Biomechanical Analysis of Human Gait When Changing Velocity and Carried Loads: Simulation Study with OpenSim.

Walking is one of the main activities of daily life and gait analysis can provide crucial data for the computation of biomechanics in many fields. In multiple applications, having reference data that include a variety of gait conditions could be useful for assessing walking performance. However, limited extensive reference data are available as many conditions cannot be easily tested experimentally. For this reason, a musculoskeletal model in OpenSim coupled with gait data (at seven different velocities) was used to simulate seven carried loads and all the combinations between the two parameters. The effects on lower limb biomechanics were measured with torque, power, and mechanical work. The results demonstrated that biomechanics was influenced by both speed and load. Our results expand the previous literature: in the majority of previous work, only a subset of the presented conditions was investigated. Moreover, our simulation approach provides comprehensive data that could be useful for applications in many areas, such as rehabilitation, orthopedics, medical care, and sports.

Influence of Backpack Carriage and Walking Speed on Muscle Synergies in Healthy Children.

Four to five muscle synergies account for children's locomotion and appear to be consistent across alterations in speed and slopes. Backpack carriage induces alterations in gait kinematics in healthy children, raising questions regarding the clinical consequences related to orthopedic and neurological diseases and ergonomics. However, to support clinical decisions and characterize backpack carriage, muscle synergies can help with understanding the alterations induced in this condition at the motor control level. In this study, we investigated how children adjust the recruitment of motor patterns during locomotion, when greater muscular demands are required (backpack carriage). Twenty healthy male children underwent an instrumental gait analysis and muscle synergies extraction during three walking conditions: self-selected, fast and load conditions. In the fast condition, a reduction in the number of synergies (three to four) was needed for reconstructing the EMG signal with the same accuracy as in the other conditions (three to five). Synergies were grouped in only four clusters in the fast condition, while five clusters were needed for the self-selected condition. The right number of clusters was not clearly identified in the load condition. Speed and backpack carriage altered nearly every spatial-temporal parameter of gait, whereas kinematic alterations reflected mainly hip and pelvis adaptations. Although the synergistic patterns were consistent across conditions, indicating a similar motor pattern in different conditions, the fast condition required fewer synergies for reconstructing the EMG signal with the same level of accuracy.

A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation.

In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.

Recent developments in muscle synergy analysis in young people with neurodevelopmental diseases: A Systematic Review.

The central nervous system simplifies motor control by sending motor commands activating groups of muscles, known as synergies. Physiological locomotion can be described as a coordinated recruitment of four to five muscle synergies. The first studies on muscle synergies in patients affected by neurological diseases were on stroke survivors. They showed that synergies can be used as biomarkers for motor impairment as they vary in patients with respect to healthy people. Likewise, muscle synergy analysis has been applied to developmental diseases (DD). The need for a comprehensive view of the present findings is crucial for comparing results achieved so far and promote future directions in the field. In the present review, we screened three scientific databases and selected thirty-six papers investigating muscle synergies extracted from locomotion in children affected by DD. Thirty-one articles investigate how cerebral palsy (CP) influences motor control, the currently exploited method in studying motor control in CP and finally the effects of treatments in these patients in terms of synergies and biomechanics; two articles investigate how muscle synergies vary in Duchenne muscular dystrophy (DMD), and three other articles assess other developmental pathologies, such as chronic and acute neuropathic pain. For CP, most of the studies demonstrate that the number of synergies is lower and that the synergy composition varies in the affected children with respect to normal controls. Still, the predictability of treatment's effects and the etiology of muscle synergy variation are open questions, as it has been reported that treatments minimally modify synergies, even if they improve biomechanics. The application of different algorithms in extracting synergies might bring about more subtle differences. Considering DMD, no correlation was found between non-neural muscle weakness and muscle modules' variation, while in chronic pain a decreased number of synergies was observed as a possible consequence of plastic adaptations. Even if the potential of the synergistic approach for clinical and rehabilitation practices is recognized, there is not full consensus on protocols nor widely accepted guidelines for the systematic clinical adoption of the method in DD. We critically commented on the current findings, on the methodological issues and the relative open points, and on the clinical impact of muscle synergies in neurodevelopmental diseases to fill the gap for applying the method in clinical practice.

