Central autonomic control in spontaneously hypertensive rats: a study on phasic phenomena during rapid-eye-movement sleep

The cardiovascular regulation undergoes wide changes in the different states of sleepwake cycle. In particular, the relationship between spontaneous fluctuations in heart period and arterial pressure clearly shows differences between the two sleep states. In non rapid-eye-movement sleep, heart rhythm is under prevalent baroreflex control, whereas in rapid-eye-movement sleep central autonomic commands prevail (Zoccoli et al., 2001). Moreover, during rapid-eye-movement sleep the cardiovascular variables show wide fluctuations around their mean value. In particular, during rapid-eyemovement sleep, the arterial pressure shows phasic hypertensive events which are superimposed upon the tonic level of arterial pressure. These phasic increases in arterial pressure are accompanied by an increase in heart rate (Sei & Morita, 1996; Silvani et al., 2005). Thus, rapid-eye-movement sleep may represent an “autonomic stress test” for the cardiovascular system, able to unmask pathological patterns of cardiovascular regulation (Verrier et al. 2005), but this hypothesis has never been tested experimentally. The aim of this study was to investigate whether rapid-eye-movement sleep may reveal derangements in central autonomic cardiovascular control in an experimental model of essential hypertension. The study was performed in Spontaneously Hypertensive Rats, which represent the most widely used model of essential hypertension, and allow full control of genetic and environmental confounding factors. In particular, we analyzed the cardiovascular, electroencephalogram, and electromyogram changes associated with phasic hypertensive events during rapid-eyemovement sleep in Spontaneously Hypertensive Rats and in their genetic Wistar Kyoto control strain. Moreover, we studied also a group of Spontaneously Hypertensive Rats made phenotypically normotensive by means of a chronic treatment with an angiotensin converting enzyme inhibitor, the Enalapril maleate, from the age of four weeks to the end of the experiment. All rats were implanted with electrodes for electroencephalographic and electromyographic recordings and with an arterial catheter for arterial pressure measurement. After six days for postoperative recovery, the rats were studied for five days, at an age of ten weeks.The study indicated that the peak of mean arterial pressure increase during the phasic hypertensive events in rapid-eye-movement sleep did not differ significantly between Spontaneously Hypertensive Rats and Wistar Kyoto rats, while on the other hand Spontaneously Hypertensive Rats showed a reduced increase in the frequency of theta rhythm and a reduced tachicardia with respect to Wistar Kyoto rats. The same pattern of changes in mean arterial pressure, heart period, and theta frequency was observed between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate. Spontaneously Hypertensive Rats do not differ from Wistar Kyoto rats only in terms of arterial hypertension, but also due to multiple unknown genetic differences. Spontaneously Hypertensive Rats were developed by selective breeding of Wistar Kyoto rats based only on the level of arterial pressure. However, in this process, multiple genes possibly unrelated to hypertension may have been selected together with the genetic determinants of hypertension (Carley et al., 2000). This study indicated that Spontaneously Hypertensive Rats differ from Wistar Kyoto rats, but not from Spontaneously Hypertensive Rats treated with Enalapril maleate, in terms of arterial pH and theta frequency. This feature may be due to genetic determinants unrelated to hypertension. In sharp contrast, the persistence of differences in the peak of heart period decrease and the peak of theta frequency increase during phasic hypertensive events between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate demonstrates that the observed reduction in central autonomic control of the cardiovascular system in Spontaneously Hypertensive Rats is not an irreversible consequence of inherited genetic determinants. Rather, the comparison between Spontaneously Hypertensive Rats and Spontaneously Hypertensive Rats treated with Enalapril maleate indicates that the observed differences in central autonomic control are the result of the hypertension per se. This work supports the view that the study of cardiovascular regulation in sleep provides fundamental insight on the pathophysiology of hypertension, and may thus contribute to the understanding of this disease, which is a major health problem in European countries (Wolf-Maier et al., 2003) with its burden of cardiac, vascular, and renal complications.

