Publications by authors named "Tiwana Varrecchia"

13 Publications

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An artificial neural network approach to detect presence and severity of Parkinson's disease via gait parameters.

PLoS One 2021 19;16(2):e0244396. Epub 2021 Feb 19.

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

Introduction: Gait deficits are debilitating in people with Parkinson's disease (PwPD), which inevitably deteriorate over time. Gait analysis is a valuable method to assess disease-specific gait patterns and their relationship with the clinical features and progression of the disease.

Objectives: Our study aimed to i) develop an automated diagnostic algorithm based on machine-learning techniques (artificial neural networks [ANNs]) to classify the gait deficits of PwPD according to disease progression in the Hoehn and Yahr (H-Y) staging system, and ii) identify a minimum set of gait classifiers.

Methods: We evaluated 76 PwPD (H-Y stage 1-4) and 67 healthy controls (HCs) by computerized gait analysis. We computed the time-distance parameters and the ranges of angular motion (RoMs) of the hip, knee, ankle, trunk, and pelvis. Principal component analysis was used to define a subset of features including all gait variables. An ANN approach was used to identify gait deficits according to the H-Y stage.

Results: We identified a combination of a small number of features that distinguished PwPDs from HCs (one combination of two features: knee and trunk rotation RoMs) and identified the gait patterns between different H-Y stages (two combinations of four features: walking speed and hip, knee, and ankle RoMs; walking speed and hip, knee, and trunk rotation RoMs).

Conclusion: The ANN approach enabled automated diagnosis of gait deficits in several symptomatic stages of Parkinson's disease. These results will inspire future studies to test the utility of gait classifiers for the evaluation of treatments that could modify disease progression.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244396PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894951PMC
February 2021

The Sensor-Based Biomechanical Risk Assessment at the Base of the Need for Revising of Standards for Human Ergonomics.

Sensors (Basel) 2020 Oct 10;20(20). Epub 2020 Oct 10.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00040 Rome, Italy.

Due to the epochal changes introduced by "Industry 4.0", it is getting harder to apply the varying approaches for biomechanical risk assessment of manual handling tasks used to prevent work-related musculoskeletal disorders (WMDs) considered within the International Standards for ergonomics. In fact, the innovative human-robot collaboration (HRC) systems are widening the number of work motor tasks that cannot be assessed. On the other hand, new sensor-based tools for biomechanical risk assessment could be used for both quantitative "direct instrumental evaluations" and "rating of standard methods", allowing certain improvements over traditional methods. In this light, this Letter aims at detecting the need for revising the standards for human ergonomics and biomechanical risk assessment by analyzing the WMDs prevalence and incidence; additionally, the strengths and weaknesses of traditional methods listed within the International Standards for manual handling activities and the next challenges needed for their revision are considered. As a representative example, the discussion is referred to the lifting of heavy loads where the revision should include the use of sensor-based tools for biomechanical risk assessment during lifting performed with the use of exoskeletons, by more than one person (team lifting) and when the traditional methods cannot be applied. The wearability of sensing and feedback sensors in addition to human augmentation technologies allows for increasing workers' awareness about possible risks and enhance the effectiveness and safety during the execution of in many manual handling activities.
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http://dx.doi.org/10.3390/s20205750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599507PMC
October 2020

Pelvic obliquity as a compensatory mechanism leading to lower energy recovery: Characterization among the types of prostheses in subjects with transfemoral amputation.

Gait Posture 2020 07 12;80:280-284. Epub 2020 Jun 12.

Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100, Latina, Italy; Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy.

Background: Subjects with transfemoral amputation (TFA) show an asymmetric gait pattern associated with a decreased ability to recover mechanical energy and an increased metabolic cost of walking.

Research Question: This study aimed to identify the spatio-temporal and kinematic gait variables correlated with mechanical energy values in subjects with TFA and to observe the ability of the identified parameters to discriminate between TFA and controls according to the type of prosthesis.

Methods: The gait of 40 subjects with TFA was evaluated with a motion 3-D optoelectronic system. Nine subjects wore a mechanical prosthesis (TFAm), seventeen a C-Leg prosthesis (TFAc), and fourteen a Genium prosthesis (TFAg). Spatio-temporal and pelvic kinematic parameters were measured. Energy recovery was measured relative to the whole-body center of mass (CoM) kinematics as the fraction of mechanical energy recovered during each walking step (R-step). Correlation tests and multiple linear regression analyses were used to evaluate the correlation and association between kinematic and energy variables, respectively. Receiver operating characteristics curves were plotted to assess the ability of the correlated parameter to distinguish subjects with TFA from controls, and optimal cutoff point values were calculated according to the type of prosthesis.