Biomechanical assessment of the ipsilesional upper limb in post-stroke patients during multi-joint reaching tasks: A quantitative study.

In hemiplegic patients with stroke, investigating the ipsilesional limb may shed light on the upper limb motor control, impairments and mechanisms of functional recovery. Usually investigation of motor impairment and rehabilitative interventions in patients are performed only based on the contralesional limb. Previous studies found that also the ipsilesional limb presents motor deficits, mostly evaluated with clinical scales which could lack of sensibility. To quantitatively evaluate the performance of the ipsilesional limb in patient with stroke, we conducted an observational study in which 49 hemiplegic patients were enrolled, divided in subgroups based on the severity of impairment of the contralesional limb, and assessed with a kinematic, dynamic and motor control evaluation protocol on their ipsilesional upper limb during reaching movements. Measurements were repeated in the acute and subacute phases and compared to healthy controls. Our results showed that the ipsilesional limb presented lower kinematic and dynamic performances with respect to the healthy controls. Patients performed the movements slower and with a reduced range of motion, indicating a difficulty in controlling the motion of the arm. The energy and the power outputs were lower in both shoulder and elbow joint with a high significance level, confirming the limitation found in kinematics. Moreover, we showed that motor deficits were higher in the acute phase with respect to the subacute one and we found higher significant differences in the group with a more severe contralesional limb impairment. Ipsilesional upper limb biomechanics adds significant and more sensible measures for assessments based on multi-joints dynamics, providing a better insight on the upper limb motor control after stroke. These results could have clinical implications while evaluating and treating ipsilesional and contralesional upper limb impairments and dysfunctions in patients with stroke.

Detailed characterization of physiological EMG activations and directional tuning of upper-limb and trunk muscles in point-to-point reaching movements.

In recent years, several studies have investigated upper-limb motion in a variety of scenarios including motor control, physiology, rehabilitation and industry. Such applications assess people's kinematics and muscular performances, focusing on typical movements that simulate daily-life tasks. However, often only a limited interpretation of the EMG patterns is provided. In fact, rarely the assessments separate phasic (movement-related) and tonic (postural) EMG components, as well as the EMG in the acceleration and deceleration phases. With this paper, we provide a comprehensive and detailed characterization of the activity of upper-limb and trunk muscles in healthy people point-to-point upper limb movements. Our analysis includes in-depth muscle activation magnitude assessment, separation of phasic (movement-related) and tonic (postural) EMG activations, directional tuning, distinction between activations in the acceleration and deceleration phases. Results from our study highlight a predominant postural activity with respect to movement related muscular activity. The analysis based on the acceleration phase sheds light on finer motor control strategies, highlighting the role of each muscle in the acceleration and deceleration phase. The results of this study are applicable to several research fields, including physiology, rehabilitation, design of robots and assistive solutions, exoskeletons.

Robot Fully Assisted Upper-Limb Functional Movements Against Gravity to Drive Recovery in Chronic Stroke: A Pilot Study.

Background: Stroke is becoming more and more a disease of chronically disabled patients, and new approaches are needed for better outcomes. An intervention based on robot fully assisted upper-limb functional movements is presented. Objectives: To test the immediate and sustained effects of the intervention in reducing impairment in chronic stroke and to preliminarily verify the effects on activity. Methodology: Nineteen patients with mild-to-severe impairment underwent 12 40-min rehabilitation sessions, 3 per week, of robot-assisted reaching and hand-to-mouth movements. The primary outcome measure was the Fugl-Meyer Assessment (FMA) at T1, immediately after treatment (n = 19), and at T2, at a 6-month follow-up (n = 10). A subgroup of 11 patients was also administered the Wolf Motor Function Test Time (WMFT TIME) and Functional Ability Scale (WMFT FAS) and Motor Activity Log (MAL) Amount Of Use (AOU), and Quality Of Movement (QOM). Results: All patients were compliant with the treatment. There was improvement on the FMA with a mean difference with respect to the baseline of 6.2 points at T1, after intervention (n = 19, 95% CI = 4.6-7.8, p < 0.0002), and 5.9 points at T2 (n = 10, 95% CI = 3.6-8.2, p < 0.005). Significant improvements were found at T1 on the WMFT FAS (n = 11, +0.3/5 points, 95% CI = 0.2-0.4, p < 0.004), on the MAL AOU (n = 11, +0.18/5, 95% CI = 0.07-0.29, p < 0.02), and the MAL QOM (n = 11, +0.14/5, 95% CI = 0.08-0.20, p < 0.02). Conclusions: Motor benefits were observed immediately after intervention and at a 6-month follow-up. Reduced impairment would appear to translate to increased activity. Although preliminary, the results are encouraging and lay the foundation for future studies to confirm the findings and define the optimal dose-response curve. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03208634.