Tools and methods for the quality assurance of force platforms in human movement analysis

The human movement analysis (HMA) aims to measure the abilities of a subject to stand or to walk. In the field of HMA, tests are daily performed in research laboratories, hospitals and clinics, aiming to diagnose a disease, distinguish between disease entities, monitor the progress of a treatment and predict the outcome of an intervention [Brand and Crowninshield, 1981; Brand, 1987; Baker, 2006]. To achieve these purposes, clinicians and researchers use measurement devices, like force platforms, stereophotogrammetric systems, accelerometers, baropodometric insoles, etc. This thesis focus on the force platform (FP) and in particular on the quality assessment of the FP data. The principal objective of our work was the design and the experimental validation of a portable system for the in situ calibration of FPs. The thesis is structured as follows: Chapter 1. Description of the physical principles used for the functioning of a FP: how these principles are used to create force transducers, such as strain gauges and piezoelectrics transducers. Then, description of the two category of FPs, three- and six-component, the signals acquisition (hardware structure), and the signals calibration. Finally, a brief description of the use of FPs in HMA, for balance or gait analysis. Chapter 2. Description of the inverse dynamics, the most common method used in the field of HMA. This method uses the signals measured by a FP to estimate kinetic quantities, such as joint forces and moments. The measures of these variables can not be taken directly, unless very invasive techniques; consequently these variables can only be estimated using indirect techniques, as the inverse dynamics. Finally, a brief description of the sources of error, present in the gait analysis. Chapter 3. State of the art in the FP calibration. The selected literature is divided in sections, each section describes: systems for the periodic control of the FP accuracy; systems for the error reduction in the FP signals; systems and procedures for the construction of a FP. In particular is detailed described a calibration system designed by our group, based on the theoretical method proposed by ?. This system was the “starting point” for the new system presented in this thesis. Chapter 4. Description of the new system, divided in its parts: 1) the algorithm; 2) the device; and 3) the calibration procedure, for the correct performing of the calibration process. The algorithm characteristics were optimized by a simulation approach, the results are here presented. In addiction, the different versions of the device are described. Chapter 5. Experimental validation of the new system, achieved by testing it on 4 commercial FPs. The effectiveness of the calibration was verified by measuring, before and after calibration, the accuracy of the FPs in measuring the center of pressure of an applied force. The new system can estimate local and global calibration matrices; by local and global calibration matrices, the non–linearity of the FPs was quantified and locally compensated. Further, a non–linear calibration is proposed. This calibration compensates the non– linear effect in the FP functioning, due to the bending of its upper plate. The experimental results are presented. Chapter 6. Influence of the FP calibration on the estimation of kinetic quantities, with the inverse dynamics approach. Chapter 7. The conclusions of this thesis are presented: need of a calibration of FPs and consequential enhancement in the kinetic data quality. Appendix: Calibration of the LC used in the presented system. Different calibration set–up of a 3D force transducer are presented, and is proposed the optimal set–up, with particular attention to the compensation of non–linearities. The optimal set–up is verified by experimental results.

