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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.

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.

The present work aims to present the current virtual design process of scoliosis braces and propose an improvement by considering the internal geometry. Starting from the external scanning it is possible to apply only corrections that do not consider the interaction with the human body. For this reason we propose to embed the 3D model reconstruction of the skeleton of the patient from the medical images. This would bring to a better virtual design process that could help avoiding the current need for a physical positive mold. The final goal of such a change is to pass from the current thermoforming production to the use of additive manufacturing. In the paper, we briefly analyze the choice of the most convenient 3D printing technology and the selection of a proper material that can be comparable to the ones used for thermoforming. Finally, a case study is presented to test the assumptions regarding both the design and manufacturing processes.

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.

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.

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.

SummaryBackground: Acquired brain injury (ABI) may result in lifelong impairment of physical, cognitive, and psychosocial functions. Several rehabilitative treatments are often needed to support walking recovery, thus participants’ engagement becomes a crucial aspect, especially when patients are children. In the last few years, traditional physiotherapy (PT) has been flanked by innovative technologies for rehabilitation in the fields of robotics and Virtual Reality (VR). Preliminary results have shown interesting perspectives in the use of a VR system, the GRAIL (Gait Real-time Analysis Interactive Lab), in improving walking abilities in a small group of children with ABI, although further insights are needed about its use as rehabilitative tool in the pediatric population.Objectives: To evaluate the efficacy of a rehabilitation treatment on a GRAIL system for the improvement of walking abilities, in a group of children suffering from ABI.Methods: 12 children with ABI (study group – SG; mean age = 12.1 ± 3.8 years old) underwent a 10-session treatment with the GRAIL, an instrumented multi-sensor platform based on immersive VR for gait training and rehabilitation in engaging VR environments. Before (T0) and at the end of the treatment (T1), the participants were assessed by means of functional scales (Gross Motor Function Measure (GMFM), Functional Assessment Questionnaire (FAQ), 6-Minute Walk Test (6minWT) and the 3D-Gait Analysis, over ground (OGA) and on GRAIL (GGA).Results: All the participants completed the rehabilitative treatment. The functional evaluations showed an improvement in Gross Motor abilities (GMFM-88, p = 0.008), especially in standing (GMFM-D, p = 0.007) and walking (GMFM-E, p = 0.005), an increase of the endurance (6minWT, p = 0.002), and enhanced autonomy in daily life activities (FAQ, p = 0.025). OGA identified a significant decrease of the Gillette Gait Index for the impaired side and a general increase of symmetry. GGA showed improvements in spatiotemporal parameters and joints range of motion that moved towards normality and symmetry recovery.Conclusions: A 10-session treatment with GRAIL on children with ABI led to improvements in their walking abilities and enhanced their engagement during the training. This is desirable when long life impairments are faced and children’s motor functions have to be regained and it supports the leading role that VR might have in the rehabilitation field.

Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging technique, largely used in paediatric research. However, there is not a standardized and widely accepted protocol for fNIRS data processing with potential effects on the reliability and replicability of the obtained results. The present study is within this framework aiming at the identification of an adequate pre-processing pipeline to be used for the analysis of children fNIRS datasets. The performance of five different motion correction techniques, based on the principal component analysis and on the wavelet filtering, was evaluated by analyzing fNIRS data recorded in 22 typically developing children (mean age 11.4 years). The results showed that the wavelet analysis combined with a moving average filter achieved the best performance, suggesting that this technique might become a gold-standard approach for motion artifacts correction in fNIRS children’s datasets.

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.

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 and acquired brain injury 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 182 children, 110 with acquired brain injury (ABI) and 72 with cerebral palsy (CP) and with Gross Motor Function Classification System (GMFCS) levels I-IV were evaluated retrospectively. Interventions Patients underwent a combined treatment of robotic-assisted gait training and physical therapy. Main Outcome Measure(s) 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 three fixed factors and one 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.

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.

