Effect of Exoskeleton-Assisted Rehabilitation Over Prefrontal Cortex in Multiple Sclerosis Patients: A Neuroimaging Pilot Study.

Application of a passive and fully articulated exoskeleton, called Human Body Posturizer (HBP), has been demonstrated to improve mobility, response accuracy and ambulation in multiple sclerosis (MS) patients. By using functional magnetic imaging (fMRI) during a visuomotor discrimination task, we performed a pilot study to evaluate the effect of HBP over the neural correlates of motor and cognitive functions which are typically impaired in MS patients. Specifically, we tested the effect of a 6-week multidisciplinary rehabilitation intervention on two groups of MS patients: a control group who followed a standard physiotherapeutic rehabilitation protocol, and an experimental group who used the HBP during physical exercises in addition to the standard protocol. We found that, after treatment, the experimental group exhibited a significant lower activity (as compared to the control group) in the inferior frontal gyrus. This post-treatment activity reduction can be explained as a retour to a normal range, being the amount of iFg activity observed in the experimental patients very similar to that observed in healthy subjects. These findings indicate that the use of HBP during rehabilitation intervention normalizes the prefrontal activity, mitigating the cortical hyperactivity associated to MS.

The Effect of a Physical Training with the Use of an Exoskeleton on Depression Levels in Institutionalized Elderly Patients: A Pilot Study.

CONTEXT: The Human Body Posturizer (HBP) is an exoskeleton used in the neurorehabilitation. The HBP may improve motor control by stimulating the pre-frontal cortex, a brain region involved also in the inhibitory modulation of the amygdala whose hyperactivity is involved in the mechanisms of depression. OBJECTIVE: The aim of the study was to investigate in institutionalized elderly patients the effects on depression of a physical training with the use of the HBP compared to a traditional training. DESIGN: Randomized controlled trial. PARTICIPANTS: 20 institutionalized patients (mean age = 88, ds = ± 5, 3 males) with moderate depression levels. INTERVENTION: The participants were randomly assigned to: a) HBP Group, which carried out physical training using the HBP; b) Excercise Group, which carried out a training without the use of the orthosis. The training was conducted for 6 months (3 sessions each week), with the same kind of exercises with or without the HBP according to the assignment group. MEASUREMENTS: Participants were evaluated at baseline using the Tinetti balance and Gait scale, the Mini Mental State Examination and the Geriatric Handicap Scale. The Geriatric Depression Scale was administered to the participants before and after the period of training. RESULTS: The two groups were homogeneous for age, baseline motor ability (risk falls), handicap score, cognitive functioning and depression levels. After 6 months of exercise training a significant reduction in depression levels was reported only in the HBP Group (p <.01). CONCLUSIONS: A positive effect of the HBP in the modulation of mood in institutionalized elderly subjects was found. It is possible to hypothesis that a traditional training without the HBP may require more time to achieve significant results. Clinical implications will be discussed.

Measurement of the Q

We measured the g_{1} spin structure function of the deuteron at low Q^{2}, where QCD can be approximated with chiral perturbation theory (χPT). The data cover the resonance region, up to an invariant mass of W≈1.9 GeV. The generalized Gerasimov-Drell-Hearn sum, the moment Γ_{1}^{d} and the spin polarizability γ_{0}^{d} are precisely determined down to a minimum Q^{2} of 0.02 GeV^{2} for the first time, about 2.5 times lower than that of previous data. We compare them to several χPT calculations and models. These results are the first in a program of benchmark measurements of polarization observables in the χPT domain.

Fall prevention in the young old using an exoskeleton human body posturizer: a randomized controlled trial.