Il passato nell’epoca della sua (ri)producibilità digitale. Torino 1943 - 45. Metodologia della ricerca con tecnologie informatiche. Sistema storico-territoriale di informazione multimediale

Se il lavoro dello storico è capire il passato come è stato compreso dalla gente che lo ha vissuto, allora forse non è azzardato pensare che sia anche necessario comunicare i risultati delle ricerche con strumenti propri che appartengono a un'epoca e che influenzano la mentalità di chi in quell'epoca vive. Emergenti tecnologie, specialmente nell’area della multimedialità come la realtà virtuale, permettono agli storici di comunicare l’esperienza del passato in più sensi. In che modo la storia collabora con le tecnologie informatiche soffermandosi sulla possibilità di fare ricostruzioni storiche virtuali, con relativi esempi e recensioni? Quello che maggiormente preoccupa gli storici è se una ricostruzione di un fatto passato vissuto attraverso la sua ricreazione in pixels sia un metodo di conoscenza della storia che possa essere considerato valido. Ovvero l'emozione che la navigazione in una realtà 3D può suscitare, è un mezzo in grado di trasmettere conoscenza? O forse l'idea che abbiamo del passato e del suo studio viene sottilmente cambiato nel momento in cui lo si divulga attraverso la grafica 3D? Da tempo però la disciplina ha cominciato a fare i conti con questa situazione, costretta soprattutto dall'invasività di questo tipo di media, dalla spettacolarizzazione del passato e da una divulgazione del passato parziale e antiscientifica. In un mondo post letterario bisogna cominciare a pensare che la cultura visuale nella quale siamo immersi sta cambiando il nostro rapporto con il passato: non per questo le conoscenze maturate fino ad oggi sono false, ma è necessario riconoscere che esiste più di una verità storica, a volte scritta a volte visuale. Il computer è diventato una piattaforma onnipresente per la rappresentazione e diffusione dell’informazione. I metodi di interazione e rappresentazione stanno evolvendo di continuo. Ed è su questi due binari che è si muove l’offerta delle tecnologie informatiche al servizio della storia. Lo scopo di questa tesi è proprio quello di esplorare, attraverso l’utilizzo e la sperimentazione di diversi strumenti e tecnologie informatiche, come si può raccontare efficacemente il passato attraverso oggetti tridimensionali e gli ambienti virtuali, e come, nel loro essere elementi caratterizzanti di comunicazione, in che modo possono collaborare, in questo caso particolare, con la disciplina storica. La presente ricerca ricostruisce alcune linee di storia delle principali fabbriche attive a Torino durante la seconda guerra mondiale, ricordando stretta relazione che esiste tra strutture ed individui e in questa città in particolare tra fabbrica e movimento operaio, è inevitabile addentrarsi nelle vicende del movimento operaio torinese che nel periodo della lotta di Liberazione in città fu un soggetto politico e sociale di primo rilievo. Nella città, intesa come entità biologica coinvolta nella guerra, la fabbrica (o le fabbriche) diventa il nucleo concettuale attraverso il quale leggere la città: sono le fabbriche gli obiettivi principali dei bombardamenti ed è nelle fabbriche che si combatte una guerra di liberazione tra classe operaia e autorità, di fabbrica e cittadine. La fabbrica diventa il luogo di "usurpazione del potere" di cui parla Weber, il palcoscenico in cui si tengono i diversi episodi della guerra: scioperi, deportazioni, occupazioni .... Il modello della città qui rappresentata non è una semplice visualizzazione ma un sistema informativo dove la realtà modellata è rappresentata da oggetti, che fanno da teatro allo svolgimento di avvenimenti con una precisa collocazione cronologica, al cui interno è possibile effettuare operazioni di selezione di render statici (immagini), di filmati precalcolati (animazioni) e di scenari navigabili interattivamente oltre ad attività di ricerca di fonti bibliografiche e commenti di studiosi segnatamente legati all'evento in oggetto. Obiettivo di questo lavoro è far interagire, attraverso diversi progetti, le discipline storiche e l’informatica, nelle diverse opportunità tecnologiche che questa presenta. Le possibilità di ricostruzione offerte dal 3D vengono così messe a servizio della ricerca, offrendo una visione integrale in grado di avvicinarci alla realtà dell’epoca presa in considerazione e convogliando in un’unica piattaforma espositiva tutti i risultati. Divulgazione Progetto Mappa Informativa Multimediale Torino 1945 Sul piano pratico il progetto prevede una interfaccia navigabile (tecnologia Flash) che rappresenti