The aim of this study is to assess the ability of EEG-based indices in providing relevant information about cognitive engagement level during the execution of a clinical sustained attention (SA) test in healthy volunteers and DAI (diffused axonal injury)-affected patients. We computed three continuous power-based engagement indices (P β /P α , 1/P α , and P β / (P α + P θ )) from EEG recordings in a control group (n = 7) and seven DAI-affected patients executing a 10-min Conners’ “not-X” continuous performance test (CPT). A correlation analysis was performed in order to investigate the existence of relations between the EEG metrics and behavioral parameters in both the populations. P β /P α and 1/P α indices were found to be correlated with reaction times in both groups while P β / (P α + P θ ) and P β /P α also correlated with the errors rate for DAI patients. In line with previous studies, time course fluctuations revealed a first strong decrease of attention after 2 min from the beginning of the test and a final fading at the end. Our results provide evidence that EEG-derived indices extraction and evaluation during SA tasks are helpful in the assessment of attention level in healthy subjects and DAI patients, offering motivations for including EEG monitoring in cognitive rehabilitation practice.

The processing of auditory stimuli is essential for the correct perception of language and deficits in this ability are often related to the presence or development of language disorders. The motor imitation (e.g. tapping or beating) of rhythmic sequences can be a very sensitive correlate of deficits in auditory processing. Thus, the study of the tapping performance, with the investigation of both temporal and intensity information, might be very useful. The present work is aimed at the development and preliminary testing of a tapping device to be used for the imitation and/or the production of rhythmic sequences, allowing the recording of both tapping duration and intensity. The device is essentially made up of a Force Sensing Resistor and an Arduino UNO board. It was validated using different sampling frequencies (f s ) in a group of 10 young healthy adults investigating its efficacy in terms of touch and intensity detection by means of two testing procedures. Results demonstrated a good performance of the device when programmed with fs equal to 50 and 100Hz. Moreover, both temporal and intensity parameters were extracted, thus supporting the potential use of the device for the analysis of the imitation or production of rhythmic sequences. This work represents a first step for the development of a useful, low cost tool to support the diagnosis, training and rehabilitation of language disorders.

Recently, a few software applications (apps) have been developed to enhance vocabulary and conceptual networks to address the needs of children with language impairments (LI), but there is no evidence about their impact and their usability in therapy contexts. Here, we try to fill this gap presenting a system aimed at improving the semantic competence and the structural knowledge of children with LI. The goal of the study is to evaluate learnability, usability, user satisfaction and quality of the interaction between the system and the children. The system consists of a tablet, hosting an app with educational and training purposes, equipped with a Near Field Communication (NFC) reader, used to interact with the user by means of objects. Fourteen preschool children with LI played with the device during one 45-minute speech therapy session. Reactions and feedbacks were recorded and rated. The system proved to be easy to understand and learn, as well as engaging and rewarding. The success of the device probably rests on the integration of smart technology and real, tangible objects. The device can be seen as a valuable aid to support and enhance communication abilities in children with LI as well as typically developing individuals.

The Colibri project is introduced, whose aim is setting up a shared database of Magnetic Resonance images concerning pediatric patients affected by neurological rare disorders. The project involves 19 Italian centers of excellence in pediatric neuro-radiology and is supported by the nationwide coordinating center for the Information and Communication Technology research infrastructure. After the first year devoted to the design and the implementation, in November 2014 the system finally went into service at the centers involved in the project. This paper illustrates the initial assessment of the user perception and provides some preliminary statistics about its use.

Independent component analysis (ICA) decomposition can be used for the identification and localization of brain generators. ICA separates EEG data into a sum of maximally distinct signals (independent components, ICs). Source localization algorithms can be directly applied to the component projections (scalp maps). Usually, brain-generated ICs are well modeled using one equivalent dipole or, in the case of IC scalp maps that appear bilaterally symmetric, with two position-symmetric dipoles. Selection of ICs for bilateral dipole fitting is typically performed by visual inspection, a time-consuming and subjective step. We have developed and tested a routine for automated recommendation of ICs that may be best fit with a position-symmetric dual-dipole model. The algorithm is based on near bilateral symmetry of IC scalp map maxima and minima. Results showed good classification accuracy and specificity. Sensitivity can be optimized by adjusting free parameters as suggested.

