Advances in upper limb stroke rehabilitation: a technology push

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

Assessing the effectiveness of robot facilitated neurorehabilitation for relearning motor skills following a stroke

A growing awareness of the potential for machine-mediated neurorehabilitation has led to several novel concepts for delivering these therapies. To get from laboratory demonstrators and prototypes to the point where the concepts can be used by clinicians in practice still requires significant additional effort, not least in the requirement to assess and measure the impact of any proposed solution. To be widely accepted a study is required to use validated clinical measures but these tend to be subjective, costly to administer and may be insensitive to the effect of the treatment. Although this situation will not change, there is good reason to consider both clinical and mechanical assessments of recovery. This article outlines the problems in measuring the impact of an intervention and explores the concept of providing more mechanical assessment techniques and ultimately the possibility of combining the assessment process with aspects of the intervention.

Suitability of pesticide risk indicators for less developed countries: a comparison

Pesticide risk indicators provide simple support in the assessment of environmental and health risks from pesticide use, and can therefore inform policies to foster a sustainable interaction of agriculture with the environment. For their relative simplicity, indicators may be particularly useful under conditions of limited data availability and resources, such as in Less Developed Countries (LDCs). However, indicator complexity can vary significantly, in particular between those that rely on an exposure–toxicity ratio (ETR) and those that do not. In addition, pesticide risk indicators are usually developed for Western contexts, which might cause incorrect estimation in LDCs. This study investigated the appropriateness of seven pesticide risk indicators for use in LDCs, with reference to smallholding agriculture in Colombia. Seven farm-level indicators, among which 3 relied on an ETR (POCER, EPRIP, PIRI) and 4 on a non-ETR approach (EIQ, PestScreen, OHRI, Dosemeci et al., 2002), were calculated and then compared by means of the Spearman rank correlation test. Indicators were also compared with respect to key indicator characteristics, i.e. user friendliness and ability to represent the system under study. The comparison of the indicators in terms of the total environmental risk suggests that the indicators not relying on an ETR approach cannot be used as a reliable proxy for more complex, i.e. ETR, indicators. ETR indicators, when user-friendly, show a comparative advantage over non-ETR in best combining the need for a relatively simple tool to be used in contexts of limited data availability and resources, and for a reliable estimation of environmental risk. Non-ETR indicators remain useful and accessible tools to discriminate between different pesticides prior to application. Concerning the human health risk, simple algorithms seem more appropriate for assessing human health risk in LDCs. However, further research on health risk indicators and their validation under LDC conditions is needed.

Towards a method for the economic evaluation of environmental indicators in UK Integrated Arable Farming Systems

Integrated Arable Farming Systems (IAFS), which involve a reduction in the use of off-farm inputs, are attracting considerable research interest in the UK. The objectives of these systems experiments are to compare their financial performance with that from conventional or current farming practices. To date, this comparison has taken little account of any environmental benefits (or disbenefits) of the two systems. The objective of this paper is to review the assessment methodologies available for the analysis of environmental impacts. To illustrate the results of this exercise, the methodology and environmental indicators chosen are then applied to data from one of the LINK - Integrated Farming Systems experimental sites. Data from the Pathhead site in Southern Scotland are used to evaluate the use of invertebrates and nitrate loss as environmental indicators within IAFS. The results suggest that between 1992 and 1995 the biomass of earthworms fell by 28 kg per hectare on the integrated rotation and rose by 31 kg per hectare on the conventional system. This led to environmental costs ranging between £2.24 and £13.44 per hectare for the integrated system and gains of between £2.48 and £14.88 for the conventional system. In terms of nitrate, the integrated system had an estimated loss of £72.21 per hectare in comparison to £149.40 per hectare on the conventional system. Conclusions are drawn about the advantages and disadvantages of this type of analytical framework. Keywords: Farming systems; IAFS; Environmental valuation; Economics; Earthworms; Nitrates; Soil fauna

The persistence of solar activity indicators and the descent of the sun into Maunder Minimum conditions

