the EUROMAC registry. After approximately 3 years of data collection, the data in the registry was analysed. RESULTS: Of 282 patients with confirmed diagnoses of muscle glycogenosis, 269 had McArdle disease. New phenotypic features of McArdle disease were suggested, including a higher frequency (51.4%) of fixed weakness than reported before, normal CK values in a minority of patients (6.8%), ptosis in 8 patients, body mass index above background population and number of comorbidities with a higher frequency than in the background population (hypothyroidism, coronary heart disease). CONCLUSIONS: The EUROMAC project and registry have provided insight into new phenotypic features of McArdle disease and the variety of co-comorbidities affecting people with McArdle disease. This should lead to better management of these disorders in the future, including controlling weight, and preventive screening for thyroid and coronary artery diseases, as well as physical examination with attention on occurrence of ptosis and fixed muscle weakness. Normal serum creatine kinase in a minority of patients stresses the need to not discard a diagnosis of McArdle disease even though creatine kinase is normal and episodes of myoglobinuria are absent.

Minimum Clinically Important Difference of Gross Motor Function and Gait Endurance in Children with Motor Impairment: A Comparison of Distribution-Based Approaches.

OBJECTIVE: The minimum clinically important difference (MCID) is a standard way of measuring clinical relevance. The objective of this work was to establish the MCID for the 6-minute walking test (6minWT) and the Gross Motor Function Measure (GMFM-88) in pediatric gait disorders. METHODS: A cohort, pretest-posttest study was conducted in a hospitalized care setting. A total of 182 patients with acquired brain injury (ABI) or cerebral palsy (CP) performed 20 robot-assisted gait training sessions complemented with 20 sessions of physical therapy over 4 weeks. Separate MCIDs were calculated using 5 distribution-based approaches, complemented with an anonymized survey completed by clinical professionals. RESULTS: The MCID range for the 6minWT was 20-38 m in the ABI cohort, with subgroup ranges of 20-36 m for GMFCS I-II, 23-46 m for GMFCS III, and 24-46 m for GMFCS IV. MCIDs for the CP population were 6-23 m, with subgroup ranges of 4-28 m for GMFCS I-II, 9-19 m for GMFCS III, and 10-27 m for GMFCS IV. For GMFM-88 total score, MCID values were 1.1%-5.3% for the ABI cohort and 0.1%-3.0% for the CP population. For dimension "D" of the GMFM, MCID ranges were 2.3%-6.5% and 0.8%-5.2% for ABI and CP populations, respectively. For dimension "E," MCID ranges were 2.8%-6.5% and 0.3%-4.9% for ABI and CP cohorts, respectively. The survey showed a large interquartile range, but the results well mimicked the distribution-based methods. CONCLUSIONS: This study identified for the first time MCID ranges for 6minWT and GMFM-88 in pediatric patients with neurological impairments, offering useful insights for clinicians to evaluate the impact of treatments. Distribution-based methods should be used with caution: methods based on pre-post correlation may underestimate MCID when applied to patients with small improvements over the treatment period. Our results should be complemented with estimates obtained using consensus- and anchor-based approaches.

Wearable Inertial Sensors to Assess Gait during the 6-Minute Walk Test: A Systematic Review.

Wearable sensors are becoming increasingly popular for complementing classical clinical assessments of gait deficits. The aim of this review is to examine the existing knowledge by systematically reviewing a large number of papers focusing on the use of wearable inertial sensors for the assessment of gait during the 6-minute walk test (6MWT), a widely recognized, simple, non-invasive, low-cost and reproducible exercise test. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 28 full-text articles. Then, the available knowledge was summarized regarding study design, subjects enrolled (number of patients and pathological condition, if any, age, male/female ratio), sensor characteristics (type, number, sampling frequency, range) and body placement, 6MWT protocol and extracted parameters. Results were critically discussed to suggest future directions for the use of inertial sensor devices in the clinics.

EEG Effective Source Projections Are More Bilaterally Symmetric in Infants Than in Adults.