The functional recovery of upper limbs is one of the goals of the rehabilitation of children affected by Acquired Brain Injury. Sensorimotor stimulation exercises, particularly the Constraint-Induced Movement Therapy (CIMT) and robot-aided therapy are promising in children. However, exhaustive data about their effectiveness in the clinical practice and differences of these treatments still lack in the literature. Therefore, the aim of this study is to perform a preliminary comparative evaluation among CIMT, robot-aided therapy with Armeo®Spring and conventional physiokinesitherapy about their efficacy in upper limb rehabilitation of children after ABI. A group of 10 children was treated with two of the three abovementioned therapies, randomly chosen in the order. The evaluation included clinical and functional scales as well as 3D kinematics to objectively measure the outcome. Our results showed improvements at the elbow and shoulder after CIMT and ARMEO, whereas physiokinesitherapy frequently showed changes in the opposite direction. Further, many improvements in terms of trunk rotation and joints selectivity were conveyed by the robot-aided therapy. Future studies will be aimed at increasing the sample size and thus generalizing these results.

Identifying movement abnormalities from raw Electromyography (EMG) data requires three steps that are the data pre-processing, the feature extraction and training a classifier. As EMG data shows large variation (even for consecutive trials in a single subject) probabilistic classifiers like naive Bayes or probabilistic support vector machines have been proposed. The used feature representations (e.g., principal components analysis, non negative matrix factorization, wavelet transformation) however, can not capture the variation. Here, we propose a fully Bayesian approach where both, the features and the classifier, are probabilistic models. The generative model reproduces the observed variance in the EMG data, provides an estimate of the reliability of the predictions and can be applied in combination with dimensionality reduction techniques such as PCA and NMF. In first tests, we found that these probabilistic extensions outperforms classical approaches in terms of the prediction of knee abnormalities from few samples with a performance of 86 percent of correctly classified abnormalities.

SummaryIntroduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objectives: The great potential of robots in extracting quantitative and meaningful data is not always exploited in clinical practice. The aim of the present work is to describe a simple parameter to assess the performance of subjects during upper limb robotic training exploiting data automatically recorded by the robot, with no additional effort for patients and clinicians. Methods: Fourteen children affected by cerebral palsy (CP) performed a training with Armeo®Spring. Each session was evaluated with P, a simple parameter that depends on the overall performance recorded, and median and interquartile values were computed to perform a group analysis. Results: Median (interquartile) values of P significantly increased from 0.27 (0.21) at T0 to 0.55 (0.27) at T1 . This improvement was functionally validated by a significant increase of the Melbourne Assessment of Unilateral Upper Limb Function. Conclusions: The parameter described here was able to show variations in performance over time and enabled a quantitative evaluation of motion abilities in a way that is reliable with respect to a well-known clinical scale.

Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disease, which affects the autonomic nervous system and in particular the breathing control. Patients show abnormal ventilatory response to both hypoxia and hypercapnia. Thus, mild or severe apnea crisis can occur, especially during sleep, and ventilatory assistance is required all the night long. Oxy-hemoglobin blood concentration (SpO2) is monitored by means of a pulse-oximeters and used to detect risk situations. These are signaled by the only commercial alarm systems available, that are the ones integrated in the ventilators and pulse-oximeters, which do not provide an adequate domiciliary assistance for CCHS patients. Therefore, we developed an assistive device which performs different multisensory stimulation strategies based on patient SpO2 level. The device efficacy, previously validated on healthy subjects, is under investigation in a population of patients affected by CCHS.

The Gait Real-time Analysis Interactive Lab (GRAIL) is an instrumented multi-sensor platform based on immersive virtual reality for gait training and rehabilitation. Few studies have been included GRAIL to evaluate gait patterns in normal and disabled people and to improve gait in adults, while at our knowledge no evidence on its use for the rehabilitation of children is available. In this study, 4 children suffering from acquired brain injury (ABI) underwent a 5 session treatment with GRAIL, to improve walking and balance ability in engaging VR environments. The first and the last sessions were partially dedicated to gait evaluation. Results are promising: improvements were recorded at the ankle level, selectively at the affected side, and at the pelvic level, while small changes were measured at the hip and knee joints, which were already comparable to healthy subjects. All these changes also conveyed advances in the symmetry of the walking pattern. In the next future, a longer intervention will be proposed and more children will be enrolled to strongly prove the effectiveness of GRAIL in the rehabilitation of children with ABI.

