A. Cappozzo

Should the instructions issued to the subject in traditional static posturography be standardised

The postural ability of a subject is usually evaluated through the observation of the centre of pressure parameters obtained through posturography. These parameters are known to be sensitive to various factors and standards have consequently been proposed for data acquisition and analysis. A factor usually not taken into due consideration but likely to influence the postural exam is the kind of standing posture (e.g. natural or immobile) a subject is instructed to maintain. This study aimed at investigating whether instructions issued in a traditional static posturographic test influence its outcome and hence should be considered in the standardisation of the posturography protocols. Two groups of young healthy subjects were each issued one of two common instructions, stand quietly or stand as still as possible, by means of projected instructions. Differences between the two groups were investigated for commonly calculated centre of pressure parameters. All these parameters, but the mean frequency, were significantly different, with variations in the range between 8% (mean velocity) and 71% (confidence circle area). These results suggest that instructions given to the subjects strongly influence the outcome of posturography and should, hence, be standardised.

A spot check for estimating stereophotogrammetric errors

Good practice rules in the management of a movement analysis laboratory recommend that photogrammetric measurement errors are assessed, prior to every experimental session, using an ad hoc experiment referred to as a spot check. The paper proposes an inexpensive and easy to make spot check. The test uses a rigid rod carrying two markers and a target point taken on the line joining them and coinciding with the rod tip. The latter point is placed in a fixed and measured position in the laboratory frame and the markers are tracked while the rod is kept stationary and while it is manually made to rotate about the target point. Several target points are used within the measurement volume. The instantaneous errors with which the laboratory co-ordinates of the latter points are reconstructed are determined and submitted to statistical analysis. A normalisation procedure is illustrated that aims at making the test results independent from the geometry of the test object. The experimental and analytical methods underlying the proposed spot check were validated experimentally in two movement analysis laboratories using repeated tests. A rod, 1.5 m long, carrying four markers was used. In this way, several test-object geometries were tested. Results confirmed that the photogrammetric error could be divided into a zero-mean random and a systematic component. It was shown that the normalisation procedure was effective for the standard deviation of both error components when the two markers were located at a distance between them 1.5 times larger than the distance of their centroid from the tip of the rod. The systematic component bias could not be normalised, however a conservative value of it could be estimated. The two above-mentioned normalised standard deviations and the bias value can be taken as descriptors of the photogrammetric error of the specific measuring system tested. These parameters may also be used to assess the precision and the accuracy with which the laboratory position of a target point, defined relative to any specified marker cluster, may be reconstructed during movement analysis.

Control of the upper body movements during level walking in patients with facioscapulohumeral dystrophy

Facioscapulohumeral dystrophy (FSHD) is a muscular disease usually spreading from upper to lower body and characterised by asymmetric muscle weakness. Walking ability is compromised in these patients, with a consequent high risk of falls. A quantitative analysis of the upper body oscillations may unveil useful information about the capacity of these patients to stabilise the head, maintain balance, and compensate for lower limb muscle weakness during walking. This study involved 13 patients with FSHD and 13 healthy volunteers. The trajectories of three points located on the cranio-caudal axis, at head, shoulder, and pelvis levels, during level walking, were analysed. The range of motion of these three points and the attenuation of the relevant accelerations going from pelvis to head level were used to describe the upper body movements during walking. The patients had wider and less symmetrical oscillations than the healthy controls both in antero-posterior and medio-lateral directions. Furthermore, the capacity of the patients to attenuate the accelerations going from pelvis to head level was reduced. These features may be related not only to upper body muscle weakness, but also to a strategy functional to the compensation of proximal leg muscle weakness. In conclusion, this study highlighted that the control of upper body oscillations and of head stability is reduced in patients with FSHD, suggesting that the assessment of the upper body movements should be included in the treatment decision process.

The onset of type 2 diabetes: Proposal for a multi-scale model

Background Type 2 diabetes mellitus (T2D) is a common age-related disease, and is a major health concern, particularly in developed countries where the population is aging, including Europe. The multi-scale immune system simulator for the onset of type 2 diabetes (MISSION-T2D) is a European Union-funded project that aims to develop and validate an integrated, multilevel, and patient-specific model, incorporating genetic, metabolic, and nutritional data for the simulation and prediction of metabolic and inflammatory processes in the onset and progression of T2D. The project will ultimately provide a tool for diagnosis and clinical decision making that can estimate the risk of developing T2D and predict its progression in response to possible therapies. Recent data showed that T2D and its complications, specifically in the heart, kidney, retina, and feet, should be considered a systemic disease that is sustained by a pervasive, metabolically-driven state of inflammation. Accordingly, there is an urgent need (1) to understand the complex mechanisms underpinning the onset of this disease, and (2) to identify early patient-specific diagnostic parameters and related inflammatory indicators. Objective We aim to accomplish this mission by setting up a multi-scale model to study the systemic interactions of the biological mechanisms involved in response to a variety of nutritional and metabolic stimuli and stressors. Methods Specifically, we will be studying the biological mechanisms of immunological/inflammatory processes, energy intake/expenditure ratio, and cell cycle rate. The overall architecture of the model will exploit an already established immune system simulator as well as several discrete and continuous mathematical methods for modeling of the processes critically involved in the onset and progression of T2D. We aim to validate the predictions of our models using actual biological and clinical data. Results This study was initiated in March 2013 and is expected to be completed by February 2016. Conclusions MISSION-T2D aims to pave the way for translating validated multilevel immune-metabolic models into the clinical setting of T2D. This approach will eventually generate predictive biomarkers for this disease from the integration of clinical data with metabolic, nutritional, immune/inflammatory, genetic, and gut microbiota profiles. Eventually, it should prove possible to translate these into cost-effective and mobile-based diagnostic tools.

A neurofuzzy inference system based on biomechanical features for the evaluation of the effects of physical training.

The current study aimed to evaluate physical training effects. For this purpose, a classifier was implemented by taking into account biomechanical features selected from force-plate measurements and a neurofuzzy algorithm for data management and relevant decision-making. Measurements included two sets of sit-to-stand (STS) trials involving two homogeneous groups, experimental and control, of elders. They were carried out before and after a 12-week heavy resistance strength-training program undergone by the experimental group. Pre- and post-training differences were analysed, and percentages of membership to “trained” and “untrained” fuzzy sets calculated. The method was shown to be appropriate for detecting significant training-related changes. Detection accuracy was higher than 87%. Slightly weaker results were obtained using a neural approach, suggesting the need for a larger sample size. In conclusion, the use of a set of biomechanical features and of a neurofuzzy algorithm allowed to propose a global score for evaluating the effectiveness of a specific training program.

Musculoskeletal system modelling for the evaluation of motor disability

Musculoskeletal system models aimed at assessing activity limitation and impairment of a specific individual in the domain of mobility are presented. A thorough biomechanical analysis of selected motor tasks would be effective but awkward to apply in clinical practice by reason of the complexity of both instrumentation and experimental protocols. Therefore, different methods are proposed that entail the measurement of a minimum number of biomechanical variables. However, since data thus obtained do not necessarily lend themselves to straightforward interpretation, they are fed to models of the musculoskeletal system that embody the invariant aspects of both the modelled system and the specific motor task (minimum measured-input models). Two different sets of mathematical models are presented that aim at assessing activity limitation and establishing a relationship between this limitation and impairment, respectively.