Although anatomical brain hemispheric asymmetries have been clearly documented in the infant brain, findings concerning functional hemispheric specialization have been inconsistent. The present report aims to assess whether bilaterally symmetric synchronous activity between the two hemispheres is a characteristic of the infant brain. To asses cortical bilateral synchronicity, we used decomposition by independent component analysis (ICA) of high-density electroencephalographic (EEG) data collected in an auditory passive oddball paradigm. Decompositions of concatenated 64-channel EEG data epochs from each of 34 typically developing 6-month-old infants and from 18 healthy young adults participating in the same passive auditory oddball protocol were compared to characterize differences in functional brain organization between early life and adulthood. Our results show that infant EEG decompositions comprised a larger number of independent component (IC) effective source processes compatible with a cortical origin and having bilaterally near-symmetric scalp projections (13.8% of the infant data ICs presented a bilateral pattern vs. 4.3% of the adult data ICs). These IC projections could be modeled as the sum of potentials volume-conducted to the scalp from synchronous locally coherent field activities in corresponding left and right cortical source areas. To conclude, in this paradigm, source-resolved infant brain EEG exhibited more bilateral synchronicity than EEG produced by the adult brain, supporting the hypothesis that more strongly unilateral and likely more functionally specialized unihemispheric cortical field activities are concomitants of brain maturation.

Virtual Reality Social Prediction Improvement and Rehabilitation Intensive Training (VR-SPIRIT) for paediatric patients with congenital cerebellar diseases: study protocol of a randomised controlled trial.

BACKGROUND: Patients with cerebellar malformations exhibit not only movement problems, but also important deficits in social cognition. Thus, rehabilitation approaches should not only involve the recovery of motor function but also of higher-order abilities such as processing of social stimuli. In keeping with the general role of the cerebellum in anticipating and predicting events, we used a VR-based rehabilitation system to implement a social cognition intensive training specifically tailored to improve predictive abilities in social scenarios (VR-Spirit). METHODS/DESIGN: The study is an interventional randomised controlled trial that aims to recruit 42 children, adolescents and young adults with congenital cerebellar malformations, randomly allocated to the experimental group or the active control group. The experimental group is administered the VR-Spirit, requiring the participants to compete with different avatars in the reaching of recreational equipment and implicitly prompting them to form expectations about their playing preference. The active control group participates in a VR-training with standard games currently adopted for motor rehabilitation. Both trainings are composed by eight 45-min sessions and are administered in the GRAIL VR laboratory (Motekforce Link, Netherlands), an integrated platform that allows patients to move in natural and attractive VR environments. An evaluation session in VR with the same paradigm used in the VR-Spirit but implemented in a different scenario is administered at the beginning (T0) of the two trainings (T1) and at the end (T2). Moreover, a battery of neurocognitive tests spanning different domains is administered to all participants at T0, T2 and in a follow-up session after 2 months from the end of the two trainings (T3). DISCUSSION: This study offers a novel approach for rehabilitation based on specific neural mechanisms of the cerebellum. We aim to investigate the feasibility and efficacy of a new, intensive, social cognition training in a sample of Italian patients aged 7-25 years with congenital cerebellar malformations. We expect that VR-Spirit could enhance social prediction ability and indirectly improve cognitive performance in diverse domains. Moreover, through the comparison with a VR-active control training we aim to verify the specificity of VR-Spirit in improving social perception skills. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN 22332873. Retrospectively registered on 12 March 2018.

Effect of Robot-Assisted Gait Training in a Large Population of Children With Motor Impairment Due to Cerebral Palsy or Acquired Brain Injury.