la pianta della città dell’epoca, attraverso la quale sia possibile avere una visione dei luoghi e dei tempi in cui la Liberazione prese forma, sia a livello concettuale, sia a livello pratico. Questo intreccio di coordinate nello spazio e nel tempo non solo migliora la comprensione dei fenomeni, ma crea un maggiore interesse sull’argomento attraverso l’utilizzo di strumenti divulgativi di grande efficacia (e appeal) senza perdere di vista la necessità di valicare le tesi storiche proponendosi come piattaforma didattica. Un tale contesto richiede uno studio approfondito degli eventi storici al fine di ricostruire con chiarezza una mappa della città che sia precisa sia topograficamente sia a livello di navigazione multimediale. La preparazione della cartina deve seguire gli standard del momento, perciò le soluzioni informatiche utilizzate sono quelle fornite da Adobe Illustrator per la realizzazione della topografia, e da Macromedia Flash per la creazione di un’interfaccia di navigazione. La base dei dati descrittivi è ovviamente consultabile essendo contenuta nel supporto media e totalmente annotata nella bibliografia. È il continuo evolvere delle tecnologie d'informazione e la massiccia diffusione dell’uso dei computer che ci porta a un cambiamento sostanziale nello studio e nell’apprendimento storico; le strutture accademiche e gli operatori economici hanno fatto propria la richiesta che giunge dall'utenza (insegnanti, studenti, operatori dei Beni Culturali) di una maggiore diffusione della conoscenza storica attraverso la sua rappresentazione informatizzata. Sul fronte didattico la ricostruzione di una realtà storica attraverso strumenti informatici consente anche ai non-storici di toccare con mano quelle che sono le problematiche della ricerca quali fonti mancanti, buchi della cronologia e valutazione della veridicità dei fatti attraverso prove. Le tecnologie informatiche permettono una visione completa, unitaria ed esauriente del passato, convogliando tutte le informazioni su un'unica piattaforma, permettendo anche a chi non è specializzato di comprendere immediatamente di cosa si parla. Il miglior libro di storia, per sua natura, non può farlo in quanto divide e organizza le notizie in modo diverso. In questo modo agli studenti viene data l'opportunità di apprendere tramite una rappresentazione diversa rispetto a quelle a cui sono abituati. La premessa centrale del progetto è che i risultati nell'apprendimento degli studenti possono essere migliorati se un concetto o un contenuto viene comunicato attraverso più canali di espressione, nel nostro caso attraverso un testo, immagini e un oggetto multimediale. Didattica La Conceria Fiorio è uno dei luoghi-simbolo della Resistenza torinese. Il progetto è una ricostruzione in realtà virtuale della Conceria Fiorio di Torino. La ricostruzione serve a arricchire la cultura storica sia a chi la produce, attraverso una ricerca accurata delle fonti, sia a chi può poi usufruirne, soprattutto i giovani, che, attratti dall’aspetto ludico della ricostruzione, apprendono con più facilità. La costruzione di un manufatto in 3D fornisce agli studenti le basi per riconoscere ed esprimere la giusta relazione fra il modello e l’oggetto storico. Le fasi di lavoro attraverso cui si è giunti alla ricostruzione in 3D della Conceria: . una ricerca storica approfondita, basata sulle fonti, che possono essere documenti degli archivi o scavi archeologici, fonti iconografiche, cartografiche, ecc.; . La modellazione degli edifici sulla base delle ricerche storiche, per fornire la struttura geometrica poligonale che permetta la navigazione tridimensionale; . La realizzazione, attraverso gli strumenti della computer graphic della navigazione in 3D. Unreal Technology è il nome dato al motore grafico utilizzato in numerosi videogiochi commerciali. Una delle caratteristiche fondamentali di tale prodotto è quella di avere uno strumento chiamato Unreal editor con cui è possibile costruire mondi virtuali, e che è quello utilizzato per questo progetto. UnrealEd (Ued) è il software per creare livelli per Unreal e i giochi basati sul motore di Unreal. E’ stata utilizzata la versione gratuita dell’editor. Il risultato finale del progetto è un ambiente virtuale navigabile raffigurante una ricostruzione accurata della Conceria Fiorio ai tempi della Resistenza. L’utente può visitare l’edificio e visualizzare informazioni specifiche su alcuni punti di interesse. La navigazione viene effettuata in prima persona, un processo di “spettacolarizzazione” degli ambienti visitati attraverso un arredamento consono permette all'utente una maggiore immersività rendendo l’ambiente più credibile