Publications by authors named "Giorgia Chini"

14 Publications

  • Page 1 of 1

Equivalent Weight: Connecting Exoskeleton Effectiveness with Ergonomic Risk during Manual Material Handling.

Int J Environ Res Public Health 2021 Mar 7;18(5). Epub 2021 Mar 7.

Advanced Robotics, Istituto Italiano di Tecnologia, Via Morego, 30, 16163 Genova, Italy.

Occupational exoskeletons are becoming a concrete solution to mitigate work-related musculoskeletal disorders associated with manual material handling activities. The rationale behind this study is to search for common ground for exoskeleton evaluators to engage in dialogue with corporate Health & Safety professionals while integrating exoskeletons with their workers. This study suggests an innovative interpretation of the effect of a lower-back assistive exoskeleton and related performances that are built on the benefit delivered through reduced activation of the erector spinae musculature. We introduce the concept of "equivalent weight" as the weight perceived by the wearer, and use this to explore the apparent reduced effort needed when assisted by the exoskeleton. Therefore, thanks to this assistance, the muscles experience a lower load. The results of the experimental testing on 12 subjects suggest a beneficial effect for the back that corresponds to an apparent reduction of the lifted weight by a factor of 37.5% (the perceived weight of the handled objects is reduced by over a third). Finally, this analytical method introduces an innovative approach to quantify the ergonomic benefit introduced by the exoskeletons' assistance. This aims to assess the ergonomic risk to support the adoption of exoskeletons in the workplace.
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http://dx.doi.org/10.3390/ijerph18052677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967312PMC
March 2021

Progressive Modular Rebalancing System and Visual Cueing for Gait Rehabilitation in Parkinson's Disease: A Pilot, Randomized, Controlled Trial With Crossover.

Front Neurol 2019 29;10:902. Epub 2019 Aug 29.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

The progressive modular rebalancing (PMR) system is a comprehensive rehabilitation approach derived from proprioceptive neuromuscular facilitation principles. PMR training encourages focus on trunk and proximal muscle function through direct perception, strength, and stretching exercises and emphasizes bi-articular muscle function in the improvement of gait performance. Sensory cueing, such as visual cues (VC), is one of the more established techniques for gait rehabilitation in PD. In this study, we propose PMR combined with VC for improving gait performance, balance, and trunk control during gait in patients with PD. Our assumption herein was that the effect of VC may add to improved motor performance induced by the PMR treatment. The primary aim of this study was to evaluate whether the PMR system plus VC was a more effective treatment option than standard physiotherapy in improving gait function in patients with PD. The secondary aim of the study was to evaluate the effect of this treatment on motor function severity. Two-center, randomized, controlled, observer-blind, crossover study with a 4-month washout period. Forty individuals with idiopathic PD in Hoehn and Yahr stages 1-4. Eight-week rehabilitation programs consisting of PMR plus VC (treatment A) and conventional physiotherapy (treatment B). Spatiotemporal gait parameters, joint kinematics, and trunk kinematics. UPDRS-III scale scores. The rehabilitation program was well-tolerated by individuals with PD and most participants showed improvements in gait variables and UPDRS-III scores with both treatments. However, patients who received PMR with VC showed better results in gait function with regard to gait performance (increased step length, gait speed, and joint kinematics), gait balance (increased step width and double support duration), and trunk control (increased trunk motion) than those receiving conventional physiotherapy. While crossover results revealed some differences in primary outcomes, only 37.5% of patients crossed over between the groups. As a result, our findings should be interpreted cautiously. The PMR plus VC program could be used to improve gait function and severity motor of motor deficit in individuals with PD. : www.ClinicalTrials.gov, identifier NCT03346265.
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http://dx.doi.org/10.3389/fneur.2019.00902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6730596PMC
August 2019

Prediction of Responsiveness of Gait Variables to Rehabilitation Training in Parkinson's Disease.

Front Neurol 2019 2;10:826. Epub 2019 Aug 2.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy.