Cerebral palsy (CP), one of the most common neurological disorders in childhood, features affected individual's motor skills and muscle actions. This results in elevated heart rate and rate of oxygen uptake during sub-maximal exercise, thus indicating a mean energy expenditure higher than healthy subjects. Rehabilitation, currently involving also robot-based devices, may have an impact also on these aspects. In this study, an ecological setting has been proposed to evaluate the energy expenditure of 4 children with CP before and after a robot-assisted gait training. Even if the small sample size makes it difficult to give general indications, results presented here are promising. Indeed, children showed an increasing trend of the energy expenditure per minute and a decreasing trend of the energy expenditure per step, in accordance to the control group. These data suggest a metabolic benefit of the treatment that may increase the locomotion efficiency of disabled children.

The great potential of robots in extracting quantitative and meaningful data is not always exploited. The aim of the present work is to propose a simple parameter that allows to follow the performance of subjects during upper limb robotic training with no additional effort for patients or clinicians.

In the past few years, new devices for children and disabilities has proliferated thanks to the development of more and more inexpensive mobile technology and to the availability of free-downloadable software applications. In this work we describe the design, development and testing of an integrated system which combines the use of a tablet, a group of toys (e.g. small plastic animals), Near Field Communication (NFC) technology and a software application with educational purposes. The goals of the device are to improve the structural knowledge and the semantic competences of typically developing and disabled children while offering an entertaining environment.

Improving walking ability is one of the main goals of a rehabilitation procedure. New technologies based on Virtual Reality (VR) has been recently flanked standard therapies. In this study, 4 children suffering from acquired brain injury (ABI) underwent a 5 session treatment with the Gait Real-time Analysis Interactive Lab (GRAIL), to improve walking and balance ability. The GRAIL is an instrumented multi-sensor platform based on immersive virtual reality for gait training and rehabilitation in engaging VR environments, which has been included in few studies to evaluate gait patterns in normal and disabled people and to improve gait in adults. Results are promising: improvements were recorded at the ankle level, selectively at the affected side, and at the pelvic level, thus improving the walking pattern symmetry. Small changes were measured at the hip and knee joints, which were already comparable to healthy subjects. These results suggest that a longer intervention may be even more effective. In the next future more children will be enrolled to strongly prove the effectiveness of GRAIL in the rehabilitation of children with ABI.

Rare diseases occur infrequently or rarely in a population and among them, nearly 75% affect children. To date, their low prevalence and heterogeneity resulted in a lack of scientific knowledge and prevented an access to a quick and correct diagnosis. The sharing of multiple sources of information from different centers and actors may have a key role in this field. In order to address this issue, a network of Italian centers of excellence in pediatric neuroradiology launched the Colibri project with the aim to collect, share and process data about rare disease patients. The goal is to constitute a large dataset including Magnetic Resonance images and other clinical data of pediatric subjects in order to provide a service for the research and the consultation. The dataset will be made available through an architecture whose components are compliant with the DICOM Standard and will encompass a security mechanism to ensure subject privacy.

In the past few years, technology for children and disabilities has proliferated thanks to the development of more and more inexpensive mobile technology and to the availability of free-downloadable software applications. However, at our knowledge a multisensory teaching application for both normal and disabled children still lacks in this landscape. In this work we describe the design and development of an integrated system which combines the use of a tablet, a group of toys (e.g. small plastic animals), Near Field Communication (NFC) technology and a software application with educational purposes to improve the speed of learning and entertainment value for users.

Congenital Central Hypoventilation Syndrome is a genetic disease characterized by alveolar hypoventilation and autonomic dysregulation. Patients have hypoventilations, especially during sleep, conditioning hypercapnia which can lead to neurological damage and death. They therefore need mechanical ventilators, that provide sufficient gas exchange, and pulse-oximeters that monitor oxy-hemoglobin blood concentration. Due to the restrictions regarding domiciliary assistive devices, the presence of a caregiver is required all night long. Currently, the only alarm systems available are the ones integrated in the ventilators and monitoring systems. During the night, multiple false alarms may occur, interrupting the sleep and causing anxiety. In this work we describe an assistive device that acquires real-time data from a pulse-oximeter, provides a multisensory stimulation if oxygen saturation falls under a certain threshold, and wakes up the patient if the hypoxia is severe. Tests on healthy subjects have shown that the device guarantees rapid awakenings, with a stimulator-dependent efficacy, and that it does not affect sleep efficiency. The purpose of the device is to determine a gentle awakening if mild hypoxia conditions persist, and to assure rapid awakening when a severe hypoxia occurs, reducing false alarms, improving the quality of sleep and increasing the self-sufficiency of the patients.