Low-Cost Tracking Systems Allow Fine Biomechanical Evaluation of Upper-Limb Daily-Life Gestures in Healthy People and Post-Stroke Patients.

Since the release of the first Kinect in 2011, low-cost technologies for upper-limb evaluation has been employed frequently for rehabilitation purposes. However, a limited number of studies have assessed the potential of the Kinect V2 for motor evaluations. In this paper, a simple biomechanical protocol has been developed, in order to assess the performances of healthy people and patients, during daily-life reaching movements, with focus on some of the patients' common compensatory strategies. The assessment considers shoulder range of motion, elbow range of motion, trunk compensatory strategies, and movement smoothness. Seventy-seven healthy people and twenty post-stroke patients participated to test the biomechanical assessment. The testing protocol included four different experimental conditions: (1) dominant limb and (2) non-dominant limb of 77 healthy people, and (3) the more impaired limb of 20 post-stroke hemiparetic patients, and (4) the less-impaired limb of 11 patients (subgroup of the original 20). Biomechanical performances of the four groups were compared. Results showed that the dominant and non-dominant limbs of healthy people had comparable performances (p > 0.05). On the contrary, condition (3) showed statistically significant differences between the healthy dominant/non-dominant limb and the less-affected limb in hemiparetic patients, for all parameters of assessment (p < 0.001). In some cases, the less-affected limb of the patients also showed statistical differences (p < 0.05), with respect to the healthy people. Such results suggest that Kinect V2 has the potential for being employed at home, laboratory or clinical environment, for the evaluation of patients' motor performances.

Assisting Operators in Heavy Industrial Tasks: On the Design of an Optimized Cooperative Impedance Fuzzy-Controller With Embedded Safety Rules.

Human-robot cooperation is increasingly demanded in industrial applications. Many tasks require the robot to enhance the capabilities of humans. In this scenario, safety also plays an important role in avoiding any accident involving humans, robots, and the environment. With this aim, the paper proposes a cooperative fuzzy-impedance control with embedded safety rules to assist human operators in heavy industrial applications while manipulating unknown weight parts. The proposed methodology is composed by four main components: (i) an inner Cartesian impedance controller (to achieve the compliant robot behavior), (ii) an outer fuzzy controller (to provide the assistance to the human operator), (iii) embedded safety rules (to limit force/velocity during the human-robot interaction enhancing safety), and (iv) a neural network approach (to optimize the control parameters for the human-robot collaboration on the basis of the target indexes of assistance performance defined for this purpose). The main achieved result refers to the capability of the controller to deal with uncertain payloads while assisting and empowering the human operator, both embedding in the controller safety features at force and velocity levels and minimizing the proposed performance indexes. The effectiveness of the proposed approach is verified with a KUKA iiwa 14 R820 manipulator in an experimental procedure where human subjects evaluate the robot performance in a collaborative lifting task of a 10 kg part.

Muscle Synergy Analysis of a Hand-Grasp Dataset: A Limited Subset of Motor Modules May Underlie a Large Variety of Grasps.

Background: Kinematic and muscle patterns underlying hand grasps have been widely investigated in the literature. However, the identification of a reduced set of motor modules, generalizing across subjects and grasps, may be valuable for increasing the knowledge of hand motor control, and provide methods to be exploited in prosthesis control and hand rehabilitation. Methods: Motor muscle synergies were extracted from a publicly available database including 28 subjects, executing 20 hand grasps selected for daily-life activities. The spatial synergies and temporal components were analyzed with a clustering algorithm to characterize the patterns underlying hand-grasps. Results: Motor synergies were successfully extracted on all 28 subjects. Clustering orders ranging from 2 to 50 were tested. A subset of ten clusters, each one represented by a spatial motor module, approximates the original dataset with a mean maximum error of 5% on reconstructed modules; however, each spatial synergy might be employed with different timing and recruited at different grasp stages. Two temporal activation patterns are often recognized, corresponding to the grasp/hold phase, and to the pre-shaping and release phase. Conclusions: This paper presents one of the biggest analysis of muscle synergies of hand grasps currently available. The results of 28 subjects performing 20 different grasps suggest that a limited number of time dependent motor modules (shared among subjects), correctly elicited by a control activation signal, may underlie the execution of a large variety of hand grasps. However, spatial synergies are not strongly related to specific motor functions but may be recruited at different stages, depending on subject and grasp. This result can lead to applications in rehabilitation and assistive robotics.

