Proximal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-operative Rehabilitation Protocol.

Background: Reconstructions of the proximal femur after massive resections represent one of the main challenges in orthopedic oncology. Among the possible treatments, megaprostheses represent one of the most used and reliable reconstructive approaches. Although literature about their outcomes has flourished through the last decades, a consensus rehabilitative treatment is still far from being established. Materials and methods: We evaluated the functional results of all our oncologic cases treated between 2016 and 2022 that could follow our standardized post-operative rehabilitative approach, consisting in progressive hip mobilization and early weight-bearing. Results: Twenty-two cases were included in our study. On average, their hospitalization lasted 15.1 days. The seated position was achieved on average within 3.7 days after surgery, the standing position reached 5.4 after surgery, while assisted deambulation was started 6.4 days after surgery. After a mean post-operative follow-up of 44.0 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggested a statistically significant inverse linear correlation between post-operative functionality and patients' age, resection length, and the start of deambulation. Conclusions: A correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximize patients' post-operative functional outcomes.

Distal Femur Megaprostheses in Orthopedic Oncology: Evaluation of a Standardized Post-Operative Rehabilitation Protocol.

BACKGROUND AND OBJECTIVES: Megaprostheses are the most used reconstructive approach for patients who have undergone massive resection of their distal femurs due to bone tumors. Although the literature about their outcomes has flourished in recent decades, to date, a consensus on rehabilitative treatment is yet to be established. In this study, we report on our experience with our latest standardized rehabilitation program, evaluating our results in a mid-to-long-term scenario. MATERIALS AND METHODS: We evaluated the functional results of all our oncologic patients treated between 2016 and 2022 who could follow our standardized post-operative rehabilitative approach, consisting of progressive knee mobilization and early weight-bearing. RESULTS: Sixteen cases were included in our study. The average duration of the patients' hospitalization was 12.2 days. A standing position was reached on average 4.1 days after surgery, while assisted walking was started 4.5 days after surgery. After a mean post-operative follow-up of 46.7 months, our patients' mean MSTS score was 23.2 (10-30). Our data suggest that the sooner patients could achieve a standing position (R = -0.609; p = 0.012) and start walking (R = -0.623; p = 0.010), the better their final functional outcomes regarding their MSTS scores. CONCLUSIONS: Rehabilitation should be considered a pivotal factor in decreeing the success of distal femur megaprosthetic implants in long-surviving oncologic patients. Correct rehabilitation, focused on early mobilization and progressive weight-bearing, is crucial to maximizing the post-operative functional outcomes of these patients.

Cerebellar adaptive mechanisms explain the optimal control of saccadic eye movements.

Cerebellar synaptic plasticity is vital for adaptability and fine tuning of goal-directed movements. The perceived sensory errors between desired and actual movement outcomes are commonly considered to induce plasticity in the cerebellar synapses, with an objective to improve desirability of the executed movements. In rapid goal-directed eye movements called saccades, the only available sensory feedback is the direction of reaching error information received only at end of the movement. Moreover, this sensory error dependent plasticity can only improve the accuracy of the movements, while ignoring other essential characteristics such as reaching in minimum-time. In this work we propose a rate based, cerebellum inspired adaptive filter model to address refinement of both accuracy and movement-time of saccades. We use optimal control approach in conjunction with information constraints posed by the cerebellum to derive bio-plausible supervised plasticity rules. We implement and validate this bio-inspired scheme on a humanoid robot. We found out that, separate plasticity mechanisms in the model cerebellum separately control accuracy and movement-time. These plasticity mechanisms ensure that optimal saccades are produced by just receiving the direction of end reaching error as an evaluative signal. Furthermore, the model emulates encoding in the cerebellum of movement kinematics as observed in biological experiments.

Experimental and Computational Study on Motor Control and Recovery After Stroke: Toward a Constructive Loop Between Experimental and Virtual Embodied Neuroscience.