In clinical practice, the great potential of robots in extracting quantitative and meaningful data is not always exploited. The aim of the present paper is to propose a simple parameter that allows to follow the performance of subjects during upper limb robotic training with no additional effort for patients or clinicians. Armeo®Spring has been used to perform a training on 14 children affected by cerebral palsy (CP). Each session was evaluated with the new parameter allowing us to observe variations in subjects' performance over time. A preliminary validation of the parameter was performed by means of Melbourne clinical scale. Further studies are required to compare the results with kinematics data and other clinical scales.

Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disease that causes an autonomous nervous system dysregulation. Patients are unable to have a correct ventilation, especially during sleep, facing risk of death. Therefore, most of them are mechanically ventilated during night and their blood oxygenation is monitored, while a supervisor keeps watch over them. If low oxygen levels are detected by the pulse-oximeter, an alarm fires; the supervisor deals with the situation and, if there is neither a technical problem nor a false alarm, wakes the subject, as CCHS patients usually recover from hypoxia when roused from sleep. During a single night multiple alarms may occur, causing fractioned sleep for the subject and a lasting state of anxiety for supervisors. In this work we introduce a novel device that can: acquire realtime data from a pulse-oximeter; provide a multisensory stimulation (e.g. by means of an air fan, a vibrating pillow, and a buzzer), if saturation falls under a threshold; stop the stimulation if oxygenation recovers; wake up the patient or the supervisor if the suffering state lasts beyond a safe interval. The main aim of this work is to lessen the number of awakenings, improving the quality of sleep and life for patients and their supervisors, and to increase young and adult CCHS patients autonomy. Initial testing of the device on a CCHS patient and his supervisor has provided encouraging preliminary results.

Objective and quantitative measurement is crucial in the definition of functional impairment and in the tracking of disease progress over time of patients affected by progressive pathologies, such as ataxia. A new experimental procedure for the quantitative description of upper limb movement and coordination analysis was developed by the integration of an optoelectronic system and dedicated electronic board with four visual and pressure stimuli. 20 passive retroreflective markers were placed on the subject's body and two types pointing tests were defined: in the first one, the subjects were asked to reach with the index finger five consecutive times each of the three targets ("repetitive test"), and in the second one, the subjects were asked to randomly reach the targets with the index finger ("random test"). The preliminary results showed that patients affected by ataxia took more time with a less smooth finger tip movement to perform the reaching tests when compared to healthy subjects. The velocity was lower and its profile was more irregular in ataxic subjects. The new developed experimental procedure seems to be very promising in the quantitative description of upper limb movements of pathological and healthy subjects and it seems to be able to distinguish the impairments due to different levels of ataxia.

Movement disturbances play an intrinsic part in autism. Upper limb movements like reach-and-throw seem to be helpful in early identification of children affected by autism. Nevertheless few works investigate the application of classifying methods to upper limb movements. In this study we used a machine learning approach Support Vector Machine (SVM) for identifying peculiar features in reach-and-throw movements. 10 pre-scholar age children with autism and 10 control subjects performing the same exercises were analyzed. The SVM algorithm proved to be able to separate the two groups: accuracy of 100% was achieved with a soft margin algorithm, and accuracy of 92.5% with a more conservative one. These results were obtained with a radial basis function kernel, suggesting that a non-linear analysis is possibly required. ©2009 IEEE.

Post surgical patients need to resume a correct load distribution over both legs in order to facilitate bone osteogenesis. We propose a device for continuously monitoring lower limbs loads. It can be used by the patient to be aware of his loading conditions, by the physician or physical therapist to perform a quantitative analysis of applied loads. We tested the device on two subjects and verified its capability to detect reduced loads on the affected limb and its usefulness in helping to recognize in which walking phases.