Robotic Assistance for Upper Limbs May Induce Slight Changes in Motor Modules Compared With Free Movements in Stroke Survivors: A Cluster-Based Muscle Synergy Analysis.

Background: The efficacy of robot-assisted rehabilitation as a technique for achieving motor recovery is still being debated. The effects of robotic assistance are generally measured using standard clinical assessments. Few studies have investigated the value of human-centered instrumental analysis, taking the modular organization of the human neuromotor system into account in assessing how stroke survivors interact with robotic set-ups. In this paper, muscle synergy analysis was coupled with clustering procedures to elucidate the effect of human-robot interaction on the spatial and temporal features, and directional tuning of motor modules during robot-assisted movements. Methods: Twenty-two stroke survivors completed a session comprising a series of hand-to-mouth movements with and without robotic assistance. Patients were assessed instrumentally, recording kinematic, and electromyographic data to extract spatial muscle synergies and their temporal components. Patients' spatial synergies were grouped by means of a cluster analysis, matched pairwise across conditions (free and robot-assisted movement), and compared in terms of their spatial and temporal features, and directional tuning, to examine how robotic assistance altered their motor modules. Results: Motor synergies were successfully extracted for all 22 patients in both conditions. Seven clusters (spatial synergies) could describe the original datasets, in both free and robot-assisted movements. Interacting with the robot slightly altered the spatial synergies' features (to a variable extent), as well as their temporal components and directional tuning. Conclusions: Slight differences were identified in the characteristics of spatial synergies, temporal components and directional tuning of the motor modules of stroke survivors engaging in free and robot-assisted movements. Such effects are worth investigating in the framework of a modular description of the neuromusculoskeletal system to shed more light on human-robot interaction, and the effects of robotic assistance and rehabilitation.

Assessing User Transparency with Muscle Synergies during Exoskeleton-Assisted Movements: A Pilot Study on the LIGHTarm Device for Neurorehabilitation.

Exoskeleton devices for upper limb neurorehabilitation are one of the most exploited solutions for the recovery of lost motor functions. By providing weight support, passively compensated exoskeletons allow patients to experience upper limb training. Transparency is a desirable feature of exoskeletons that describes how the device alters free movements or interferes with spontaneous muscle patterns. A pilot study on healthy subjects was conducted to evaluate the feasibility of assessing transparency in the framework of muscle synergies. For such purpose, the LIGHTarm exoskeleton prototype was used. LIGHTarm provides gravity support to the upper limb during the execution of movements in the tridimensional workspace. Surface electromyography was acquired during the execution of three daily life movements (reaching, hand-to-mouth, and hand-to-nape) in three different conditions: free movement, exoskeleton-assisted (without gravity compensation), and exoskeleton-assisted (with gravity compensation) on healthy people. Preliminary results suggest that the muscle synergy framework may provide valuable assessment of user transparency and weight support features of devices aimed at rehabilitation.

Kinect V2 implementation and testing of the reaching performance scale for motor evaluation of patients with neurological impairment.

Automated procedures for neurological patients' motor evaluation may take advantage of the coupling between clinical scales and motion tracking devices to provide affordable, quantified and reliable assessment to be used in clinics, in surgeries and domestic environment. In this study, 20 post-stroke patients performed frontal reaching movements with their more affected limb, and a physician administered the Reaching Performance Scale (RPS) to assess motor functionality. At the same time, patients' kinematics were recorded with the Kinect V2 sensor. An automated algorithm was developed to compute the RPS based on Kinect V2 tracking data, and visual and Kinect V2 RPS scores were compared. Results showed very high statistical correlation between the automated procedure and the visual administration (Pearson Correlation Coefficient: R = 0.90, p < 0.001). While the number of patients is limited, the automated RPS seems to be successfully applicable to different levels of impairment, from mild to severe.

