Rehabilitation Engineering in Parkinson's disease

Impairment of postural control is a common consequence of Parkinson's disease (PD) that becomes more and more critical with the progression of the disease, in spite of the available medications. Postural instability is one of the most disabling features of PD and induces difficulties with postural transitions, initiation of movements, gait disorders, inability to live independently at home, and is the major cause of falls. Falls are frequent (with over 38% falling each year) and may induce adverse consequences like soft tissue injuries, hip fractures, and immobility due to fear of falling. As the disease progresses, both postural instability and fear of falling worsen, which leads patients with PD to become increasingly immobilized. The main aims of this dissertation are to: 1) detect and assess, in a quantitative way, impairments of postural control in PD subjects, investigate the central mechanisms that control such motor performance, and how these mechanism are affected by levodopa; 2) develop and validate a protocol, using wearable inertial sensors, to measure postural sway and postural transitions prior to step initiation; 3) find quantitative measures sensitive to impairments of postural control in early stages of PD and quantitative biomarkers of disease progression; and 4) test the feasibility and effects of a recently-developed audio-biofeedback system in maintaining balance in subjects with PD. In the first set of studies, we showed how PD reduces functional limits of stability as well as the magnitude and velocity of postural preparation during voluntary, forward and backward leaning while standing. Levodopa improves the limits of stability but not the postural strategies used to achieve the leaning. Further, we found a strong relationship between backward voluntary limits of stability and size of automatic postural response to backward perturbations in control subjects and in PD subjects ON medication. Such relation might suggest that the central nervous system presets postural response parameters based on perceived maximum limits and this presetting is absent in PD patients OFF medication but restored with levodopa replacement. Furthermore, we investigated how the size of preparatory postural adjustments (APAs) prior to step initiation depend on initial stance width. We found that patients with PD did not scale up the size of their APA with stance width as much as control subjects so they had much more difficulty initiating a step from a wide stance than from a narrow stance. This results supports the hypothesis that subjects with PD maintain a narrow stance as a compensation for their inability to sufficiently increase the size of their lateral APA to allow speedy step initiation in wide stance. In the second set of studies, we demonstrated that it is possible to use wearable accelerometers to quantify postural performance during quiet stance and step initiation balance tasks in healthy subjects. We used a model to predict center of pressure displacements associated with accelerations at the upper and lower back and thigh. This approach allows the measurement of balance control without the use of a force platform outside the laboratory environment. We used wearable accelerometers on a population of early, untreated PD patients, and found that postural control in stance and postural preparation prior to a step are impaired early in the disease when the typical balance and gait intiation symptoms are not yet clearly manifested. These novel results suggest that technological measures of postural control can be more sensitive than clinical measures. Furthermore, we assessed spontaneous sway and step initiation longitudinally across 1 year in patients with early, untreated PD. We found that changes in trunk sway, and especially movement smoothness, measured as Jerk, could be used as an objective measure of PD and its progression. In the third set of studies, we studied the feasibility of adapting an existing audio-biofeedback device to improve balance control in patients with PD. Preliminary results showed that PD subjects found the system easy-to-use and helpful, and they were able to correctly follow the audio information when available. Audiobiofeedback improved the properties of trunk sway during quiet stance. Our results have many implications for i) the understanding the central mechanisms that control postural motor performance, and how these mechanisms are affected by levodopa; ii) the design of innovative protocols for measuring and remote monitoring of motor performance in the elderly or subjects with PD; and iii) the development of technologies for improving balance, mobility, and consequently quality of life in patients with balance disorders, such as PD patients with augmented biofeedback paradigms.

Transport infrastructure and economic development in least developed countries: the case of Afghanistan

This PhD thesis tries to show the impact of transport infrastructure in economic development in least developed countries and in particular in the case of Afghanistan. Some least developed countries during 1990 to 1999 experienced lack of investment in transportation. Lack of investment further increased the economic development gap between developed and least developed countries. Moreover, lack of literature and research in poor countries such as Afghanistan encouraged me to do my research in this country in order to unveil the problems, facing poor people who are living in inaccessible places and suffer from lack of economic opportunities and long term unemployment. This thesis shows the effect of inaccessibility and immobility in economic opportunities and basic social services in Afghanistan. This thesis is important because it covers the role of transport infrastructures at the moment that international community promised to rebuild the infrastructures of post conflict Afghanistan.

Still/moving images. Il rapporto dialettico tra cinema e fotografia nelle pratiche artistiche contemporanee.

Tra le plurime conseguenze dell’avvento del digitale, la riarticolazione dei rapporti tra immagine statica e immagine in movimento è certamente una delle più profonde. Sintomatica dei cambiamenti in atto sia nei film studies sia nella storia dell’arte, tale riarticolazione richiede un ripensamento dei confini disciplinari tradizionali entro cui il cinema e la fotografia sono stati affrontati come oggetti di studio separati e distinti. Nell’adottare un approccio molteplice, volto a comprendere prospettive provenienti dalla New Film History e dalla media archaeology, dalla teoria dell’arte e dagli studi visuali, questo lavoro esplora l’esistenza di una relazione dialettica tra il cinema e la fotografia intesa in modo duplice: come tensione costitutiva tra due media indissolubilmente connessi – non tanto in considerazione di un medesimo principio realistico di rappresentazione quanto, piuttosto, in virtù di uno scambio incessante nella modellizzazione di categorie quali il tempo, il movimento, l’immobilità, l’istante, la durata; come istanza peculiare della pratica artistica contemporanea, paradigma di riferimento nella produzione estetica di immagini. La tesi si suddivide in tre capitoli. Il primo si concentra sul rapporto tra l’immobilità e il movimento dell’immagine come cifra in grado di connettere l’estetica delle attrazioni e la cronofotografia a una serie di esperienze filmiche e artistiche prodotte nei territori delle avanguardie. Il secondo capitolo considera l’emergenza, dagli anni Novanta, di pratiche artistiche in cui l’incontro intermediale tra film e fotografia fornisce modelli di analisi volti all’indagine dell’attuale condizione estetica e tecnologica. Il terzo offre una panoramica critica su un caso di studio, la GIF art. La GIF è un formato digitale obsoleto che consente di produrre immagini che appaiono, simultaneamente, come fisse e animate; nel presente lavoro, la GIF è discussa come un medium capace di contraddire i confini attraverso cui concepiamo l’immagine fissa e in movimento, suggerendo, inoltre, un possibile modello di pensiero storico-cronologico anti-lineare.