ABSTRACT
Hand movements are particularly impaired in patients with Parkinson's Disease (PD), contributing to functional disability and difficulties in activities of daily living. Growing evidence has shown that robot-assisted therapy may be considered an effective and reliable method for the delivery of the highly repetitive training that is needed to trigger neuroplasticity, as intensive, repetitive and task-oriented training could be an ideal strategy to facilitate the relearning of motor function and to minimize motor deficit. The purpose of this study is to evaluate the improvement of hand function with semi-autonomous exercises using an upper extremity exoskeleton in patients with PD. A multicenter, parallel-group, randomized clinical trial was then carried out at the IRCCS Centro Neurolesi Bonino-Pulejo (Messina, Italy). Thirty subjects with a diagnosis of PD and a Hoehn-Yahr score between 2 and 3 were enrolled in the study. Patients were 1:1 randomized into either the experimental group (ERT), receiving 45 min training daily, 6 days weekly, for 8 weeks with Armeo®Spring (Volketswil, Switzerland) (a gravity-supporting device), or the control group (CPT), which was subjected to the same amount of conventional physical therapy. Motor abilities were assessed before and after the end of the training. The main outcomes measures were the Nine-hole peg test and the motor section of the UPDRS. All patients belonging to ERT and 9 out of 15 patients belonging to the CPT completed the trial. ERT showed a greater improvement in the primary outcome measure (nine-hole peg test) than CPT. Moreover, a statistically significant improvement was found in ERT concerning upper limb mobility, and disease burden as compared to CPT. Using an upper extremity exoskeleton (i.e., the Armeo®Spring) for semi-autonomous training in an inpatient setting is a new perspective to train patients with PD to improve their dexterity, executive function and, potentially, quality of life.
ABSTRACT
Bacterial biofilms exhibit up to 1000 times greater resistance to antibiotic or host immune clearance than planktonic cells. Pseudomonas aeruginosa produces retractable type IV pili (T4P) that facilitate twitching motility on surfaces. The deployment of pili is one of the first responses of bacteria to surface interactions and because of their ability to contribute to cell surface adhesion and biofilm formation, this has relevance to medical device-associated infections. While polymer chemistry is known to influence biofilm development, its impact on twitching motility is not understood. Here, we combine a polymer microarray format with time-lapse automated microscopy to simultaneously assess P. aeruginosa twitching motility on 30 different methacrylate/acrylate polymers over 60 min post inoculation using a high-throughput system. During this critical initial period where the decision to form a biofilm is thought to occur, similar numbers of bacterial cells accumulate on each polymer. Twitching motility is observed on all polymers irrespective of their chemistry and physical surface properties, in contrast to the differential biofilm formation noted after 24 h of incubation. However, on the microarray polymers, P. aeruginosa cells twitch at significantly different speeds, ranging from 5 to â¼13 nm/s, associated with crawling or walking and are distinguishable from the different cell surface tilt angles observed. Chemometric analysis using partial least-squares (PLS) regression identifies correlations between surface chemistry, as measured by time-of-flight secondary ion mass spectrometry (ToF-SIMS), and both biofilm formation and single-cell twitching speed. The relationships between surface chemistry and these two responses are different for each process. There is no correlation between polymer surface stiffness and roughness as determined by atomic force measurement (AFM), or water contact angle (WCA), and twitching speed or biofilm formation. This reinforces the dominant and distinct contributions of material surface chemistry to twitching speed and biofilm formation.