The recent low and prolonged minimum of the solar cycle, along with the slow growth in activity of the new cycle, has led to suggestions that the Sun is entering a Grand Solar Minimum (GSMi), potentially as deep as the Maunder Minimum (MM). This raises questions about the persistence and predictability of solar activity. We study the autocorrelation functions and predictability R^2_L(t) of solar indices, particularly group sunspot number R_G and heliospheric modulation potential phi for which we have data during the descent into the MM. For R_G and phi, R^2_L (t) > 0.5 for times into the future of t = 4 and 3 solar cycles, respectively: sufficient to allow prediction of a GSMi onset. The lower predictability of sunspot number R_Z is discussed. The current declines in peak and mean R_G are the largest since the onset of the MM and exceed those around 1800 which failed to initiate a GSMi.

Measuring societal awareness of the rural agrarian landscape: indicators and scale issues

The work presented in this report is part of the effort to define the landscape state and diversity indicator in the frame of COM (2006) 508 “Development of agri-environmental indicators for monitoring the integration of environmental concerns into the common agricultural policy”. The Communication classifies the indicators according to their level of development, which, for the landscape indicator is “in need of substantial improvements in order to become fully operational”. For this reason a full re-definition of the indicator has been carried out, following the initial proposal presented in the frame of the IRENA operation (“Indicator Reporting on the Integration of Environmental Concerns into Agricultural Policy”). The new proposal for the landscape state and diversity indicator is structured in three components: the first concerns the degree of naturalness, the second landscape structure, the third the societal appreciation of the rural landscape. While the first two components rely on a strong bulk of existing literature, the development of the methodology has made evident the need for further analysis of the third component, which is based on a newly proposed top-down approach. This report presents an in-depth analysis of such component of the indicator, and the effort to include a social dimension in large scale landscape assessment.

Cortical activation during executed, imagined, observed, and passive wrist movements in healthy volunteers and stroke patients

Motor imagery, passive movement, and movement observation have been suggested to activate the sensorimotor system without overt movement. The present study investigated these three covert movement modes together with overt movement in a within-subject design to allow for a fine-grained comparison of their abilities in activating the sensorimotor system, i.e. premotor, primary motor, and somatosensory cortices. For this, 21 healthy volunteers underwent functional magnetic resonance imaging (fMRI). In addition we explored the abilities of the different covert movement modes in activating the sensorimotor system in a pilot study of 5 stroke patients suffering from chronic severe hemiparesis. Results demonstrated that while all covert movement modes activated sensorimotor areas, there were profound differences between modes and between healthy volunteers and patients. In healthy volunteers, the pattern of neural activation in overt execution was best resembled by passive movement, followed by motor imagery, and lastly by movement observation. In patients, attempted overt execution was best resembled by motor imagery, followed by passive movement, and lastly by movement observation. Our results indicate that for severely hemiparetic stroke patients motor imagery may be the preferred way to activate the sensorimotor system without overt behavior. In addition, the clear differences between the covert movement modes point to the need for within-subject comparisons.

Developing consensus on hospital prescribing indicators of potential harms amenable to decision support

Aim: To develop a list of prescribing indicators specific for the hospital setting that would facilitate the prospective collection of high severity and/or high frequency prescribing errors, which are also amenable to electronic clinical decision support (CDS). Method: A three-stage consensus technique (electronic Delphi) was carried out with 20 expert pharmacists and physicians across England. Participants were asked to score prescribing errors using a 5-point Likert scale for their likelihood of occurrence and the severity of the most likely outcome. These were combined to produce risk scores, from which median scores were calculated for each indicator across the participants in the study. The degree of consensus between the participants was defined as the proportion that gave a risk score in the same category as the median. Indicators were included if a consensus of 80% or more was achieved. Results: A total of 80 prescribing errors were identified by consensus as being high or extreme risk. The most common drug classes named within the indicators were antibiotics (n=13), antidepressants (n=8), nonsteroidal anti-inflammatory drugs (n=6), and opioid analgesics (n=6).The most frequent error type identified as high or extreme risk were those classified as clinical contraindications (n=29/80). Conclusion: 80 high risk prescribing errors in the hospital setting have been identified by an expert panel. These indicators can serve as the basis for a standardised, validated tool for the collection of data in both paperbased and electronic prescribing processes, as well as to assess the impact of electronic decision support implementation or development.