e immediatamente codificabile. L’architettura Unreal Technology ha permesso di ottenere un buon risultato in un tempo brevissimo, senza che fossero necessari interventi di programmazione. Questo motore è, quindi, particolarmente adatto alla realizzazione rapida di prototipi di una discreta qualità, La presenza di un certo numero di bug lo rende, però, in parte inaffidabile. Utilizzare un editor da videogame per questa ricostruzione auspica la possibilità di un suo impiego nella didattica, quello che le simulazioni in 3D permettono nel caso specifico è di permettere agli studenti di sperimentare il lavoro della ricostruzione storica, con tutti i problemi che lo storico deve affrontare nel ricreare il passato. Questo lavoro vuole essere per gli storici una esperienza nella direzione della creazione di un repertorio espressivo più ampio, che includa gli ambienti tridimensionali. Il rischio di impiegare del tempo per imparare come funziona questa tecnologia per generare spazi virtuali rende scettici quanti si impegnano nell'insegnamento, ma le esperienze di progetti sviluppati, soprattutto all’estero, servono a capire che sono un buon investimento. Il fatto che una software house, che crea un videogame di grande successo di pubblico, includa nel suo prodotto, una serie di strumenti che consentano all'utente la creazione di mondi propri in cui giocare, è sintomatico che l'alfabetizzazione informatica degli utenti medi sta crescendo sempre più rapidamente e che l'utilizzo di un editor come Unreal Engine sarà in futuro una attività alla portata di un pubblico sempre più vasto. Questo ci mette nelle condizioni di progettare moduli di insegnamento più immersivi, in cui l'esperienza della ricerca e della ricostruzione del passato si intreccino con lo studio più tradizionale degli avvenimenti di una certa epoca. I mondi virtuali interattivi vengono spesso definiti come la forma culturale chiave del XXI secolo, come il cinema lo è stato per il XX. Lo scopo di questo lavoro è stato quello di suggerire che vi sono grosse opportunità per gli storici impiegando gli oggetti e le ambientazioni in 3D, e che essi devono coglierle. Si consideri il fatto che l’estetica abbia un effetto sull’epistemologia. O almeno sulla forma che i risultati delle ricerche storiche assumono nel momento in cui devono essere diffuse. Un’analisi storica fatta in maniera superficiale o con presupposti errati può comunque essere diffusa e avere credito in numerosi ambienti se diffusa con mezzi accattivanti e moderni. Ecco perchè non conviene seppellire un buon lavoro in qualche biblioteca, in attesa che qualcuno lo scopra. Ecco perchè gli storici non devono ignorare il 3D. La nostra capacità, come studiosi e studenti, di percepire idee ed orientamenti importanti dipende spesso dai metodi che impieghiamo per rappresentare i dati e l’evidenza. Perché gli storici possano ottenere il beneficio che il 3D porta con sè, tuttavia, devono sviluppare un’agenda di ricerca volta ad accertarsi che il 3D sostenga i loro obiettivi di ricercatori e insegnanti. Una ricostruzione storica può essere molto utile dal punto di vista educativo non sono da chi la visita ma, anche da chi la realizza. La fase di ricerca necessaria per la ricostruzione non può fare altro che aumentare il background culturale dello sviluppatore. Conclusioni La cosa più importante è stata la possibilità di fare esperienze nell’uso di mezzi di comunicazione di questo genere per raccontare e far conoscere il passato. Rovesciando il paradigma conoscitivo che avevo appreso negli studi umanistici, ho cercato di desumere quelle che potremo chiamare “leggi universali” dai dati oggettivi emersi da questi esperimenti. Da punto di vista epistemologico l’informatica, con la sua capacità di gestire masse impressionanti di dati, dà agli studiosi la possibilità di formulare delle ipotesi e poi accertarle o smentirle tramite ricostruzioni e simulazioni. Il mio lavoro è andato in questa direzione, cercando conoscere e usare strumenti attuali che nel futuro avranno sempre maggiore presenza nella comunicazione (anche scientifica) e che sono i mezzi di comunicazione d’eccellenza per determinate fasce d’età (adolescenti). Volendo spingere all’estremo i termini possiamo dire che la sfida che oggi la cultura visuale pone ai metodi tradizionali del fare storia è la stessa che Erodoto e Tucidide contrapposero ai narratori di miti e leggende. Prima di Erodoto esisteva il mito, che era un mezzo perfettamente adeguato per raccontare e dare significato al passato di una tribù o di una città. In un mondo post letterario la nostra conoscenza del passato sta sottilmente mutando nel momento in cui lo vediamo