Results: Among the spatio-temporal and kinematic parameters correlated to R-step, only pelvic obliquity of the prosthetic side was significantly associated with R-step. It showed an excellent ability to discriminate between TFA and controls. Furthermore, pelvic obliquity showed an excellent discriminative ability in identifying TFAm and TFAc and a good discriminative ability in identifying TFAg from controls.

Significance: Pelvic obliquity plays an important role in energy recovery during gait for subjects using prosthetics. This information might be exploited to monitor the adaptation of subjects with TFA to prosthetic devices, to lower the energetic cost of walking potentially, and to reduce the long-term risks of secondary physical complications in prosthetic users.
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http://dx.doi.org/10.1016/j.gaitpost.2020.06.013DOI Listing
July 2020

Impairment of Global Lower Limb Muscle Coactivation During Walking in Cerebellar Ataxias.

Cerebellum 2020 Aug;19(4):583-596

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

The aim of this study was to investigate the time-varying multi-muscle coactivation function (TMCf) in the lower limbs during gait and its relationship with the biomechanical and clinical features of patients with cerebellar ataxia. A total of 23 patients with degenerative cerebellar ataxia (16 with spinocerebellar ataxia, 7 with adult-onset ataxia of unknown etiology) and 23 age-, sex-, and speed-matched controls were investigated. The disease severity was assessed using the Scale for the Assessment and Rating of Ataxia (SARA) in all patients. During walking, simultaneous acquisition of kinematic, kinetic, and electromyography data was performed using a motion analysis system. The coactivation was processed throughout the gait cycle using the TMCf, and the following parameters were measured: synthetic coactivation index, full width at half maximum, and center of activity. Spatiotemporal (walking speed, stance duration, swing duration, first and second double-support durations, step length, step width, stride length, Center of Mass displacement), kinetic (vertical component of GRFs), and energy consumption (total energy consumption and mechanical energy recovered) parameters were also measured. The coactivation variables were compared between patients and controls and were correlated with both clinical and gait variables. A significantly increased global TMCf was found in patients compared with controls. In addition, the patients showed a significant shift of the center of activity toward the initial contact and a significant reduction in energy recovery. All coactivation parameters were negatively correlated with gait speed, whereas the coactivation index and center of activity were positively correlated with both center-of-mass mediolateral displacement values and SARA scores. Our findings suggest that patients use global coactivation as a compensatory mechanism during the earliest and most challenging subphase (loading response) of the gait cycle to reduce the lateral body sway, thus improving gait stability at the expense of effective energy recovery. This information could be helpful in optimizing rehabilitative treatment aimed at improving lower limb muscle control during gait in patients with cerebella ataxia.
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http://dx.doi.org/10.1007/s12311-020-01142-6DOI Listing
August 2020

Global Muscle Coactivation of the Sound Limb in Gait of People with Transfemoral and Transtibial Amputation.

Sensors (Basel) 2020 Apr 29;20(9). Epub 2020 Apr 29.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Monte Porzio Catone, 00185 Rome, Italy.

The aim of this study was to analyze the effect of the level of amputation and various prosthetic devices on the muscle activation of the sound limb in people with unilateral transfemoral and transtibial amputation. We calculated the global coactivation of 12 muscles using the time-varying multimuscle coactivation function method in 37 subjects with unilateral transfemoral amputation (10, 16, and 11 with mechanical, electronic, and bionic prostheses, respectively), 11 subjects with transtibial amputation, and 22 healthy subjects representing the control group. The results highlighted that people with amputation had a global coactivation temporal profile similar to that of healthy subjects. However, amputation increased the level of the simultaneous activation of many muscles during the loading response and push-off phases of the gait cycle and decreased it in the midstance and swing subphases. This increased coactivation probably plays a role in prosthetic gait asymmetry and energy consumption. Furthermore, people with amputation and wearing electronic prosthesis showed lower global coactivation when compared with people wearing mechanical and bionic prostheses. These findings suggest that the global lower limb coactivation behavior can be a useful tool to analyze the motor control strategies adopted and the ability to adapt to the prosthetic device.
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http://dx.doi.org/10.3390/s20092543DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7249183PMC
April 2020

Wearable-based Temporal Parameters of Gait in Circuitous Routes under Dual-Task Conditions.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:1224-1227

12 young adults were requested to walk along a circuitous path including turns, slaloms, stair ascending and descending, while wearing an inertial sensor placed on the back at the lumbar level. The path was completed under two conditions: with no additive cognitive task, and while performing a cognitive task and texting on a smartphone. Different temporal global parameters of gait were extracted from the inertial sensor data, to check for differences driven by the presence of the cognitive task. Regularity, durations, and temporal characteristics of gait resulted significantly affected from the presence of the additional task, and this effect was only in part due to a modification coming from the decrease in walking speed.
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http://dx.doi.org/10.1109/EMBC.2019.8856531DOI Listing
July 2019

Common and specific gait patterns in people with varying anatomical levels of lower limb amputation and different prosthetic components.