Gait disorders represent one of the most disabling features of Parkinson's disease, which may benefit from rehabilitation. No consistent evidence exists about which gait biomechanical factors can be modified by rehabilitation and which clinical characteristic can predict rehabilitation-induced improvements. The aims of the study were as follows: (i) to recognize the gait parameters modifiable by a short-term rehabilitation program; (ii) to evaluate the gait parameters that can normalize after rehabilitation; and (iii) to identify clinical variables predicting improvements in gait function after rehabilitation. Thirty-six patients affected by idiopathic Parkinson's disease in Hoehn-Yahr stage 1-3 and 22 healthy controls were included in the study. Both clinical and instrumental (gait analysis) evaluations were performed before and after a 10-weeks rehabilitation treatment. Time-distance parameters, lower limb joint, and trunk kinematics were measured. At baseline evaluation with matched speed, almost all gait parameters were significantly different between patients and healthy controls. After the 10-weeks rehabilitation, most gait parameters improved, and spatial asymmetry and trunk rotation normalized. Multiple linear regression of gender combined with Unified Parkinson's Disease Rating Scale-III predicted both ΔSpeed and ΔStep length of both sides; gender combined with Unified Parkinson's Disease Rating Scale-II predicted ΔCadence; age combined with Hoehn-Yahr score and disease duration predicted Δtrunk rotation range of motion. Impaired gait parameters are susceptible to improvement by rehabilitation, and younger men with Parkinson's disease who are less severely affected and at early disease stage are more susceptible to improvements in gait function after a 10-weeks rehabilitation program.
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http://dx.doi.org/10.3389/fneur.2019.00826DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6688512PMC
August 2019

Biomechanical characterization of the Junzuki karate punch: indexes of performance.

Eur J Sport Sci 2018 Jul 3;18(6):796-805. Epub 2018 Apr 3.

b Rehabilitation Centre , Policlinico Italia , Rome , Italy.

The aims of this study were: (i) to determine kinematic, kinetic, and electromyographic characteristics of Junzuki karate punch in professional karate athletes; (ii) to identify biomechanical parameters that correlate with punch force and lead to a higher punching performance; (iii) to verify the presence of muscle co-activation in the upper limb, trunk, and lower limb muscles. Data were collected from nine experienced karatekas from the Accademia Italiana Karate e Arti Marziali during the execution of the specific punch. Mean punch forces (181.2 N) delivered to the target, the range of motion of both right and left knees (1.13 and 0.82 rad) and right elbow (1.49 rad) joints, and the angles at impact (knee: 0.81 and 0.91 rad; elbow: 1.19 rad) in the sagittal plane were computed. Furthermore, the trunk rotational angular acceleration (63.1 rads), force related to the lower limbs (550.2 and 425.1 N), and co-activation index for the upper limb (36.1% and 34.7%), trunk (24.5% and 16%), and lower limbs (16.0% and 16.1%) muscles were evaluated bilaterally. Significant positive correlations were found between the punch force and both right and left knee flexion at the instant of impact and right and left leg force. Significant negative correlation was found between the punch force and maximum trunk angular acceleration. Significant differences (p = .03) in the co-activation index among the upper limb, trunk, and lower limbs muscles highlighted a rostro-caudal gradient on both body sides. This research could be of use to performers and coaches when considering training preparations.
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http://dx.doi.org/10.1080/17461391.2018.1455899DOI Listing
July 2018

Dataset on gait patterns in degenerative neurological diseases.

Data Brief 2018 Feb 12;16:806-816. Epub 2017 Dec 12.

Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18 - 00184 Roma, Italy.

We collected the gait parameters and lower limb joint kinematics of patients with three different types of primary degenerative neurological diseases: (i) cerebellar ataxia (19 patients), (ii) hereditary spastic paraparesis (26 patients), and (iii) Parkinson's disease (32 patients). Sixty-five gender-age matched healthy subjects were enrolled as control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls.
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http://dx.doi.org/10.1016/j.dib.2017.12.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5773445PMC
February 2018

Identification of specific gait patterns in patients with cerebellar ataxia, spastic paraplegia, and Parkinson's disease: A non-hierarchical cluster analysis.

Hum Mov Sci 2018 Feb 28;57:267-279. Epub 2017 Sep 28.

Department of Mechanical and Aerospace Engineering, "Sapienza" University of Rome, Via Eudossiana 18, 00184 Roma, Italy.