Making robust policy decision using global biodiversity indicators

In order to influence global policy effectively, conservation scientists need to be able to provide robust predictions of the impact of alternative policies on biodiversity and measure progress towards goals using reliable indicators. We present a framework for using biodiversity indicators predictively to inform policy choices at a global level. The approach is illustrated with two case studies in which we project forwards the impacts of feasible policies on trends in biodiversity and in relevant indicators. The policies are based on targets agreed at the Convention on Biological Diversity (CBD) meeting in Nagoya in October 2010. The first case study compares protected area policies for African mammals, assessed using the Red List Index; the second example uses the Living Planet Index to assess the impact of a complete halt, versus a reduction, in bottom trawling. In the protected areas example, we find that the indicator can aid in decision-making because it is able to differentiate between the impacts of the different policies. In the bottom trawling example, the indicator exhibits some counter-intuitive behaviour, due to over-representation of some taxonomic and functional groups in the indicator, and contrasting impacts of the policies on different groups caused by trophic interactions. Our results support the need for further research on how to use predictive models and indicators to credibly track trends and inform policy. To be useful and relevant, scientists must make testable predictions about the impact of global policy on biodiversity to ensure that targets such as those set at Nagoya catalyse effective and measurable change.

Examining the large-scale spatial coherence of European drought using regional indicators of precipitation and streamflow deficit

Droughts tend to evolve slowly and affect large areas simultaneously, which suggests that improved understanding of spatial coherence of drought would enable better mitigation of drought impacts through enhanced monitoring and forecasting strategies. This study employs an up-to-date dataset of over 500 river flow time series from 11 European countries, along with a gridded precipitation dataset, to examine the spatial coherence of drought in Europe using regional indicators of precipitation and streamflow deficit. The drought indicators were generated for 24 homogeneous regions and, for selected regions, historical drought characteristics were corroborated with previous work. The spatial coherence of drought characteristics was then examined at a European scale. Historical droughts generally have distinctive signatures in their spatio-temporal development, so there was limited scope for using the evolution of historical events to inform forecasting. Rather, relationships were explored in time series of drought indicators between regions. Correlations were generally low, but multivariate analyses revealed broad continental-scale patterns, which appear to be related to large-scale atmospheric circulation indices (in particular, the North Atlantic Oscillation and the East Atlantic West Russia pattern). A novel methodology for forecasting was developed (and demonstrated with reference to the United Kingdom), which predicts drought from drought i.e. uses spatial coherence of drought to facilitate early warning of drought in a target region, from drought which is developing elsewhere in Europe.Whilst the skill of the methodology is relatively modest at present, this approach presents a potential new avenue for forecasting, which offers significant advantages in that it allows prediction for all seasons, and also shows some potential for forecasting the termination of drought conditions.

Analysis of EEG signal to detect motor command generation towards stroke rehabilitation

Our aim is to reconstruct the brain-body loop of stroke patients via an EEG-driven robotic system. After the detection of motor command generation, the robotic arm should assist patient’s movement at the correct moment and in a natural way. In this study we performed EEG measurements from healthy subjects performing discrete spontaneous motion. An EEG analysis based on the temporal correlation of the brain activity was employed to determine the onset of single motion motor command generation.