Being able to replicate real experiments with computational simulations is a unique opportunity to refine and validate models with experimental data and redesign the experiments based on simulations. However, since it is technically demanding to model all components of an experiment, traditional approaches to modeling reduce the experimental setups as much as possible. In this study, our goal is to replicate all the relevant features of an experiment on motor control and motor rehabilitation after stroke. To this aim, we propose an approach that allows continuous integration of new experimental data into a computational modeling framework. First, results show that we could reproduce experimental object displacement with high accuracy via the simulated embodiment in the virtual world by feeding a spinal cord model with experimental registration of the cortical activity. Second, by using computational models of multiple granularities, our preliminary results show the possibility of simulating several features of the brain after stroke, from the local alteration in neuronal activity to long-range connectivity remodeling. Finally, strategies are proposed to merge the two pipelines. We further suggest that additional models could be integrated into the framework thanks to the versatility of the proposed approach, thus allowing many researchers to achieve continuously improved experimental design.

A Cerebellum-Inspired Learning Approach for Adaptive and Anticipatory Control.

The cerebellum, which is responsible for motor control and learning, has been suggested to act as a Smith predictor for compensation of time-delays by means of internal forward models. However, insights about how forward model predictions are integrated in the Smith predictor have not yet been unveiled. To fill this gap, a novel bio-inspired modular control architecture that merges a recurrent cerebellar-like loop for adaptive control and a Smith predictor controller is proposed. The goal is to provide accurate anticipatory corrections to the generation of the motor commands in spite of sensory delays and to validate the robustness of the proposed control method to input and physical dynamic changes. The outcome of the proposed architecture with other two control schemes that do not include the Smith control strategy or the cerebellar-like corrections are compared. The results obtained on four sets of experiments confirm that the cerebellum-like circuit provides more effective corrections when only the Smith strategy is adopted and that minor tuning in the parameters, fast adaptation and reproducible configuration are enabled.

Combining Evolutionary and Adaptive Control Strategies for Quadruped Robotic Locomotion.

In traditional robotics, model-based controllers are usually needed in order to bring a robotic plant to the next desired state, but they present critical issues when the dimensionality of the control problem increases and disturbances from the external environment affect the system behavior, in particular during locomotion tasks. It is generally accepted that the motion control of quadruped animals is performed by neural circuits located in the spinal cord that act as a Central Pattern Generator and can generate appropriate locomotion patterns. This is thought to be the result of evolutionary processes that have optimized this network. On top of this, fine motor control is learned during the lifetime of the animal thanks to the plastic connections of the cerebellum that provide descending corrective inputs. This research aims at understanding and identifying the possible advantages of using learning during an evolution-inspired optimization for finding the best locomotion patterns in a robotic locomotion task. Accordingly, we propose a comparative study between two bio-inspired control architectures for quadruped legged robots where learning takes place either during the evolutionary search or only after that. The evolutionary process is carried out in a simulated environment, on a quadruped legged robot. To verify the possibility of overcoming the reality gap, the performance of both systems has been analyzed by changing the robot dynamics and its interaction with the external environment. Results show better performance metrics for the robotic agent whose locomotion method has been discovered by applying the adaptive module during the evolutionary exploration for the locomotion trajectories. Even when the motion dynamics and the interaction with the environment is altered, the locomotion patterns found on the learning robotic system are more stable, both in the joint and in the task space.

A comprehensive gaze stabilization controller based on cerebellar internal models.