DUALarm: An open-source and 3D-printable device for upper limb neurorehabilitation.

Positively advocating that low-cost additive 3D-printing technologies and open-source licensed software/hardware platforms represent an optimal solution to realize low-cost equipment, a mechanical and 3D-printable device for bilateral upper-limb rehabilitation is presented. The design and manufacturing process of this wheel-geared mechanism, enabling in-phase and anti-phase movements, will be openly provided online with the aim of making a set of customizable devices for neurorehabilitation exploitable all over the world even by people/countries with limited economical and technological resources. In order to characterize the interaction with the device, preliminary trials with EMG and kinematics recordings were performed on healthy subjects.

Muscle Synergies-Based Characterization and Clustering of Poststroke Patients in Reaching Movements.

BACKGROUND: A deep characterization of neurological patients is a crucial step for a detailed knowledge of the pathology and maximal exploitation and customization of the rehabilitation therapy. The muscle synergies analysis was designed to investigate how muscles coactivate and how their eliciting commands change in time during movement production. Few studies investigated the value of muscle synergies for the characterization of neurological patients before rehabilitation therapies. In this article, the synergy analysis was used to characterize a group of chronic poststroke hemiplegic patients. METHODS: Twenty-two poststroke patients performed a session composed of a sequence of 3D reaching movements. They were assessed through an instrumental assessment, by recording kinematics and electromyography to extract muscle synergies and their activation commands. Patients' motor synergies were grouped by the means of cluster analysis. Consistency and characterization of each cluster was assessed and clinically profiled by comparison with standard motor assessments. RESULTS: Motor synergies were successfully extracted on all 22 patients. Five basic clusters were identified as a trade-off between clustering precision and synthesis power, representing: healthy-like activations, two shoulder compensatory strategies, two elbow predominance patterns. Each cluster was provided with a deep characterization and correlation with clinical scales, range of motion, and smoothness. CONCLUSION: The clustering of muscle synergies enabled a pretherapy characterization of patients. Such technique may affect several aspects of the therapy: prediction of outcomes, evaluation of the treatments, customization of doses, and therapies.

Kinect V2 Performance Assessment in Daily-Life Gestures: Cohort Study on Healthy Subjects for a Reference Database for Automated Instrumental Evaluations on Neurological Patients.

BACKGROUND: The increase of sanitary costs related to poststroke rehabilitation requires new sustainable and cost-effective strategies for promoting autonomous and dehospitalized motor training. In the Riprendo@Home and Future Home for Future Communities research projects, the promising approach of introducing low-cost technologies that promote home rehabilitation is exploited. In order to provide reliable evaluation of patients, a reference database of healthy people's performances is required and should consider variability related to healthy people performances. METHODS: 78 healthy subjects performed several repetitions of daily-life gestures, the reaching movement (RM) and hand-to-mouth (HtMM) movement with both the dominant and nondominant upper limbs. Movements were recorded with a Kinect V2. A synthetic biomechanical protocol based on kinematical, dynamical, and motor control parameters was used to assess motor performance of the healthy people. The investigation was conducted by clustering participants depending on their limb dominancy (right/left), gender (male/female), and age (young/middle/senior) as sources of variability. RESULTS: Results showed that limb dominancy has minor relevance in affecting RM and HtMM; gender has relevance in affecting the HtMM; age has major effect in affecting RM and HtMM. CONCLUSIONS: An investigation of healthy subjects' upper limb performances during daily-life gestures was performed with the Kinect V2 sensor. Findings will be the basis for a database of normative data for neurological patients' motor evaluation.

Using robot fully assisted functional movements in upper-limb rehabilitation of chronic stroke patients: preliminary results.