Hum Mov Sci 2019 Mar 16;66:9-21. Epub 2019 Mar 16.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, 00078 Monte Porzio Catone, Rome, Italy.

The present study's aim was to identify the kinematic and kinetic gait patterns and to measure the energy consumption in people with amputation according to both the anatomical level of amputation and the type of prosthetic components in comparison with a control group matched for the gait speed. Fifteen subjects with unilateral transtibial amputation (TTA), forty with unilateral transfemoral amputation (TFA) (9 with mechanical, 17 with CLeg and 14 with Genium prosthesis) and forty healthy subjects were recruited. We computed the time-distance gait parameters; the range of angular motion (RoM) at hip, knee and ankle joints, and at the trunk and pelvis; the values of the 2 peaks of vertical force curve; the full width at half maximum (FWHM) and center of activity (CoA) of vertical force; the mechanical behavior in terms of energy recovery (R-step) and energy consumption. The main results were: i) both TTA and TFA show a common gait pattern characterized by a symmetric increase of step length, step width, double support duration, pelvic obliquity, trunk lateral bending and trunk rotation RoMs compared to control groups. They show also an asymmetric increase of stance duration and of Peak1 in non-amputated side and a decrease of ankle RoM in amputated side; ii) only TFA show a specific gait pattern, depending on the level of amputation, characterized by a symmetric reduction of R-step and an asymmetric decrease of stance duration, CoA and FWHM and an increase of Peak1 in the amputated side and of hip and knee RoM, CoA and FWHM in the non-amputated side; iii) people with amputation with Genium prosthesis show a longer step length and increased hip and knee RoMs compared to people with amputation with mechanical prosthesis who conversely show an increased pelvic obliquity: these are specific gait patterns depending of the type of prosthesis. In conclusion, we identified both common and specific gait patterns in people with amputation, either regardless of, or according to their level of amputation and the type of prosthetic component.
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http://dx.doi.org/10.1016/j.humov.2019.03.008DOI Listing
March 2019

Erratum: Alberto, R. et al., Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review. Int. J. Environ. Res. Public Health 2018, 15, 2001.

Int J Environ Res Public Health 2018 11 16;15(11). Epub 2018 Nov 16.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.

Due to an error during production, the first author's name of the published paper [...].
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http://dx.doi.org/10.3390/ijerph15112569DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265804PMC
November 2018

Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review.

Int J Environ Res Public Health 2018 09 13;15(9). Epub 2018 Sep 13.

Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy.

: In order to reduce the risk of work-related musculoskeletal disorders (WMSDs) several methods have been developed, accepted by the international literature and used in the workplace. The purpose of this systematic review was to describe recent implementations of wearable sensors for quantitative instrumental-based biomechanical risk assessments in prevention of WMSDs. : Articles written until 7 May 2018 were selected from PubMed, Scopus, Google Scholar and Web of Science using specific keywords. : Instrumental approaches based on inertial measurement units and sEMG sensors have been used for direct evaluations to classify lifting tasks into low and high risk categories. Wearable sensors have also been used for direct instrumental evaluations in handling of low loads at high frequency activities by using the local myoelectric manifestation of muscle fatigue estimation. In the field of the rating of standard methods, on-body wireless sensors network-based approaches for real-time ergonomic assessment in industrial manufacturing have been proposed. : Few studies foresee the use of wearable technologies for biomechanical risk assessment although the requirement to obtain increasingly quantitative evaluations, the recent miniaturization process and the need to follow a constantly evolving manual handling scenario is prompting their use.
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http://dx.doi.org/10.3390/ijerph15092001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163390PMC
September 2018

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

Mechanical lifting energy consumption in work activities designed by means of the "revised NIOSH lifting equation".

Ind Health 2017 Oct 7;55(5):444-454. Epub 2017 Aug 7.

