Nicoleta Bugnariu

Ottawa Panel evidence-based clinical practice guidelines for the management of osteoarthritis in adults who are obese or overweight.

Background and Purpose The objective of this review was to construct an updated evidence-based clinical practice guideline on the use of physical activity and diet for the management of osteoarthritis (OA) in adults (>18 years of age) who are obese or overweight (body mass index ≥25 kg/m2). Data Sources Articles were extracted from the following databases: MEDLINE, EMBASE (Current Contents), SPORTDiscus, SUM, Scopus, CINAHL, AMED, BIOMED, PubMed, ERIC, the Cochrane Controlled Trials, and PEDro. Study Selection The Ottawa Panel and research assistance team strictly applied the inclusion and exclusion criteria from previous Ottawa Panel publications. Data Extraction An a priori literature search was conducted for articles related to obesity and OA of the lower extremities that were published from January 1, 1966, to November 30, 2010. Inclusion criteria and the methods to grade the recommendations were created by the Ottawa Panel. Data Synthesis Recommendations were graded based on the strength of evidence (A, B, C, C+, D, D+, or D−) as well as experimental design (I for randomized controlled trials and II for nonrandomized studies). In agreement with previous Ottawa Panel methods, Cochrane Collaboration methods were utilized for statistical analysis. Clinical significance was established by an improvement of ≥15% in the experimental group compared with the control group. There were a total of 79 recommendations from 9 articles. From these recommendations, there were 36 positive recommendations: 21 grade A and 15 grade C+. There were no grade B recommendations, and all recommendations were of clinical benefit. Limitations Further research is needed, as more than half of the trials were of low methodological quality. Conclusions This review suggests that physical activity and diet programs are beneficial, specifically for pain relief (9 grade A recommendations) and improved functional status (6 grade A and 7 grade C+ recommendations), for adults with OA who are obese or overweight. The Ottawa Panel was able to demonstrate that when comparing physical activity alone, diet alone, physical activity combined with diet, and control groups, the intervention including physical activity and diet produced the most beneficial results.

RoDiCA: a human-robot interaction system for treatment of childhood autism spectrum disorders

In this paper, we describe the implementation of interactive robotics in virtual environments accomplishing human-robot interaction for treatment of Autism Spectrum Disorders (ASDs). Interaction between our system and children suffering from ASDs is accomplished by teaching them body language such as hand and arm motion, facial expressions and speech to encourage them to engage in social interaction with other humans and for improving their motor skills. A Kinect sensor is used to allow direct control of the humanoid robot, Zeno, by the therapist or child to enable dynamic interaction. The motions of Zeno and the child are recorded simultaneously by a motion capture system to assess the interaction. Specifically, we compare arm and torso motions of the child which should closely follow those of the robot. This behavior can be used for clinical treatment and diagnosis during robot assisted therapy. Therapists can take advantage of this interactive behavior to achieve desired poses of the robot that may be beneficial to children with ASDs to enhance their motor skills as well as their social interaction skills. In order to compare the motion characteristics of robots and subjects, we use various metrics such as cross correlation and signal 2-norm. Results show that the childs motion follows the robots motion closely and the analysis techniques are reasonable indicators to compare the similarity of the human and robot motions.

Human-Robot Upper Body Gesture Imitation Analysis for Autism Spectrum Disorders

In this paper we combine robot control and data analysis techniques into a system aimed at early detection and treatment of autism. A humanoid robot - Zeno is used to perform interactive upper body gestures which the human subject can imitate or initiate. The result of interaction is recorded using a motion capture system, and the similarity of gestures performed by human and robot is measured using the Dynamic Time Warping algorithm. This measurement is proposed as a quantitative similarity measure to objectively analyze the quality of the imitation interaction between the human and the robot. In turn, the clinical hypothesis is that this will serve as a consistent quantitative measurement, and can be used to obtain information about the condition and possible improvement of children with autism spectrum disorders. Experimental results with a small set of child subjects are presented to illustrate our approach.

Level of Immersion in Virtual Environments Impacts the Ability to Assess and Teach Social Skills in Autism Spectrum Disorder

Abstract Virtual environments (VEs) may be useful for delivering social skills interventions to individuals with autism spectrum disorder (ASD). Immersive VEs provide opportunities for individuals with ASD to learn and practice skills in a controlled replicable setting. However, not all VEs are delivered using the same technology, and the level of immersion differs across settings. We group studies into low-, moderate-, and high-immersion categories by examining five aspects of immersion. In doing so, we draw conclusions regarding the influence of this technical manipulation on the efficacy of VEs as a tool for assessing and teaching social skills. We also highlight ways in which future studies can advance our understanding of how manipulating aspects of immersion may impact intervention success.

