The SWORD tele-rehabilitation system.

In spite of the growing interest verified in the field of technology-based interventions for Stroke rehabilitation, there is still no global solution that is both successful and suitable for a widespread use [1,2]. In this article, we present a novel tele-rehabilitation tool designed to be used for ambulatory patients, and developed towards the motor recovery of the patient's upper-limb. The SWORD system combines a movement quantification system that analyzes the quality of the motor task performed with a biofeedback console. The proposed structure defines the SWORD system as a complete tele-rehabilitation framework that enables a direct connection between clinical and ambulatory settings. Currently a randomized clinical trial is being designed in order to assess the effectiveness of the SWORD tele-rehabilitation system.

The vibratory stimulus as a neurorehabilitation tool for stroke patients: proof of concept and tolerability test.

INTRODUCTION: Current scientific knowledge reinforces that successful reorganization of surviving nervous tissue supports cognitive and motor recovery after stroke. The development of new neurorehabilitation tools to modulate this physiologic process is needed. In this context, vibratory stimuli are a noninvasive form of proprioceptive stimulation of the nervous system and are freely available and easy to use at a low cost. OBJECTIVES: To access the feasibility and tolerability of targeted vibratory stimuli delivered through a wearable device in an early post-stroke setting. PATIENTS AND METHODS: Five stroke patients were recruited from a stroke unit setting having a first ever medial cerebral artery ischemic stroke with motor deficit. The stimulation device developed delivered external vibratory stimuli to major joints at preprogrammed arrays of intensity, duration and interval of actuation. The tolerability test was set for five-hour duration and during that period data on vital parameters, cognitive, motor and sensitive performance as well as anxiety scores were recorded. RESULTS: The device remained in place throughout and none of the patients or relatives asked to interrupt the tolerability test. There were no major complications during the trial or the ensuing days. Attention to the affected side during stimulation was increased in four patients, and two were reported as clearly more awake during the test. DISCUSSION: This is the first tolerability test focused on the use of targeted vibratory stimulus as a neurorehabilitation tool in stroke patients. There were no hazards to report and most interestingly the majority of patients showed increased awareness to the affected side of the body. These findings will be further analyzed under functional MRI control and on long-term ambulatory use trials.

Towards a movement quantification system capable of automatic evaluation of upper limb motor function after neurological injury.

The paper proposes an integrated system to automatically assess motor function after neurological injury. A portable motion capture system was developed in order to obtain all the relevant three dimensional kinematics of the upper limb movement. These kinematics were analyzed by means of a decision tree classifier which features where inferred from the Functional Ability Score (FAS) of the Wolf Motor Function Test (WMFT). In addition, the system is able to correctly quantify the performance time of each selected task of the WMFT. In terms of the FAS the system and the clinician show coherent results for 3 out of 5 patients in the first task tested and 4 out of 5 for the second task tested. Regarding performance time, the mean error between the system and the clinician was of 0.216 s for the 25 trials performed (5 patients, 5 tasks each). These results represent an important proof of concept towards a system capable of precisely evaluate upper limb motor function after neurological injury.

Contribution of the expression of ICAM-1, HLA-DR and IL-2R to the diagnosis of acute rejection in renal allograft aspirative cytology.

Acute rejection is associated with a poor long-term prognosis for renal allografts. Sequential fine-needle aspiration cytology (FNAC) has been used to monitor rejection. However, FNAC diagnoses rejection only when the infiltrating cells are already damaging the graft and, in some borderline cases with a low increment of inflammatory cells in the graft, FNAC lacks the specificity to diagnose rejection. In these cases, the number of inflammatory cells within the graft can decline, stabilize or increase with time. In this study, we sought to determine whether the analysis of the expression of ICAM-I, HLA-DR and IL-2R along with borderline FNAC results increases the specificity to diagnose rejection. Of 117 FNAC samples taken from 24 patients after renal transplantation, 85 (72%) were considered suitable for cytological analysis. Of these patients, 9 (37%) did not suffer an acute cellular rejection (ACR) episode and 15 (63%) had at least one ACR episode. ICAM-1 and IL-2R were studied using an immune-peroxidase technique. The ICAM-1 results are expressed as the percentage of tubular cells in the aspirate stained with this marker and the IL-2R results are expressed as the absolute number of positively stained lymphocytes in the whole cytopreparation. With a total corrected increment (TCI) of > 3 there was a sharp increase in the specificity index for rejection that reached almost 100% at a TCI of > or = 4. Sensitivity for rejection at this level was only 20%. Between a TCI of 2.5 and 2.9 the sensitivity increased to 75%, with specificity for rejection around 75%. There was an upregulation of ICAM-1 and IL-2R when FNAC diagnosed rejection but with a large overlap of the results when compared either to normal graft or acute tubular neurosis. The mean TCI during the week preceding the rejection episode was 2.5 and the TCI reached a mean value of > or = 3 only during rejection. The peak ICAM-1 and IL-2R expression occurred during the week preceding the clinically evident rejection episode. The expression of ICAM-1 by > or = 70% of the tubular cells increased the specificity for rejection of a TCI of > or = 2.5 to 100%. In the same way, the specificity for rejection increased up to 90% when eight to ten IL-2R-positive lymphocytes were seen along with a TCI of > or = 2.5. There was no further increase in specificity after that. A specificity index of 100% for rejection could be obtained for moderate levels of both ICAM-1 (70% or more tubular cells) and IL-2R (eight or more lymphocytes). ICAM-1 expression in 70% or more tubular cells and/or IL-2R expression in eight or more lymphocytes was found in 58% of the FNAC aspirates with a TCI between 2.5 and 2.9. In conclusion, the expression of IL-2R in lymphoid cells and ICAM-1 in tubular cells was upregulated during rejection episodes and the upregulation preceded both the clinical and the routine FNAC diagnosis of rejection by 1 week. The ddition of these markers to the FNAC increased substantially the specificity of the FNAC to diagnose rejection.