The aim of this work is to describe, using functional imaging techniques, the spatial and temporal distribution of neural activations ensuing from execution of cognitive functions and to find correlation in data coming from analysis modalities related to different physical properties. A 10-mm continuous performance test (CPT) was administered to a group of healthy subjects as measure of sustained attention. Images of electroencephalography (EEG) and of near infrared spectroscopy (NIRS) were recorded during the task. cerebral activation's measure is obtained from the recording of quantities linked with electrical neural activity for the EEG and with change in blood oxygenation for the NIRS system. Good agreement was found between the two modalities, both showing higher activation in the middle upper frontal region and similar temporal trend. A further understanding of the superior central nervous system behavior can be achieved from combined use of both imaging modalities.

Current health scenarios have witnessed increased attention for home care as a way to enhance the quality of service provision and reduce costs. In recent times, clinical information systems (CISs) have undergone significant development and they now include useful applications for doctors, nurses and other health professionals. The present work investigates the possible integration of a home-based telemonitoring system within a CIS to enhance its potentials. Test results showed a smooth integration and highlighted multiple advantages such as use of a single interface for the management of several data types, inclusion of health-related data about in-hospital and home periods, workflow creation and check points during home care provision, use of consistent criteria for data security and privacy protection.

In the health care context, devices for automated staff / patient identification provide multiple benefits, including error reduction in drug administration, an easier and faster use of the Electronic Health Record, enhanced security and control features when accessing confidential data, etc. Current identification systems (e.g. smartcards, bar codes) are not completely seamless to users and require mechanical operations that sometimes are difficult to perform for impaired subjects. Emerging wireless RFID technologies are encouraging, but cannot still be introduced in health care environments due to their electromagnetic emissions and the need for large size antenna to operate at reasonable distances. The present work describes a prototype of wearable device for automated staff and patient identification which is small in size and complies with the in-hospital electromagnetic requirements. This prototype also implements an anti-counterfeit option. Its experimental application allowed the introduction of some security functions for confidential data management.

� Abstract—In otoneurology the analisys of Subjective Vertical perception is a useful tool to investigate macular function and central otolithic pathways. The Subjective Vertical is perceived using visual, vestibular and proprioceptive subsystems. In this work we propose a new device that can assess just the tactile / somatosensory subsystem contribution compared to other commercial devices that investigate the other subsystems. The developed instrumentation is made by a bar equipped with two orthogonally oriented Micro Electro Mechanical System accelerometers that transmit data to a remote visualization apparatus. During the examination, the patient handles the bar and must align it along the direction perceived as "vertical". I. INTRODUCTION The equilibrium system is based upon complex interactions among different areas of the nervous system, that work together with other sensory subsystems (visual, vestibular, somatosensory) to let the brain know the body position in tri-dimensional space, to assume the standing position and to orient the body with respect to the gravitational field. In otoneurology the analisys of Subjective Vertical (SV) perception raised some interest, since it is a useful tool (1)(2) to investigate the correct function of vestibular maculae and central otolithic pathways. This tool is meaningful in patients complaining about vertigo and dizziness. Inputs from visual, vestibular and somatosensory systems contribute to verticality perception. Changes in these inputs (peripheral pathology) or deterioration of input elaboration abilities (central pathology) may affect the SV. We can measure subjective vertical perception according to three different sensory conditions: visual, haptic and postural. (2)(3) Some devices are available to assess the equilibrium system. For instance, the device named "EquiTest" by NeuroCom (4) can assess the equilibrium performing a stabilometric examination to a patient standing on a platform.

Informatic technologies can be the right answer to deal with some neuropsychological troubles of children. The goal of this study is the application of computer programs as a possible strategy in rehabilitation of children with cognitive problems. Four programs were designed to stimulate various basic brain functions: problem solving, categorization, logical sequence and spatial thought. The programs were tested on a group of 20 mentally retarded young subjects matched with a comparison group of 20 like subjects trained with ordinary techniques. The computer trained group showed a significant improvement in tests involving attention, motivation for learning and problem solving abilities. These results, in our opinion, would confirm the usefulness of specific software as a rehabilitative method in dealing with cognitive problems of children.