BACKGROUND: Robotic rehabilitation is promising to promote function in stroke patients. The assist as needed training paradigm has shown to stimulate neuroplasticity but often cannot be used because stroke patients are too impaired to actively control the robot against gravity. AIM: To verify whether a rehabilitation intervention based on robot fully assisted reaching against gravity (RCH) and hand-to-mouth (HTM) can promote upper-limb function in chronic stroke. DESIGN: Cohort study. SETTING: Chronic stroke outpatients referring to the robotic rehabilitation lab of a rehabilitation centre. POPULATION: Ten chronic stroke patients with mild to moderate upper-limb hemiparesis. METHODS: Patients underwent 12 sessions (3 per week) of robotic treatment using an end-effector robot Every session consisted of 20 minutes each of RCH and HtM; movements were fully assisted, but patients were asked to try to actively participate. The Fugl-Meyer Assessment (FMA) was the primary outcome measure; Medical Research Council and Modified Ashworth Scale were the secondary outcome measures. RESULTS: All patients, but one, show functional improvements (FMA section A-D, mean increment 7.2±3.9 points, P<0.008). CONCLUSIONS: This preliminary study shows that a robotic intervention based on functional movements, fully assisted, can be effective in promoting function in chronic stroke patients. These results are promising considering the short time of the intervention (1 month) and the time from the stroke event, which was large (27±20 months). A larger study, comprehensive of objective instrumental measures, is necessary to confirm the results. CLINICAL REHABILITATION IMPACT: This intervention could be extended even to subacute stroke and other neurological disorders.

Predicting Functional Recovery in Chronic Stroke Rehabilitation Using Event-Related Desynchronization-Synchronization during Robot-Assisted Movement.

Although rehabilitation robotics seems to be a promising therapy in the rehabilitation of the upper limb in stroke patients, consensus is still lacking on its additive effects. Therefore, there is a need for determining the possible success of robotic interventions on selected patients, which in turn determine the necessity for new investigating instruments supporting the treatment decision-making process and customization. The objective of the work presented in this preliminary study was to verify that fully robot assistance would not affect the physiological oscillatory cortical activity related to a functional movement in healthy subjects. Further, the clinical results following the robotic treatment of a chronic stroke patient, who positively reacted to the robotic intervention, were analyzed and discussed. First results show that there is no difference in EEG activation pattern between assisted and no-assisted movement in healthy subjects. Even more importantly, the patient's pretreatment EEG activation pattern in no-assisted movement was completely altered, while it recovered to a quasi-physiological one in robot-assisted movement. The functional improvement following treatment was large. Using pretreatment EEG recording during robot-assisted movement might be a valid approach to assess the potential ability of the patient for recovering.

An affordable, adaptable, and hybrid assistive device for upper-limb neurorehabilitation.

The paper presents a multisensory and multimodal device for neuromuscular rehabilitation of the upper limb, designed to enable enriched rehabilitation treatment in both clinical and home environments. Originating from an existing low-cost, variable-stiffness rehabilitation device, it expands its functionalities by integrating additional modules in order to augment application scenarios and applicable clinical techniques. The newly developed system focuses on the integration of a wearable neuromuscular electrical stimulation system, a virtual rehabilitation scenario, a low-cost unobtrusive sensory system and a patient model for adapting training task parameters. It also monitors the user behavior during each single session and its evolution throughout the entire training period. The result is a modular, integrated and affordable rehabilitation device, enabling a biomechanical, neurological, and physiological-based training of patients, including innovative features currently unavailable within off-the-shelf rehabilitation devices.

Normative Data for an Instrumental Assessment of the Upper-Limb Functionality.

Upper-limb movement analysis is important to monitor objectively rehabilitation interventions, contributing to improving the overall treatments outcomes. Simple, fast, easy-to-use, and applicable methods are required to allow routinely functional evaluation of patients with different pathologies and clinical conditions. This paper describes the Reaching and Hand-to-Mouth Evaluation Method, a fast procedure to assess the upper-limb motor control and functional ability, providing a set of normative data from 42 healthy subjects of different ages, evaluated for both the dominant and the nondominant limb motor performance. Sixteen of them were reevaluated after two weeks to perform test-retest reliability analysis. Data were clustered into three subgroups of different ages to test the method sensitivity to motor control differences. Experimental data show notable test-retest reliability in all tasks. Data from older and younger subjects show significant differences in the measures related to the ability for coordination thus showing the high sensitivity of the method to motor control differences. The presented method, provided with control data from healthy subjects, appears to be a suitable and reliable tool for the upper-limb functional assessment in the clinical environment.