Human-robot interaction as a tool to evaluate and quantify motor imitation behavior in children with Autism Spectrum Disorders

Children with Autism Spectrum Disorders (ASD) have difficulties engaging in imitation behavior. Available clinical tests that evaluate imitation rely on subjective observation and categorical “yes” or “no” data. We describe the development of a method to quantify imitation using a robot, kinematic data and a Dynamic Time Warping algorithm. A realistic-looking robot performed movements such as “waving hello/goodbye”, “good job fist bump” and encouraged children with ASD and controls to imitate it. Preliminary results show that children with ASD interact positively with the robot and the DTW similarity measure may serve as both a meaningful and objective tool for evaluating the quality of imitation behavior.

Motor function in children with Autism spectrum disorders

This Autism spectrum disorders (ASD) are among the most common pediatric diagnoses. Using child friendly interactive virtual environments we evaluated motor function as children performed dynamic tasks, such as pointing, reaching, standing balance and walking. Seven pairs of boys with ASD and age-matched controls between 2 and 12 years old participated. Although motor difficulties are not considered a core feature of autism, growing evidence suggest the trajectories for development of balance, walking and reaching have a different slope (slower rate) compared to controls. During childhood, evaluation of specific motor impairments can serve as markers for screening/diagnosis of ASD.

Virtual Reality Reveals Mechanisms of Balance and Locomotor Impairments

This chapter reviews how VR can be used to investigate normal and disturbed mechanisms of balance and locomotor control. Loss of upright balance control resulting in falls is a major health problem for older adults and stroke survivors. Balance and mobility deficits arise not only from motor or sensory impairments but also from the inability to select and reweight pertinent sensory information. In particular, the role of the vestibular system and effects of age and stroke on the ability of the central nervous system to resolve sensory conflicts is emphasized, as well as the potential for rehabilitation protocols that include training in virtual environments to improve balance.

Development of a novel visuomotor integration paradigm by integrating a virtual environment with mobile eye-tracking and motion-capture systems

Visuomotor integration (VMI), the use of visual information to guide motor planning, execution, and modification, is necessary for a wide range of functional tasks. To comprehensively, quantitatively assess VMI, we developed a paradigm integrating virtual environments, motion-capture, and mobile eye-tracking. Virtual environments enable tasks to be repeatable, naturalistic, and varied in complexity. Mobile eye-tracking and minimally-restricted movement enable observation of natural strategies for interacting with the environment. This paradigm yields a rich dataset that may inform our understanding of VMI in typical and atypical development.

Aging-related limit of exercise efficacy on motor decline

Identifying lifestyle strategies and allied neurobiological mechanisms that reduce aging-related motor impairment is imperative, given the accelerating number of retirees and increased life expectancy. A physically active lifestyle prior to old age can reduce risk of debilitating motor decline. However, if exercise is initiated after motor decline has begun in the lifespan, it is unknown if aging itself may impose a limit on exercise efficacy to decelerate further aging-related motor decline. In Brown-Norway/Fischer 344 F1 hybrid (BNF) rats, locomotor activity begins to decrease in middle age (12–18 months). One mechanism of aging-related motor decline may be decreased expression of GDNF family receptor, GFRα-1, which is decreased in substantia nigra (SN) between 12 and 30 months old. Moderate exercise, beginning at 18 months old, increases nigral GFRα-1 and tyrosine hydroxylase (TH) expression within 2 months. In aged rats, replenishing aging-related loss of GFRα-1 in SN increases TH in SN alone and locomotor activity. A moderate exercise regimen was initiated in sedentary male BNF rats in a longitudinal study to evaluate if exercise could attenuate aging-related motor decline when initiated at two different ages in the latter half of the lifespan (18 or 24 months old). Motor decline was reversed in the 18-, but not 24-month-old, cohort. However, exercise efficacy in the 18-month-old group was reduced as the rats reached 27 months old. GFRα-1 expression was not increased in either cohort. These studies suggest exercise can decelerate motor decline when begun in the latter half of the lifespan, but its efficacy may be limited by age of initiation. Decreased plasticity of GFRα-1 expression following exercise may limit its efficacy to reverse motor decline.

Human–Robot Gesture Analysis for Objective Assessment of Autism Spectrum Disorder

In this paper we study the use of human robot interaction as a mean to objectively evaluate imitation deficits in children with autism. Robot control and data analysis methods were combined to assess the quality of interaction between the robot and the subjects. Humanoid robot Zeno was used to execute upper body gestures which the subjects were asked to imitate. The resulting motion of the subject was acquired through a motion capture system and compared with the intended motion performed by Zeno using the dynamic time warping (DTW) algorithm. During this study, the clinical hypothesis was that the resulting DTW cost can serve as a quantitative measure for the similarity between the motions, and thus can be used to objectively assess the severity of imitation deficits exhibited by the child. To validate this hypothesis, we present two sets of experiments, one with a set of healthy adults and the other with a group of children, some with autism spectrum disorder. The experiment with adult subjects serves as a statistically significant test to demonstrate the viability of the DTW cost as a similarity measure for the gesture analysis, whereas the experiment with child subjects is a pilot study to differentiate imitation performance for children with autism.