Efficacy of wrist robot-aided orthopedic rehabilitation: a randomized controlled trial.

BACKGROUND: In recent years, many studies focused on the use of robotic devices for both the assessment and the neuro-motor reeducation of upper limb in subjects after stroke, spinal cord injuries or affected by neurological disorders. Contrarily, it is still hard to find examples of robot-aided assessment and rehabilitation after traumatic injuries in the orthopedic field. However, those benefits related to the use of robotic devices are expected also in orthopedic functional reeducation. METHODS: After a wrist injury occurred at their workplace, wrist functionality of twenty-three subjects was evaluated through a robot-based assessment and clinical measures (Patient Rated Wrist Evaluation, Jebsen-Taylor and Jamar Test), before and after a 3-week long rehabilitative treatment. Subjects were randomized in two groups: while the control group (n = 13) underwent a traditional rehabilitative protocol, the experimental group (n = 10) was treated replacing traditional exercises with robot-aided ones. RESULTS: Functionality, assessed through the function subscale of PRWE scale, improved in both groups (experimental p = 0.016; control p < 0.001) and was comparable between groups, both pre (U = 45.5, p = 0.355) and post (U = 47, p = 0.597) treatment. Additionally, even though groups' performance during the robotic assessment was comparable before the treatment (U = 36, p = 0.077), after rehabilitation the experimental group presented better results than the control one (U = 26, p = 0.015). CONCLUSIONS: This work can be considered a starting point for introducing the use of robotic devices in the orthopedic field. The robot-aided rehabilitative treatment was effective and comparable to the traditional one. Preserving efficacy and safety conditions, a systematic use of these devices could lead to decrease human therapists' effort, increase repeatability and accuracy of assessments, and promote subject's engagement and voluntary participation. Trial Registration ClinicalTrial.gov ID: NCT04739644. Registered on February 4, 2021-Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/study/NCT04739644 .

Neuroprem: the Neuro-developmental outcome of very low birth weight infants in an Italian region.

INTRODUCTION: The survival of preterm babies has increased worldwide, but the risk of neuro-developmental disabilities remains high, which is of concern to both the public and professionals. The early identification of children at risk of neuro-developmental disabilities may increase access to intervention, potentially influencing the outcome. AIMS: Neuroprem is an area-based prospective cohort study on the neuro-developmental outcome of very low birth weight (VLBW) infants that aims to define severe functional disability at 2 years of age. METHODS: Surviving VLBW infants from an Italian network of 7 neonatal intensive care units (NICUs) were assessed for 24 months through the Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and neuro-functional evaluation according to the International Classification of Disability and Health (ICF-CY). The primary outcome measure was severe functional disability at 2 years of age, defined as cerebral palsy, a BSDI III cognitive composite score < 2 standard deviation (SD) or a GMDS-R global quotients score < 2 SD, bilateral blindness or deafness. RESULTS: Among 211 surviving VLBW infants, 153 completed follow-up at 24 months (72.5%). Thirteen patients (8.5%) developed a severe functional disability, of whom 7 presented with cerebral palsy (overall rate of 4.5%). Patients with cerebral palsy were all classified with ICF-CY scores of 3 or 4. BSDI III composite scores and GMDS-R subscales were significantly correlated with ICF-CY scores (p < 0.01). CONCLUSION: Neuroprem represents an Italian network of NICUs aiming to work together to ensure preterm neuro-developmental assessment. This study updates information on VLBW outcomes in an Italian region, showing a rate of cerebral palsy and major developmental disabilities in line with or even lower than those of similar international studies. Therefore, Neuroprem provides encouraging data on VLBW neurological outcomes and supports the implementation of a preterm follow-up programme from a national network perspective.

Assessment of human wrist rigidity and pain in post-traumatic patients.

The aim of this work is to present a novel robot-based method to assess the sources of a lack of functionality in patients with recent traumatic wrist injuries. Post-traumatic patients experience limited range of motion as well as strength and proprioceptive deficits. These dysfunctions are related to different complications that usually follow the injuries: pain, increased rigidity, lack of movement fluency and loss of stability could arise differently, according to the severity, site and kind of lesion. Their quantitative evaluation could be essential to target rehabilitation treatments to the specific problem and to optimize and speed up the functional recovery. The use of robotic devices for assessment not only ensures objectivity and repeatability, but could also help to estimate the goodness of the evaluation itself, in terms of reliability and patient's engagement. Ten subjects with different types of wrist injuries were enrolled in this study and required to perform passive robot-guided reaching movements. Forces and angular positions were used to evaluate subject's range of motion, rigidity and pain that, considered together, allowed a comprehensive characterization of the level of healing and functionality achieved by each subject.

Vitamin A Deficiency Due to Selective Eating as a Cause of Blindness in a High-Income Setting.

Vitamin A is a fat-soluble micronutrient involved in the regulation of several physiologic functions, such as visual acuity, epithelial tissue integrity, immune response, and gene expression, thus playing a crucial role in childhood growth and development. Although vitamin A deficiency (VAD) in resource-limited settings is still an actual issue and represents the leading cause of preventable childhood blindness, its occurrence in high-income countries is rare, although possibly underdiagnosed because of its nonspecific early manifestations. A good awareness of VAD symptoms and risk factors could aid its early diagnosis, which is fundamental to undertake a prompt treatment and to prevent ocular complications. Nevertheless, the role of restrictive dietary habits, increasingly common in developed countries, is often overlooked in infants and children. We present a case of VAD with permanent ocular sequelae in a 5-year-old girl from a high-income country. In the case described, VAD ensued from a highly restricted diet, mainly limited to oat milk, which had been followed for more than 2 years. This child presented with ocular symptoms, opportunistic infection, anemia, poor growth, and a diffuse squamous metaplasia of the bladder; after commencing retinol supplementation, a gradual healing of clinical VAD manifestations occurred, with the exception of the ocular sequelae, which resulted in irreversible visual loss.