In a multi-speciality rehabilitation centre, where child neuropsychiatrists, neurologists, physical rehabilitators, psychologists, nurses, therapists and other health care professionals actively care for patients, the moment will arrive when information security takes high priority on the chief medical officer (CMO) agenda. This has happened at the La Nostra Famiglia Institution. Local push to high priority arose from several concurrent forces, like privacy both on the patient and on the doctor side, legal and ethical aspects. Recommendations on the protection of medical data require appropriate technical and organisational measures to be taken to protect personal data against unauthorised access, alterations or any other form of inappropriate processing. In the same time quick and easy access to patient information should be granted to authorised personnel to ensure proper and in time treatment of patients. A long lasting sequence of co-operative negotiation meetings between the CMO and the chief information officer (CIO) led to appropriate outline of policies. We developed a suitable and modular architecture for designing systems that can simultaneously manage an increasing number of healthcare actors, objects and related access levels taking into account temporal conditions. Actions for keeping the prototype in use on an everyday basis are directly taken by the CMO.

Minimal brain dysfunction is considered one of the possible causes of learning problems in childhood. It can be identified only by the use of complex clinical tests, such as Touwen's (1970) neurological protocol. In this work the authors used classification trees to analyze Touwen's protocol, in order to obtain a clinical procedure simple enough to be performed during the daily routine. 415 children underwent the protocol when they were 5 years old; they were then checked at the age of 7 to evaluate their learning levels. Collected data were analyzed using a variant of the ID3 algorithm. The best identified decision tree correctly classified 95% of total population using only 40 different items out of all the 316 items of the Touwen's protocol. This result could allow one to define a sort of "typical" subject profile differentiating between normal and pathological subjects.

Subjective Visual Vertical (SVV) tests are used by orthoneurologists to assess the visual vertical perception of the subject and/or its eventually impaired performances and functional dysfunctions. In the study of the equilibrium system, especially in vertigo or dizziness affected patients, SW assessment is the only available tool to evaluate interactions between oculomotor subsystems and maculae. In spite of the importance of the test, devices currently used to perform it are quite obsolete; even worse measures can be obtained only looking at the bar and are affected by reading errors. The authors developed a new device that allow to perform the test in a simpler way and which is able to give the examiner a more precise measurement of the angle under which the subject perceives the vertical. Measures are then sent to a display far away from the patient in order to avoid giving him possible visual references.

Described is a case of bilateral homonymous hemianopsia with macular sparing, resulting from head trauma. The case presented lesions of the occipital visual areas which involved entirely the left hemisphere and only partially the right hemisphere. VEP were obtainable only from electrodes placed on the right hemisphere with both right eye and left eye stimulation. VEP mapping showed that each eye projects macular fibres towards functional areas of the right occipital hemisphere. Electrophysiological examination confirmed objectively and for the first time in man the theory of “double cortical macular representation”. Clinical implications of this finding are discussed.

Single-sweep visual evoked potential analysis would be useful in clinical electro-physiology practice because it would make possible the evaluation of transient phenomena, but recording single-sweep visual evoked potentials is difficult because of the low signal-noise ratio. To increase this ratio we used a filter based on an autoregressive with exogenous input model. We studied a group of 12 diabetic patients matched with a control group of 14 normal subjects. The model, in most cases, allowed us to extrapolate the P100 component from each single sweep of visual evoked potential. The visual evoked potential values obtained by means of averaging were not significantly different in the groups studied, but single-sweep analysis showed different distribution of the P100 component amplitude. The preliminary results of our study evidenced differences in the amplitude and latency distribution of normal and diabetic subjects, thus confirming the power of this new technique and its ability to obtain some information that is masked by the averaging method.

The detection of body movements during MR examination could help in reducing motion artifacts or to get patient responses during functional magnetic resonance. It can be supported by a slit scanner, that combines a camera with a light stripe projector to obtain 3D coordinates of points forming the external surface of the body. In this work we propose a slit scanner prototype based on a miniaturized projector without moving parts. Just small sized hardware is required to analyze the video signal, operating in time domain instead of spatial domain. To accomplish this, the camera is placed with its pixel columns as more parallel as possible to the projected light stripes and the camera video signal is analyzed by a resistor transistor logic after analog processing.