rappresentato da pixel o quando le informazioni scaturiscono non da sole, ma grazie all’interattività con il mezzo. La nostra capacità come studiosi e studenti di percepire idee ed orientamenti importanti dipende spesso dai metodi che impieghiamo per rappresentare i dati e l’evidenza. Perché gli storici possano ottenere il beneficio sottinteso al 3D, tuttavia, devono sviluppare un’agenda di ricerca volta ad accertarsi che il 3D sostenga i loro obiettivi di ricercatori e insegnanti. Le esperienze raccolte nelle pagine precedenti ci portano a pensare che in un futuro non troppo lontano uno strumento come il computer sarà l’unico mezzo attraverso cui trasmettere conoscenze, e dal punto di vista didattico la sua interattività consente coinvolgimento negli studenti come nessun altro mezzo di comunicazione moderno.

Technical innovations for the diagnosis and the rehabilitation of motor and perceptive impairments of the child with Cerebral Palsy

The treatment of the Cerebral Palsy (CP) is considered as the “core problem” for the whole field of the pediatric rehabilitation. The reason why this pathology has such a primary role, can be ascribed to two main aspects. First of all CP is the form of disability most frequent in childhood (one new case per 500 birth alive, (1)), secondarily the functional recovery of the “spastic” child is, historically, the clinical field in which the majority of the therapeutic methods and techniques (physiotherapy, orthotic, pharmacologic, orthopedic-surgical, neurosurgical) were first applied and tested. The currently accepted definition of CP – Group of disorders of the development of movement and posture causing activity limitation (2) – is the result of a recent update by the World Health Organization to the language of the International Classification of Functioning Disability and Health, from the original proposal of Ingram – A persistent but not unchangeable disorder of posture and movement – dated 1955 (3). This definition considers CP as a permanent ailment, i.e. a “fixed” condition, that however can be modified both functionally and structurally by means of child spontaneous evolution and treatments carried out during childhood. The lesion that causes the palsy, happens in a structurally immature brain in the pre-, peri- or post-birth period (but only during the firsts months of life). The most frequent causes of CP are: prematurity, insufficient cerebral perfusion, arterial haemorrhage, venous infarction, hypoxia caused by various origin (for example from the ingestion of amniotic liquid), malnutrition, infection and maternal or fetal poisoning. In addition to these causes, traumas and malformations have to be included. The lesion, whether focused or spread over the nervous system, impairs the whole functioning of the Central Nervous System (CNS). As a consequence, they affect the construction of the adaptive functions (4), first of all posture control, locomotion and manipulation. The palsy itself does not vary over time, however it assumes an unavoidable “evolutionary” feature when during growth the child is requested to meet new and different needs through the construction of new and different functions. It is essential to consider that clinically CP is not only a direct expression of structural impairment, that is of etiology, pathogenesis and lesion timing, but it is mainly the manifestation of the path followed by the CNS to “re”-construct the adaptive functions “despite” the presence of the damage. “Palsy” is “the form of the function that is implemented by an individual whose CNS has been damaged in order to satisfy the demands coming from the environment” (4). Therefore it is only possible to establish general relations between lesion site, nature and size, and palsy and recovery processes. It is quite common to observe that children with very similar neuroimaging can have very different clinical manifestations of CP and, on the other hand, children with very similar motor behaviors can have completely different lesion histories. A very clear example of this is represented by hemiplegic forms, which show bilateral hemispheric lesions in a high percentage of cases. The first section of this thesis is aimed at guiding the interpretation of CP. First of all the issue of the detection of the palsy is treated from historical viewpoint. Consequently, an extended analysis of the current definition of CP, as internationally accepted, is provided. The definition is then outlined in terms of a space dimension and then of a time dimension, hence it is highlighted where this definition is unacceptably lacking. The last part of the first section further stresses the