BACKGROUND: Fall risk in elderly has been related with physical decline, low quality of life and reduced survival. AIM: To evaluate the impact of exoskeleton human body posturizer (HBP) on the fall risk in the elderly. METHODS: 150 subjects (mean age 64.85; 79 M/71 F) with mild fall risk were randomized into two groups: 75 for group treated with human body posturizer (HBP group) and 75 for physical training without HBP group (exercise group). The effects of interventions were assessed by differences in tests related to balance and falls. Medically eligible patients were screened with Tinetti balance and Gait evaluation scale, short physical performance battery and numeric pain rating scale to determine fall risk in elderly people. RESULTS: In the HBP group there was a significant improvement in short physical performance battery, Tinetti scale and Pain Numeric rating scale with a significant reduction in fall risk (p < 0.05). In the exercise group we observed only minimal variations in the test scores. DISCUSSION: The results at the sixth and twelfth months show a twofold positive effect in the HBP group reducing fall risk and improving quality of life by reducing pain. CONCLUSION: The use of exoskeleton human body posturizer seems to be a new significant device for prevention of fall in elderly patients. Further research should be carried out to obtain more evidence on effects of robotic technology for fall prevention in the elderly.

Preliminary baropodometric analysis of young soccer players while walking: geometric morphometrics and comparative evaluation.

AIM: The plantar support and its modifications are widely studied because of their bearing on posture. In particular, past studies have focused on the support modification during specific athletic tasks to highlight the eventual correlations between foot type and the most frequent sport injuries, due to intrinsic and extrinsic components that involve the structural and functional dynamics that act on the plantar vault during static and dynamic condition. These studies have been conducted by analyzing the morphological variation of the footprint during the performance. METHODS: In the present study the variation in shape of the baropodometrical footprint of young soccer players, has been analyzed using geometric morphometrics. This approach permits a quantification of the morphological variation of the subjects using Cartesian coordinates placed at specific points on the footprint outline, and to correlate them with physical variables. RESULTS: In the present study the young soccer players displayed a narrowing of the footprint due to a transversal variation on the isthmus, when compared to children of the same age who did not play soccer. These results suggest a physiological and biomechanical organization of the foot type in soccer due to the specific athletic tasks involved. CONCLUSION: As the foot type, in sport, is strictly associated to recurrent injuries, the result obtained in this study should be considered as indicative for future analysis. In fact, a clear and univocal knowledge of this phenomenon would be useful in the planning of a training protocol to reduce the incidence of sport related injuries.

Preliminary shape analysis of the outline of the baropodometric foot: patterns of covariation, allometry, sex and age differences, and loading variations.

AIM: Baropodometrical digital techniques map the pressures exerted on the foot plant during both static and dynamic loadings. The study of the distribution of such pressures makes it possible to evaluate the postural and locomotory biomechanics together with its pathological variations. This paper is aimed at evaluating the integration between baropodometric analysis (pressure distribution) and geometrical models (shape of the footprints), investigating the pattern of variation associated with normal plantar morphology. METHODS: The sample includes 91 individuals (47 males, 44 females), ranging from 5 to 85 years of age (mean and standard deviation = 40 + or - 24).The first component of variation is largely associated with the breadth of the isthmus, along a continuous gradient of increasing/decreasing flattening of the foot plant. This character being dominant upon the whole set of morphological components even in a non-pathological sample, such multivariate computation may represent a good diagnostic tool to quantify its degree of expression in individual subject or group samples. RESULTS: Sexual differences are not significant, and allometric variations associated with increasing plantar surface or stature are not quantitatively relevant. There are some differences between adult and young individuals, associated in the latter with a widening of the medial and posterior areas. CONCLUSIONS: These results provide a geometrical framework of baropodometrical analysis, suggesting possible future applications in diagnosis and basic research.

Osteoid osteoma mimicking overuse syndromes in athletes.

This article reports the clinical features, findings at imaging, management and outcome of five athletes who presented with osteoid osteoma. The diagnosis was missed initially in all the athletes, who were managed for an overuse syndrome for many months before receiving a correct diagnosis. Osteoid osteoma can cause atypical pain, and therefore lead to delay in diagnosis and inappropriate management. Each injured athlete must be fully evaluated by history, physical examination and appropriate imaging investigations to minimize the rate of misdiagnosis and underestimation, unnecessary procedures, and delayed management.

Spinal curvature: comparison of frontal measurements with the Spinal Mouse and radiographic assessment.