Background: Patients with degenerative neurological diseases such as cerebellar ataxia, spastic paraplegia, and Parkinson's disease often display progressive gait function decline that inexorably impacts their autonomy and quality of life. Therefore, considering the related social and economic costs, one of the most important areas of intervention in neurorehabilitation should be the treatment of gait abnormalities. This study aims to determine whether an entire dataset of gait parameters recorded in patients with degenerative neurological diseases can be clustered into homogeneous groups distinct from each other and from healthy subjects. Patients affected by three different types of primary degenerative neurological diseases were studied. These diseases were: i) cerebellar ataxia (28 patients), ii) hereditary spastic paraplegia (31 patients), and iii) Parkinson's disease (70 patients). Sixty-five gender-age-matched healthy subjects were enrolled as a control group. An optoelectronic motion analysis system was used to measure time-distance parameters and lower limb joint kinematics during gait in both patients and healthy controls. When clustering single parameters, step width and ankle joint range of motion (RoM) in the sagittal plane differentiated cerebellar ataxia group from the other groups. When clustering sets of two, three, or four parameters, several pairs, triples, and quadruples of clusters differentiated the cerebellar ataxia group from the other groups. Interestingly, the ankle joint RoM parameter was present in 100% of the clusters and the step width in approximately 50% of clusters. In addition, in almost all clusters, patients with cerebellar ataxia showed the lowest ankle joint RoM and the largest step width values compared to healthy controls, patients with hereditary spastic paraplegia, and Parkinson's disease subjects. This study identified several clusters reflecting specific gait patterns in patients with degenerative neurological diseases. In particular, the specific gait pattern formed by the increased step width, reduced ankle joint RoM, and increased gait variability, can differentiate patients with cerebellar ataxia from healthy subjects and patients with spastic paraplegia or Parkinson's disease. These abnormal parameters may be adopted as sensitive tools for evaluating the effect of pharmacological and rehabilitative treatments.
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http://dx.doi.org/10.1016/j.humov.2017.09.005DOI Listing
February 2018

Myoelectric manifestation of muscle fatigue in repetitive work detected by means of miniaturized sEMG sensors.

Int J Occup Saf Ergon 2018 Sep 25;24(3):464-474. Epub 2017 Sep 25.

a Department of Occupational and Environmental Medicine, Epidemiology and Hygiene , INAIL , Italy.

Upper limb work-related musculoskeletal disorders have a 12-month prevalence ranging from 12 to 41% worldwide and can be partly caused by handling low loads at high frequency. The association between the myoelectric manifestation of elbow flexor muscle fatigue and occupational physical demand has never been investigated. It was hypothesized that an elbow flexor muscle fatigue index could be a valid risk indicator in handling low loads at high frequency. This study aims to measure the myoelectric manifestation of muscle fatigue of the three elbow flexor muscles during the execution of the work tasks in different risk conditions. Fifteen right-handed healthy adults were screened using a movement analysis laboratory consisting of optoelectronic, dynamometer and surface electromyographic systems. The main result indicates that the fatigue index calculated from the brachioradialis is sensitive to the interaction among risk classes, session and gender, and above all it is sensitive to the risk classes.
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http://dx.doi.org/10.1080/10803548.2017.1357867DOI Listing
September 2018

Harmony as a convergence attractor that minimizes the energy expenditure and variability in physiological gait and the loss of harmony in cerebellar ataxia.

Clin Biomech (Bristol, Avon) 2017 Oct 5;48:15-23. Epub 2017 Jul 5.

INAIL, Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Via Fontana Candida 1, 00040 Monte Porzio Catone, Italy. Electronic address:

Background: The harmony of the human gait was recently found to be related to the golden ratio value (ϕ). The ratio between the duration of the stance and that of the swing phases of a gait cycle was in fact found to be close to ϕ, which implies that, because of the fractal property of autosimilarity of that number, the gait ratios stride/stance, stance/swing, swing/double support, were not significantly different from one another. We studied a group of patients with cerebellar ataxia to investigate how the differences between their gait ratios and the golden ratio are related to efficiency and stability of their gait, assessed by energy expenditure and stride-to-stride variability, respectively.

Methods: The gait of 28 patients who were affected by degenerative cerebellar ataxia and of 28 healthy controls was studied using a stereophotogrammetric system. The above mentioned gait ratios, the energy expenditure estimated using the pelvis reconstructed method and the gait variability in terms of the stride length were computed, and their relationships were analyzed. Matching procedures have also been used to avoid multicollinearity biases.

Findings: The gait ratio values of the patients were farther from the controls (and hence from ϕ), even in speed matched conditions (P=0.011, Cohen's D=0.76), but not when the variability and energy expenditure were matched between the two groups (Cohen's D=0.49). In patients with cerebellar ataxia, the farther the stance-swing ratio was from ϕ, the larger the total mechanical work (R=0.64). Further, a significant positive correlation was observed between the difference of the gait ratio from the golden ratio and the severity of the disease (R=0.421, P=0.026).