A feasible study of EEG-driven assistive robotic system for stroke rehabilitation

Stroke is a medical emergency and can cause a neurological damage, affecting the motor and sensory systems. Harnessing brain plasticity should make it possible to reconstruct the closed loop between the brain and the body, i.e., association of the generation of the motor command with the somatic sensory feedback might enhance motor recovery. In order to aid reconstruction of this loop with a robotic device it is necessary to assist the paretic side of the body at the right moment to achieve simultaneity between motor command and feedback signal to somatic sensory area in brain. To this end, we propose an integrated EEG-driven assistive robotic system for stroke rehabilitation. Depending on the level of motor recovery, it is important to provide adequate stimulation for upper limb motion. Thus, we propose an assist arm incorporating a Magnetic Levitation Joint that can generate a compliant motion due to its levitation and mechanical redundancy. This paper reports on a feasibility study carried out to verify the validity of the robot sensing and on EEG measurements conducted with healthy volunteers while performing a spontaneous arm flexion/extension movement. A characteristic feature was found in the temporal evolution of EEG signal in the single motion prior to executed motion which can aid in coordinating timing of the robotic arm assistance onset.

Speech therapy after stroke: trial shows only that practice varies

Bowen and colleagues’ methods and conclusions raise concerns.1 At best, the trial evaluates the variability in current practice. In no way is it a robust test of treatment. Two communication impairments (aphasia and dysarthria) were included. In the post-acute stage spontaneous recovery is highly unpredictable, and changes in the profile of impairment during this time are common.2 Both impairments manifest in different forms,3 which may be more or less responsive to treatment. A third kind of impairment, apraxia of speech, was not excluded but was not targeted in therapy. All three impairments can and do co-occur. Whether randomised controlled trial designs can effectively cope with such complex disorders has been discussed elsewhere.4 Treatment was defined within terms of current practice but was unconstrained. Therefore, the treatment group would have received a variety of therapeutic approaches and protocols, some of which may indeed be ineffective. Only 53% of the contact time with a speech and language therapist was direct (one to one), the rest was impairment based therapy. In contrast, all of the visitors’ time was direct contact, usually in conversation. In both groups, the frequency and length of contact time varied. We already know that the transfer from impairment based therapy to functional communication can be limited and varies across individuals.5 However, it is not possible to conclude from this trial that one to one impairment based therapy should be replaced. For that, a well defined impairment therapy protocol must be directly compared with a similarly well defined functional communication therapy, with an attention control.

Pediastrum species as potential indicators of lake-level change in tropical South America

We explored the potential for using Pediastrum (Meyen), a genus of green alga commonly found in palaeoecological studies, as a proxy for lake-level change in tropical South America. The study site, Laguna La Gaiba (LLG) (17°45′S, 57°40′W), is a broad, shallow lake located along the course of the Paraguay River in the Pantanal, a 135,000-km2 tropical wetland located mostly in western Brazil, but extending into eastern Bolivia. Fourteen surface sediment samples were taken from LLG across a range of lake depths (2-5.2 m) and analyzed for Pediastrum. We found seven species, of which P. musteri (Tell et Mataloni), P. argentiniense (Bourr. et Tell), and P. cf. angulosum (Ehrenb.) ex Menegh. were identified as potential indicators of lake level. Results of the modern dataset were applied to 31 fossil Pediastrum assemblages spanning the early Holocene (12.0 kyr BP) to present to infer past lake level changes qualitatively. Early Holocene (12.0-9.8 kyr BP) assemblages do not show a clear signal, though abundance of P. simplex (Meyen) suggests relatively high lake levels. Absence of P. musteri, characteristic of deep, open water, and abundance of macrophyte-associated taxa indicate lake levels were lowest from 9.8 to 3.0 kyr BP. A shift to wetter conditions began at 4.4 kyr BP, indicated by the appearance of P. musteri, though inferred lake levels did not reach modern values until 1.4 kyr BP. The Pediastrum-inferred mid-Holocene lowstand is consistent with lower precipitation, previously inferred using pollen from this site, and is also in agreement with evidence for widespread drought in the South American tropics during the middle Holocene. An inference for steadily increasing lake level from 4.4 kyr BP to present is consistent with diatom-inferred water level rise at Lake Titicaca, and demonstrates coherence with the broad pattern of increasing monsoon strength from the late Holocene until present in tropical South America.