AIM: The Spinal Mouse is an external non-invasive device which measures the spinal shape and mobility of the spine in several planes. The aim of the present study was to evaluate the reliability and the validity of the Spinal Mouse to assess frontal standing measurements of the spine in a sample of young healthy volunteers. METHODS: Twenty-six young volunteers of both sex took part in the study. Angle data of vertebral inclination of each subject in frontal view were measured by Spinal Mouse and standard radiography for vertebral segments from T1-T2 down to L5-S1. RESULTS: Repetition of the measurements by Spinal Mouse performed by two examiners in different days resulted in no significant difference for the parameter examined, as well as measurements performed by the two examiners in the same day (P<0.05). The ICC values showed no correlation between the two devices in the following pairs of vertebrae: T2-T3, T4-T5, T5-T6, T7-T8, T8-T9, T9-T10, T11-T12, T12-L1, L1-L2, L3-L4, L4-L5. CONCLUSION: The Spinal Mouse results, concerning the standing frontal curvature of the spine, even if reliable, were poor when compared with the standard radiography.

Functional anatomy of trunk flexion-extension in isokinetic exercise: muscle activity in standing and seated positions.

AIM: This study examined the functional differences existing in the trunk flexion-extension movement in standing and seated positions during isokinetic exercises, as well as the influence of position on overload of the lumbar column. METHODS: Nine females underwent an isokinetic test at 60 and 180 degrees /s in standing and seated positions. Muscle electrical activity was assessed by means of surface electromyography (EMG). Motion angles related to the different body segments were extrapolated from video images. RESULTS: The range of motion for hip movements was statistically significantly higher in the standing position, whereas it was similar for all the other segments studied in both positions. During the first phases of the movement, the lumbar tract showed a more marked lordosis in standing position. Peak torque values were significantly higher for flexion in standing position. Surface EMG showed significant differences in both positions only for the gluteal and biceps femoris muscles. CONCLUSION: The seated position allowed made it possible to limit the involvement of the hip muscles, particularly the iliopsoas during flexion, whereas there was little contribution to the trunk extension from hip extensor muscles. In addition, trunk extensors/flexors ratio showed values variable with velocity in standing position. Therefore, if the participation of accessory muscles is avoided, the seated position allows us to more accurately assess these two groups of antagonist muscles, whose balanced ratio is essential in the prevention of spine pathologies. The seated position has also been found to be more suitable in order to limit functional overload of the lumbar column.

A synovial ganglion of the knee: two cases in athletes.

The objective of the study is to describe two cases of proximal tibiofibular ganglion cysts in high level athletes. In May 2003 and March 2005 two athletes (one tennis player in the top eighty of the Italian national ranking and a gymnast belonging to the Italian rhythmic gymnastics national team) were referred to our institution complaining of postero-lateral knee discomfort and the presence of localized swelling over the fibular head and the antero-lateral aspect of the leg, with a clinically suspected diagnosis of ganglion cyst of the proximal tibiofibular joint. Ultrasonography clearly detected the fluid-filled structures while magnetic resonance imaging confirmed the diagnosis, also showing precisely the anatomic relationship between the ganglions and the surrounding structures. Both athletes underwent surgical excision and the histological examination was compatible with a proximal tibiofibular joint ganglion cyst; as yet they have had no recurrence.

Stress fractures of the ribs in elite competitive rowers: a report of nine cases.

OBJECTIVE: The objective was to report the clinical and imaging patterns of nine cases of stress fractures of the rib diagnosed in Italian Olympic rowers. PATIENTS AND METHODS: Nine patients with stress fractures of the rib detected from 103 (8.7%) Italian team rowers competing between May 2000 and May 2006 were identified based on the database of a sports medicine institute. All athletes were male. They were aged between 17 and 31 years (mean: 24.4). Patient weight, fracture location, rowing side and imaging methods employed were noted. RESULTS: The diagnosis was made based on history, clinical examination and Tc-99m MDP bone scintigraphy. Eight of the 9 fractures were located anterolaterally between the fourth and ninth rib. In 1 of the 5 athletes with standard radiographs, a fracture line was visible and in 4 there was callus formation. In 2 athletes sonography was performed, which detected discontinuity of the rib surface and callus formation (1 case each). CONCLUSION: Stress fractures of the ribs are relatively common in competitive rowers. They are characterized by increasing lateral chest pain and typical scintigraphic, radiographic and sonographic findings.