importance of shifting from the traditional concept of CP as a palsy of development (defect analysis) towards the notion of development of palsy, i.e., as the product of the relationship that the individual however tries to dynamically build with the surrounding environment (resource semeiotics) starting and growing from a different availability of resources, needs, dreams, rights and duties (4). In the scientific and clinic community no common classification system of CP has so far been universally accepted. Besides, no standard operative method or technique have been acknowledged to effectively assess the different disabilities and impairments exhibited by children with CP. CP is still “an artificial concept, comprising several causes and clinical syndromes that have been grouped together for a convenience of management” (5). The lack of standard and common protocols able to effectively diagnose the palsy, and as a consequence to establish specific treatments and prognosis, is mainly because of the difficulty to elevate this field to a level based on scientific evidence. A solution aimed at overcoming the current incomplete treatment of CP children is represented by the clinical systematic adoption of objective tools able to measure motor defects and movement impairments. A widespread application of reliable instruments and techniques able to objectively evaluate both the form of the palsy (diagnosis) and the efficacy of the treatments provided (prognosis), constitutes a valuable method able to validate care protocols, establish the efficacy of classification systems and assess the validity of definitions. Since the ‘80s, instruments specifically oriented to the analysis of the human movement have been advantageously designed and applied in the context of CP with the aim of measuring motor deficits and, especially, gait deviations. The gait analysis (GA) technique has been increasingly used over the years to assess, analyze, classify, and support the process of clinical decisions making, allowing for a complete investigation of gait with an increased temporal and spatial resolution. GA has provided a basis for improving the outcome of surgical and nonsurgical treatments and for introducing a new modus operandi in the identification of defects and functional adaptations to the musculoskeletal disorders. Historically, the first laboratories set up for gait analysis developed their own protocol (set of procedures for data collection and for data reduction) independently, according to performances of the technologies available at that time. In particular, the stereophotogrammetric systems mainly based on optoelectronic technology, soon became a gold-standard for motion analysis. They have been successfully applied especially for scientific purposes. Nowadays the optoelectronic systems have significantly improved their performances in term of spatial and temporal resolution, however many laboratories continue to use the protocols designed on the technology available in the ‘70s and now out-of-date. Furthermore, these protocols are not coherent both for the biomechanical models and for the adopted collection procedures. In spite of these differences, GA data are shared, exchanged and interpreted irrespectively to the adopted protocol without a full awareness to what extent these protocols are compatible and comparable with each other. Following the extraordinary advances in computer science and electronics, new systems for GA no longer based on optoelectronic technology, are now becoming available. They are the Inertial and Magnetic Measurement Systems (IMMSs), based on miniature MEMS (Microelectromechanical systems) inertial sensor technology. These systems are cost effective, wearable and fully portable motion analysis systems, these features gives IMMSs the potential to be used both outside specialized laboratories and to consecutive collect series of tens of gait cycles. The recognition and selection of the most representative gait cycle is then easier and more reliable especially in CP children, considering their relevant gait cycle variability. The second section of this thesis is focused on GA. In particular, it is firstly aimed at examining the differences among five most representative GA protocols in order to assess the state of the art with respect to the inter-protocol variability. The design of a new protocol is then proposed and presented with the aim of achieving gait analysis on CP children by means of IMMS. The protocol, named ‘Outwalk’, contains original and innovative solutions oriented at obtaining joint kinematic with calibration procedures extremely comfortable for the