Gaze stabilization is essential for clear vision; it is the combined effect of two reflexes relying on vestibular inputs: the vestibulocollic reflex (VCR), which stabilizes the head in space and the vestibulo-ocular reflex (VOR), which stabilizes the visual axis to minimize retinal image motion. The VOR works in conjunction with the opto-kinetic reflex (OKR), which is a visual feedback mechanism that allows the eye to move at the same speed as the observed scene. Together they keep the image stationary on the retina. In this work, we implement on a humanoid robot a model of gaze stabilization based on the coordination of VCR, VOR and OKR. The model, inspired by neuroscientific cerebellar theories, is provided with learning and adaptation capabilities based on internal models. We present the results for the gaze stabilization model on three sets of experiments conducted on the SABIAN robot and on the iCub simulator, validating the robustness of the proposed control method. The first set of experiments focused on the controller response to a set of disturbance frequencies along the vertical plane. The second shows the performances of the system under three-dimensional disturbances. The last set of experiments was carried out to test the capability of the proposed model to stabilize the gaze in locomotion tasks. The results confirm that the proposed model is beneficial in all cases reducing the retinal slip (velocity of the image on the retina) and keeping the orientation of the head stable.

Proprioceptive Feedback through a Neuromorphic Muscle Spindle Model.

Connecting biologically inspired neural simulations to physical or simulated embodiments can be useful both in robotics, for the development of a new kind of bio-inspired controllers, and in neuroscience, to test detailed brain models in complete action-perception loops. The aim of this work is to develop a fully spike-based, biologically inspired mechanism for the translation of proprioceptive feedback. The translation is achieved by implementing a computational model of neural activity of type Ia and type II afferent fibers of muscle spindles, the primary source of proprioceptive information, which, in mammals is regulated through fusimotor activation and provides necessary adjustments during voluntary muscle contractions. As such, both static and dynamic γ-motoneurons activities are taken into account in the proposed model. Information from the actual proprioceptive sensors (i.e., motor encoders) is then used to simulate the spindle contraction and relaxation, and therefore drive the neural activity. To assess the feasibility of this approach, the model is implemented on the NEST spiking neural network simulator and on the SpiNNaker neuromorphic hardware platform and tested on simulated and physical robotic platforms. The results demonstrate that the model can be used in both simulated and real-time robotic applications to translate encoder values into a biologically plausible neural activity. Thus, this model provides a completely spike-based building block, suitable for neuromorphic platforms, that will enable the development of sensory-motor closed loops which could include neural simulations of areas of the central nervous system or of low-level reflexes.

Connecting Artificial Brains to Robots in a Comprehensive Simulation Framework: The Neurorobotics Platform.

Combined efforts in the fields of neuroscience, computer science, and biology allowed to design biologically realistic models of the brain based on spiking neural networks. For a proper validation of these models, an embodiment in a dynamic and rich sensory environment, where the model is exposed to a realistic sensory-motor task, is needed. Due to the complexity of these brain models that, at the current stage, cannot deal with real-time constraints, it is not possible to embed them into a real-world task. Rather, the embodiment has to be simulated as well. While adequate tools exist to simulate either complex neural networks or robots and their environments, there is so far no tool that allows to easily establish a communication between brain and body models. The Neurorobotics Platform is a new web-based environment that aims to fill this gap by offering scientists and technology developers a software infrastructure allowing them to connect brain models to detailed simulations of robot bodies and environments and to use the resulting neurorobotic systems for in silico experimentation. In order to simplify the workflow and reduce the level of the required programming skills, the platform provides editors for the specification of experimental sequences and conditions, environments, robots, and brain-body connectors. In addition to that, a variety of existing robots and environments are provided. This work presents the architecture of the first release of the Neurorobotics Platform developed in subproject 10 "Neurorobotics" of the Human Brain Project (HBP). At the current state, the Neurorobotics Platform allows researchers to design and run basic experiments in neurorobotics using simulated robots and simulated environments linked to simplified versions of brain models. We illustrate the capabilities of the platform with three example experiments: a Braitenberg task implemented on a mobile robot, a sensory-motor learning task based on a robotic controller, and a visual tracking embedding a retina model on the iCub humanoid robot. These use-cases allow to assess the applicability of the Neurorobotics Platform for robotic tasks as well as in neuroscientific experiments.