The ischiatic region: normal and MRI anatomy.

AIM: The aim of this study was to describe the anatomy correlated to the normal magnetic resonance imaging (MRI) images of the proximal thigh region and the ischial tuberosity. METHODS: MRI coronal and axial sequences were obtained from 20 asymptomatic volunteers (10 male and 10 female) aged 20 to 38 years (mean age: 28 years), and then they were compared with 2 anatomical dissections and 7 cryosections of 6 cadaver thighs. RESULTS: The anatomical specimens were directly correlated with MRI scans. From the comparison it could be seen how the axial MRI sequences well outlined the sciatic nerve, usually observed oval in shape with moderate signal intensity, and thus easily detectable from other surrounding organs. Other structures were also identified by axial images: the ischial tuberosity, the proximal origin of the hamstring muscles arising from the ischium and the related bursae, the gluteus maximus and its bursa, the quadratus femoris and its inconstant bursa, a triangular adipose body and vessels. Coronal scans also showed well the hamstring muscles, both in length and thickness. CONCLUSIONS: Both MRI images and cadaver dissections showed the ischial tuberosity as an interesting intersection area that could be delimited as follows: on the dorsal border the gluteus maximus and its bursa, on the dorso-medial side the hamstring muscle origin, and on the antero-lateral side the quadratus femoris muscle with its inconstant bursa and the ischial tuberosity. These anatomical and MRI descriptions are very useful to give a contribution to the right explanation of sciatic symptoms caused by those sports specifically overloading the hamstring muscles. Frequently, in fact, in these athletes a sciatic syndrome arise drawing the physician's attention to the lumbosacral joint or to the sciatic nerve course near the piriformis muscle. Another very important site where the sciatic symptoms can rise, indeed, could also be found in the hamstring muscle region, where the nerve run under the gluteus maximus beside the ischiatic bone. Athletes who manifest notorious muscle overload in this anatomical region usually show sciatic pain symptoms that are not to be related with pathologies of the lumbosacral junction nor to relationships of the sciatic nerve with the piriformis muscle but rather to relationships that this nerve acquires with either gluteal muscles as well as with muscles of the underneath ischiatic region.

A singular pancreatico-colic artery: anatomical report and clinical implications.

After dissection of the abdominal cavity of a 59-year-old male, a long artery, extending from the hepatic artery to the transverse colon, and comprised proximally within the neck of the pancreas and distally within the transverse mesocolon, has been detected. This "pancreato-colic" artery (P-C A) was 13 cm in length and 4 mm in diameter at the origin. Its mesocolic part (2.5 mm in diameter) contributed to the formation of the marginal arcade. No middle colic artery from the superior mesenteric was observed. Thus, the transverse colon was supplied by the distal part of the P-C A. Considering both the P-C A caliber and topography, attention should be paid during pancreatic resections and in the interposition of the transverse colon for esophageal replacement in order to avoid serious bleeding and necrosis. Embryologically, the proximal part of the P-C A might be regarded as an intrapancreatic variant of the tract of the longitudinal anastomosis between the ventral segmental arteries, persisting in the adult as dorsal pancreatic artery. Different from its usual retropancreatic location, this part might be entrapped inside the gland by the developing primitive pancreatic anlages. The distal, mesocolic, part of the P-C A might be regarded as a replacing middle colic artery into the dorsal mesentery during midgut rotation.

Heterotopic ossification of the ulnar collateral ligament: a description of a case in a top level weightlifting athlete.

The purpose of this paper is to describe a case of heterotopic ossification of the ulnar collateral ligament in a 29-year-old top level weightlifter. Plain radiography of the elbow determined the extent and location of heterotopic ossification. Ultrasound and MR imaging completed the instrumental set-up. This symptomatic case had the resolution of pain after 2 months of a supervised rehabilitation program. At one year follow-up the athlete is asymptomatic referring occasional minor pain only in the periods of vigorous training.