Interpretation: Harmony of gait appears to be a benchmark of physiological gait leading to physiological energy recovery and gait reliability. Neurorehabilitation of patients with ataxia might benefit from the restoration of harmony of their locomotor patterns.
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http://dx.doi.org/10.1016/j.clinbiomech.2017.07.001DOI Listing
October 2017

Use of dynamic movement orthoses to improve gait stability and trunk control in ataxic patients.

Eur J Phys Rehabil Med 2017 Oct 19;53(5):735-743. Epub 2017 Jun 19.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University, Polo Pontino, Latina, Italy.

Background: Patients with cerebellar ataxia show increased upper body movements, which have an impact on balance and walking.

Aim: In this study, we investigated the effect of using dynamic movement orthoses (DMO), designed as elastic suits, on trunk motion and gait parameters.

Design: Longitudinal uncontrolled study.

Setting: Outpatient rehabilitation unit.

Population: Eleven patients (7 men, 4 women; mean age: 49.9±9.5 years) with degenerative cerebellar ataxia were enrolled in this study.

Methods: Linear overground gait of patients was recorded by means of an optoelectronic gait analysis system before DMO use (DMO-) and during DMO use (DMO+). Time-distance parameters, lower limb joint kinematics, body sway, trunk oscillations, and gait variability (coefficient of variation [CV]) were recorded. Patient satisfaction with DMO device was measured using Quebec user evaluation of satisfaction with assistive technology.

Results: When using the DMO, patients showed a significant decrease in stance phase duration, double support phase duration, swing phase CV, pelvic range of motion (ROM), body sway, and trunk ROMs. A significant increase was observed in the swing phase duration and knee joint ROM. Out of 11 patients, 10 were either quite satisfied (8 points) or very satisfied (2 points) with the assistive device.

Conclusions: The DMO reduce the upper body motion and in improve balance-related gait parameters.

Clinical Rehabilitation Impact: We propose use of DMO as an assistive/rehabilitative device in the neurorehabilitation of cerebellar ataxia to improve the trunk control and gait stability. DMO may be considered a prototype that can be modified in terms of material characteristics, textile layers, elastic components, and diagonal and lateral seams.
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http://dx.doi.org/10.23736/S1973-9087.17.04480-XDOI Listing
October 2017

Progression of Gait Ataxia in Patients with Degenerative Cerebellar Disorders: a 4-Year Follow-Up Study.

Cerebellum 2017 06;16(3):629-637

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Via Faggiana 1668, 40100, Latina, Italy.

In the present study, the progression of gait impairment in a group of patients with primary degenerative cerebellar ataxias was observed over a period of 4 years. A total of 30 patients underwent an initial gait analysis study, and thereafter only 12 were evaluated because they completed the 2- and 4-year follow-up evaluations. Time-distance parameters, trunk and joint range of motion (RoM), and variability parameters (e.g., coefficients of variation) were measured at the baseline and at each follow-up evaluation. The scale for the assessment and rating of ataxia (SARA) was used to evaluate disease severity. We found a significant increase in the SARA score at both the 2- and 4-year follow-up evaluations. Almost all the gait variables changed significantly only at the 4-year follow-up. Particularly, we found a significant decrease in the step length and in the hip, knee, and ankle joint RoM values and noted a significant increase in the trunk rotation RoM and stride-to-stride and step length variability. Furthermore, a significant difference in ankle joint RoM was found between spinocerebellar ataxia and sporadic adult-onset ataxia patients, with the value being lower in the former group of patients. Our findings suggest that patients with degenerative cerebellar ataxias exhibit gait decline after 4 years from the baseline. Moreover, patients try to maintain an effective gait by adopting different compensatory mechanisms during the course of the disease in spite of disease progression.
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http://dx.doi.org/10.1007/s12311-016-0837-2DOI Listing
June 2017

Local Stability of the Trunk in Patients with Degenerative Cerebellar Ataxia During Walking.

Cerebellum 2017 02;16(1):26-33

Movement Analysis LAB, Rehabilitation Centre Policlinico Italia, Piazza del Campidano 6, 00162, Rome, Italy.