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

The aims of the present work were: to calculate lifting energy consumption (LEC) in work activities designed to have a growing lifting index (LI) by means of revised NIOSH lifting equation; to evaluate the relationship between LEC and forces at the L-S joint. The kinematic and kinetic data of 20 workers were recorded during the execution of lifting tasks in three conditions. We computed kinetic, potential and mechanical energy and the corresponding LEC by considering three different centers of mass of: 1) the load (CoM); 2) the multi-segment upper body model and load together (CoM); 3) the whole body and load together (CoM). We also estimated compression and shear forces. Results shows that LEC calculated for CoM and CoM grew significantly with the LI and that all the lifting condition pairs are discriminated. The correlation analysis highlighted a relationship between LEC and forces that determine injuries at the L-S joint.
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http://dx.doi.org/10.2486/indhealth.2017-0075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5633360PMC
October 2017

Increased lower limb muscle coactivation reduces gait performance and increases metabolic cost in patients with hereditary spastic paraparesis.

Clin Biomech (Bristol, Avon) 2017 Oct 29;48:63-72. Epub 2017 Jul 29.

Rehabilitation Centre, Policlinico Italia, Piazza del Campidano 6, 00162 Rome, Italy; Department of Medico-Surgical Sciences and Biotechnologies, University of Rome Sapienza, Via Faggiana 34, 04100 Latina, Italy. Electronic address:

Background: The aim of this study was to investigate the lower limb muscle coactivation and its relationship with muscles spasticity, gait performance, and metabolic cost in patients with hereditary spastic paraparesis.

Methods: Kinematic, kinetic, electromyographic and energetic parameters of 23 patients and 23 controls were evaluated by computerized gait analysis system. We computed ankle and knee antagonist muscle coactivation indexes throughout the gait cycle and during the subphases of gait. Energy consumption and energy recovery were measured as well. In addition to the correlation analysis between coactivation indexes and clinical variables, correlations between coactivation indexes and time-distance, kinematic, kinetic, and energetic parameters were estimated.

Findings: Increased coactivity indexes of both knee and ankle muscles throughout the gait cycle and during the subphases of gait were observed in patients compared with controls. Energetic parameters were significantly higher in patients than in controls. Both knee and ankle muscle coactivation indexes were positively correlated with knee and ankle spasticity (Ashworth score), respectively. Knee and ankle muscle coactivation indexes were both positively correlated with energy consumption and both negatively correlated with energy recovery.

Interpretation: Positive correlations between the Ashworth score and lower limb muscle coactivation suggest that abnormal lower limb muscle coactivation in patients with hereditary spastic paraparesis reflects a primary deficit linked to lower limb spasticity. Furthermore, these abnormalities influence the energetic mechanisms during walking. Identifying excessive muscle coactivation may be helpful in individuating the rehabilitative treatments and designing specific orthosis to restrain spasticity.
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http://dx.doi.org/10.1016/j.clinbiomech.2017.07.013DOI Listing
October 2017

Gait Patterns in Patients with Hereditary Spastic Paraparesis.

PLoS One 2016 12;11(10):e0164623. Epub 2016 Oct 12.

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

Background: Spastic gait is a key feature in patients with hereditary spastic paraparesis, but the gait characterization and the relationship between the gait impairment and clinical characteristics have not been investigated.

Objectives: To describe the gait patterns in hereditary spastic paraparesis and to identify subgroups of patients according to specific kinematic features of walking.

Methods: We evaluated fifty patients by computerized gait analysis and compared them to healthy participants. We computed time-distance parameters of walking and the range of angular motion at hip, knee, and ankle joints, and at the trunk and pelvis. Lower limb joint moments and muscle co-activation values were also evaluated.

Results: We identified three distinct subgroups of patients based on the range of motion values. Subgroup one was characterized by reduced hip, knee, and ankle joint range of motion. These patients were the most severely affected from a clinical standpoint, had the highest spasticity, and walked at the slowest speed. Subgroup three was characterized by an increased hip joint range of motion, but knee and ankle joint range of motion values close to control values. These patients were the most mildly affected and had the highest walking speed. Finally, subgroup two showed reduced knee and ankle joint range of motion, and hip range of motion values close to control values. Disease severity and gait speed in subgroup two were between those of subgroups one and three.

Conclusions: We identified three distinctive gait patterns in patients with hereditary spastic paraparesis that correlated robustly with clinical data. Distinguishing specific features in the gait patterns of these patients may help tailor pharmacological and rehabilitative treatments and may help evaluate therapeutic effects over time.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164623PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061421PMC
May 2017