Measurement of ep-->e' ppi+ pi- and baryon resonance analysis.

The cross section for the reaction ep-->e(')ppi(+)pi(-) was measured in the resonance region for 1.4

Photoproduction of the omega meson on the proton at large momentum transfer.

The differential cross section, dsigma/dt, for omega meson exclusive photoproduction on the proton above the resonance region (2.6

Photoproduction of the rho(0) meson on the proton at large momentum transfer.

The differential cross section, d sigma/dt, for rho(0) meson photoproduction on the proton above the resonance region was measured up to a momentum transfer -t = 5 GeV2 using the CLAS detector at the Thomas Jefferson National Accelerator Facility. The rho(0) channel was extracted from the measured two charged-pion cross sections by fitting the pi(+)pi(-) and p pi(+) invariant masses. The low momentum transfer region shows the typical diffractive pattern expected from Reggeon exchange. The flatter behavior at large -t cannot be explained solely in terms of QCD-inspired two-gluon exchange models. The data indicate that other processes, like quark interchange, are important to fully describe rho photoproduction.

Photoproduction of straight phi(1020) mesons on the proton at large momentum transfer

The cross section for straight phi meson photoproduction on the proton has been measured for the first time up to a four-momentum transfer -t = 4 GeV2, using the CLAS detector at the Thomas Jefferson National Accelerator Facility. At low four-momentum transfer, the differential cross section is well described by Pomeron exchange. At large four-momentum transfer, above -t = 1.8 GeV2, the data support a model where the Pomeron is resolved into its simplest component, two gluons, which may couple to any quark in the proton and in the straight phi.

Pedicle instrumentation in the thoracic spine. A morphometric and cadaveric study for placement of screws.

STUDY DESIGN: In part 1 of the study, the morphometry of thoracic pedicles and bony landmarks for pedicle screw placement were evaluated. In part 2, pedicle screws were inserted in fresh cadavers, using a different entry point in the left and right pedicles. OBJECTIVES: To identify the safest entry point and screw orientation for pedicle screws in the thoracic spine. SUMMARY OF BACKGROUND DATA: A few morphometric investigations have been performed on thoracic vertebrae, but the safest technique for screw insertion in thoracic pedicles has not been analyzed. METHODS: Mean, range, and standard deviations of pedicle transverse diameter and pedicle orientation were measured in 99 dried thoracic vertebrae. We evaluated the position of the bottom of the superior facet and that of the superior border of the transverse process in relation to the center of the pedicle. The relation between the pedicle axis and the superior facet in the frontal plane was also assessed. In part 2 of the study, pedicle screws were inserted in fresh cadavers at the intersection between the superior border of the transverse process and the middle of the superior facet (entry point A) and between the former and the lateral two thirds of the facet (entry point B). RESULTS: The smallest transverse diameter was found at 16 (mean 4.3 mm) where pedicles measured less than 5 mm in 68% of the specimens. In the frontal plane, the pedicle axis intersected the middle of the superior facet in 15% of specimens, the lateral two-thirds in 62%, and the lateral border of the facet in 23%. Of the 126 screws inserted in fresh human cadavers, 15 (24%) of the screws inserted using entry point A and 10 (16%) of those inserted using entry point B violated the pedicle cortex (P > 0.05). Six (10%) of the screws inserted using entry point A compared with no screw inserted using entry point B penetrated the anterior vertebral cortex (P = 0.03). CONCLUSIONS: Pedicles between T4 and T8 may not be wide enough for screw fixation. An entry point for pedicle screws located at the intersection between the superior border of the transverse process and the lateral two thirds of the superior facet seems more likely to be in line with the pedicle axis than do other entry points. In the lower thoracic vertebrae this entry point, in combination with insertion of the screws more medially oriented than the pedicle axis, significantly reduces the risk of violating the anterior vertebral cortex.