This study aims to evaluate trunk local stability in a group of patients with degenerative primary cerebellar ataxia and to correlate it with spatio-temporal parameters, clinical variables, and history of falls. Sixteen patients affected by degenerative cerebellar ataxia and 16 gender- and age-matched healthy adults were studied by means of an inertial sensor to measure trunk kinematics and spatio-temporal parameters during over-ground walking. Trunk local dynamic stability was quantified by the maximum Lyapunov exponent with short data series of the acceleration data. According to this index, low values indicate more stable trunk dynamics, while high values denote less stable trunk dynamics. Disease severity was assessed by means of International Cooperative Ataxia Rating Scale (ICARS) according to which higher values correspond to more severe disease, while lower values correspond to less severe disease.Patients displayed a higher short-term maximum Lyapunov exponent than controls in all three spatial planes, which was correlated with the age, onset of the disease, and history of falls. Furthermore, the maximum Lyapunov exponent was negatively correlated with ICARS balance, ICARS posture, and ICARS total scores.These findings indicate that trunk local stability during gait is lower in patients with cerebellar degenerative ataxia than that in healthy controls and that this may increase the risk of falls. Local dynamic stability of the trunk seems to be an important aspect in patients with ataxia and could be a useful tool in the evaluation of rehabilitative and pharmacological treatment outcomes.
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http://dx.doi.org/10.1007/s12311-016-0760-6DOI Listing
February 2017

Effect of 24-h continuous rotigotine treatment on stationary and non-stationary locomotion in de novo patients with Parkinson disease in an open-label uncontrolled study.

J Neurol 2015 Nov 25;262(11):2539-47. Epub 2015 Aug 25.

Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Latina, Italy.

The aim of this study was to investigate the effect of a rotigotine transdermal patch on stationary and non-stationary locomotion in de novo Parkinson disease (PD) patients in an open-label uncontrolled study. A 3-D gait analysis system was used to investigate four different locomotor tasks: steady-state linear walking, gait initiation, gait termination and 180°-turning. A series of gait variables were measured for each locomotor task. PD patients who received rotigotine treatment (4-8 mg) displayed: (1) increased step length, gait speed, cadence and arm oscillations, and reduced double support duration and step asymmetry during steady-state linear gait; (2) increased initial step length during gait initiation; (3) increased final step length and gait speed, and decreased stability index during gait termination; (4) decreased duration of turning and head-pelvis delays during 180°-turning. The main finding that emerges from the present study is that the dopamine agonist rotigotine can improve various aspects of gait in de novo PD patients.
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http://dx.doi.org/10.1007/s00415-015-7883-4DOI Listing
November 2015

Resting state cortical electroencephalographic rhythms in covert hepatic encephalopathy and Alzheimer's disease.

J Alzheimers Dis 2013 ;34(3):707-25

Department of Molecular Medicine, University of Rome Sapienza, Rome, Italy IRCCS San Raffaele Pisana, Rome, Italy.

Patients suffering from prodromal (i.e., amnestic mild cognitive impairment, aMCI) and overt Alzheimer's disease (AD) show abnormal cortical sources of resting state electroencephalographic (EEG) rhythms. Here we tested the hypothesis that these sources show extensive abnormalities in liver cirrhosis (LC) patients with a cognitive impairment due to covert and diffuse hepatic encephalopathy (CHE). EEG activity was recorded in 64 LC (including 21 CHE), 21 aMCI, 21 AD, and 21 cognitively intact (Nold) subjects. EEG rhythms of interest were delta (2-4 Hz), theta (4-8 Hz), alpha 1 (8-10.5 Hz), alpha 2 (10.5-13 Hz), beta 1 (13-20 Hz), and beta 2 (20-30 Hz). EEG cortical sources were estimated by LORETA. Widespread sources of theta (all but frontal), alpha 1 (all but occipital), and alpha 2 (parietal, temporal) rhythms were higher in amplitude in all LC patients than in the Nold subjects. In these LC patients, the activity of central, parietal, and temporal theta sources correlated negatively, and parietal and temporal alpha 2 sources correlated positively with an index of global cognitive status. Finally, widespread theta (all but frontal) and alpha 1 (all but occipital) sources showed higher activity in the sub-group of LC patients with CHE than in the patients with aMCI or AD. These results unveiled the larger spatial-frequency abnormalities of the resting state EEG sources in the CHE compared to the AD condition.
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http://dx.doi.org/10.3233/JAD-121807DOI Listing
December 2013