OBJECTIVE: To evaluate retrospectively the effect of robotic rehabilitation in a large group of children with motor impairment; an additional goal was to identify the effects in children with cerebral palsy (CP) and acquired brain injury (ABI) and with different levels of motor impairment according to the Gross Motor Function Classification System. Finally, we examined the effect of time elapsed from injury on children's functions. DESIGN: A cohort, pretest-posttest retrospective study was conducted. SETTING: Hospitalized care. PARTICIPANTS: A total of 182 children, 110 with ABI and 72 with CP and with Gross Motor Function Classification System (GMFCS) levels I-IV, were evaluated retrospectively. INTERVENTIONS: Patients underwent a combined treatment of robot-assisted gait training and physical therapy. MAIN OUTCOME MEASURES: All the patients were evaluated before and after the training using the 6-minute walk test and the Gross Motor Function Measure. A linear mixed model with 3 fixed factors and 1 random factor was used to evaluate improvements. RESULTS: The 6-minute walk test showed improvement in the whole group and in both ABI and CP. The Gross Motor Function Measure showed improvement in the whole group and in the patients with ABI but not in children with CP. The GMFCS analysis showed that all outcomes improved significantly in all classes within the ABI subgroup, whereas improvements were significant only for GMFCS III in children with CP. CONCLUSIONS: Children with motor impairment can benefit from a combination of robotic rehabilitation and physical therapy. Our data suggest positive results for the whole group and substantial differences between ABI and CP subgroups, with better results for children with ABI, that seem to be consistently related to time elapsed from injury.

Motor Improvement in Adolescents Affected by Ataxia Secondary to Acquired Brain Injury: A Pilot Study.

AIM: To assess changes in locomotion and balance in adolescents affected by ataxia secondary to acquired brain injury after a rehabilitation treatment with physiotherapy and the Gait Real-time Analysis Interactive Lab (GRAIL), an immersive virtual reality platform. METHODS: 11 ataxic adolescents (16(5) years old, 4.7(6.7) years from injury) underwent 20 45-minute sessions with GRAIL plus 20 45-minute sessions of physiotherapy in one month. Patients were assessed before and after rehabilitation with functional scales and three-dimensional multiple-step gait analysis. RESULTS: Results showed significant improvements in ataxia score assessed by the Scale for the Assessment and Rating of Ataxia, in dimension D and E of Gross Motor Function Measure, in walking endurance and in balance abilities. Moreover, the training fostered significant changes at hip, knee, and ankle joints, and the decrease of gait variability, toward healthy references. INTERPRETATION: In spite of the pilot nature of the study, data suggest that training with immersive virtual reality and physiotherapy is a promising approach for ataxic gait rehabilitation, even in chronic conditions.

Exploring the EEG mu rhythm associated with observation and execution of a goal-directed action in 14-month-old preterm infants.

Electroencephalographic mu rhythm desynchronization is thought to reflect Mirror Neuron System (MNS) activity and represents an important neural correlate of the coupling between action execution and perception. It is still unclear if the MNS in human ontogeny is already available at the beginning of postnatal life and how early experience impacts its development. Premature birth provides a "natural condition" for investigating the effects of early, atypical extra-uterine experience on MNS. The main aim of the present study was to investigate whether the MNS activity is associated with prematurity. We compared the mu rhythm activity in preterm (PT) and full-term (FT) 14-month old infants during an action observation/execution (AO/AE) task. Mu rhythm desynchronization was computed over frontal, central, parietal and occipital regions. Both groups showed mu rhythm suppression in all the scalp regions during action execution. Different desynchronization patterns emerged during action observation. Specifically, FT infants showed mu suppression in the right frontal, bilateral parietal and occipital regions; whereas PT infants exhibited mu suppression only in the right parietal region. Overall, these preliminary findings indicate that an atypical extra uterine experience might have an impact on the MNS activity.

Giok the Alien: An AR-Based Integrated System for the Empowerment of Problem-Solving, Pragmatic, and Social Skills in Pre-School Children.

The use of technology for educational purposes is a consolidated reality, and many new tools are constantly being devised and offered for use with both normally developing children and children with special needs. Nonetheless, a detailed analysis of the processes being stimulated and of the goals being pursued is often lacking or absent. In this work we describe the design, development and preliminary testing of an integrated system which combines the use of smart devices, a physical cube, augmented reality (AR) technology, a smart TV, and a software application especially designed to stimulate cognitive and social functions in pre-school children. The system was tested with three groups of children (25 children in total) during kindergarten activities. The results show that the system is easy to understand, elicits high levels of participation and social interaction, favors strategic behaviors, and can be used by the children with limited need of instruction and support by the adult. The implications for empowerment in typically developing children and the possibilities for use with children who have specific impairments in social communication are discussed.