Early predictors of short term neurodevelopmental outcome in asphyxiated cooled infants. A combined brain amplitude integrated electroencephalography and near infrared spectroscopy study.

BACKGROUND: Brain Cooling (BC) represents the elective treatment in asphyxiated newborns. Amplitude Integrated Electroencephalography (aEEG) and Near Infrared Spectroscopy (NIRS) monitoring may help to evaluate changes in cerebral electrical activity and cerebral hemodynamics during hypothermia. OBJECTIVES: To evaluate the prognostic value of aEEG time course and NIRS data in asphyxiated cooled infants. METHODS: Twelve term neonates admitted to our NICU with moderate-severe Hypoxic-Ischemic Encephalopathy (HIE) underwent selective BC. aEEG and NIRS monitoring were started as soon as possible and maintained during the whole hypothermic treatment. Follow-up was scheduled at regular intervals; adverse outcome was defined as death, cerebral palsy (CP) or global quotient <88.7 at Griffiths' Scale. RESULTS: 2/12 Infants died, 2 developed CP, 1 was normal at 6 months of age and then lost at follow-up and 7 showed a normal outcome at least at 1 year of age. The aEEG background pattern at 24 h of life was abnormal in 10 newborns; only 4 of them developed an adverse outcome, whereas the 2 infants with a normal aEEG developed normally. In infants with adverse outcome NIRS showed a higher Tissue Oxygenation Index (TOI) than those with normal outcome (80.0±10.5% vs 66.9±7.0%, p=0.057; 79.7±9.4% vs 67.1±7.9%, p=0.034; 80.2±8.8% vs 71.6±5.9%, p=0.069 at 6, 12 and 24 h of life, respectively). CONCLUSIONS: The aEEG background pattern at 24h of life loses its positive predictive value after BC implementation; TOI could be useful to predict early on infants that may benefit from other innovative therapies.

Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant.

AIM: Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV). METHODS: Chart data of infants with a birth weight <1500 gr or GA <32weeks undergoing InSurE in the period 2002-2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO(2) >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure. RESULTS: Six of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001). CONCLUSIONS: BiPAP reduced the need for MV after InSurE failure.

A combined a-EEG and MR spectroscopy study in term newborns with hypoxic-ischemic encephalopathy.

OBJECTIVES: Brain damage following a perinatal hypoxic-ischemic (HI) insult has been documented by different diagnostic techniques. The aim of the present study was to relate a-EEG time course during the first 24h of life to brain metabolic changes detected by proton MR spectroscopy ((1)H-MRS) at 7-10days of life and to evaluate their correlation with outcome. METHODS: Thirty-two patients with any grade HI encephalopathy were studied. Thirty-one out of 32 patients survived and underwent (1)H-MRS examination at 7-10days of life; a-EEG was recorded during the first 24h of life in 27/32 newborns; 26 patients underwent both examinations. Griffiths test, evaluation of motor skills, visual and hearing function were performed at regular intervals until the age of 2years. RESULTS: a-EEG at 6, 12 and 24h of life showed a significant correlation with outcome. N-acetyl-aspartate/creatine (Cr), Lactate/Cr and myo-inositol differed significantly between patients with normal or poor outcome. a-EEG time course during the first 24h of life showed improvement in newborns with normal (1)H-MRS and good outcome and a deterioration in those with abnormal (1)H-MRS and poor outcome. CONCLUSIONS: a-EEG time course may be able to document the severity and the evolution of the cerebral damage following an HI event. a-EEG is related to the severity of cerebral injury as defined by (1)H-MRS and both examinations showed a good correlation with outcome. These data, obtained in non-cooled infants, may represent reference data for future investigations in cooled infants.

Effect of posture on brain hemodynamics in preterm newborns not mechanically ventilated.

BACKGROUND: Changes in head posture influence brain hemodynamics. Optimal positioning has been recommended as 1 of 10 potentially better practices to reduce the incidence of brain injury in preterm newborns. OBJECTIVES: The aim of this study was to evaluate by near-infrared spectroscopy (NIRS) the effect of different head and body positions and the influence of gestational age (GA) and nasal continuous positive airway pressure on brain hemodynamics in very preterm newborns. METHODS: 24 stable preterm newborns were studied by NIRS in 6 different postures including head rotation and head inclination in both supine and prone positions. Changes in normalized tissue hemoglobin index (nTHI) and tissue oxygenation index (TOI) were measured after posture variations. RESULTS: No statistically significant changes in nTHI and in TOI were found in the 6 postures. nTHI variations, expression of cerebral blood volume variations, were influenced by GA. A reduction in nTHI, with a stable TOI, in the less mature infants (with GA < or = 26 weeks), occurred on head rotation; nTHI increased again when the head was derotated. CONCLUSIONS: Hemodynamic changes after posture variations depend on GA. Head rotation in newborns with GA < or = 26 weeks produced a reduction in nTHI with stable TOI. Possible physiopathological mechanisms are discussed.