patients. The results of a first in-vivo validation of Outwalk on healthy subjects are then provided. In particular, this study was carried out by comparing Outwalk used in combination with an IMMS with respect to a reference protocol and an optoelectronic system. In order to set a more accurate and precise comparison of the systems and the protocols, ad hoc methods were designed and an original formulation of the statistical parameter coefficient of multiple correlation was developed and effectively applied. On the basis of the experimental design proposed for the validation on healthy subjects, a first assessment of Outwalk, together with an IMMS, was also carried out on CP children. The third section of this thesis is dedicated to the treatment of walking in CP children. Commonly prescribed treatments in addressing gait abnormalities in CP children include physical therapy, surgery (orthopedic and rhizotomy), and orthoses. The orthotic approach is conservative, being reversible, and widespread in many therapeutic regimes. Orthoses are used to improve the gait of children with CP, by preventing deformities, controlling joint position, and offering an effective lever for the ankle joint. Orthoses are prescribed for the additional aims of increasing walking speed, improving stability, preventing stumbling, and decreasing muscular fatigue. The ankle-foot orthosis (AFO), with a rigid ankle, are primarily designed to prevent equinus and other foot deformities with a positive effect also on more proximal joints. However, AFOs prevent the natural excursion of the tibio-tarsic joint during the second rocker, hence hampering the natural leaning progression of the whole body under the effect of the inertia (6). A new modular (submalleolar) astragalus-calcanear orthosis, named OMAC, has recently been proposed with the intention of substituting the prescription of AFOs in those CP children exhibiting a flat and valgus-pronated foot. The aim of this section is thus to present the mechanical and technical features of the OMAC by means of an accurate description of the device. In particular, the integral document of the deposited Italian patent, is provided. A preliminary validation of OMAC with respect to AFO is also reported as resulted from an experimental campaign on diplegic CP children, during a three month period, aimed at quantitatively assessing the benefit provided by the two orthoses on walking and at qualitatively evaluating the changes in the quality of life and motor abilities. As already stated, CP is universally considered as a persistent but not unchangeable disorder of posture and movement. Conversely to this definition, some clinicians (4) have recently pointed out that movement disorders may be primarily caused by the presence of perceptive disorders, where perception is not merely the acquisition of sensory information, but an active process aimed at guiding the execution of movements through the integration of sensory information properly representing the state of one’s body and of the environment. Children with perceptive impairments show an overall fear of moving and the onset of strongly unnatural walking schemes directly caused by the presence of perceptive system disorders. The fourth section of the thesis thus deals with accurately defining the perceptive impairment exhibited by diplegic CP children. A detailed description of the clinical signs revealing the presence of the perceptive impairment, and a classification scheme of the clinical aspects of perceptual disorders is provided. In the end, a functional reaching test is proposed as an instrumental test able to disclosure the perceptive impairment. References 1. Prevalence and characteristics of children with cerebral palsy in Europe. Dev Med Child Neurol. 2002 Set;44(9):633-640. 2. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol. 2005 Ago;47(8):571-576. 3. Ingram TT. A study of cerebral palsy in the childhood population of Edinburgh. Arch. Dis. Child. 1955 Apr;30(150):85-98. 4. Ferrari A, Cioni G. The spastic forms of cerebral palsy : a guide to the assessment of adaptive functions. Milan: Springer; 2009. 5. Olney SJ, Wright MJ. Cerebral Palsy. Campbell S et al. Physical Therapy for Children. 2nd Ed. Philadelphia: Saunders. 2000;:533-570. 6. Desloovere K, Molenaers G, Van Gestel L, Huenaerts C, Van Campenhout A, Callewaert B, et al. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Gait Posture. 2006 Ott;24(2):142-151.

Methodological improvement of 3D fluoroscopic analysis for the robust quantification of 3D kinematics of human joints

3D video-fluoroscopy is an accurate but cumbersome technique to estimate natural or prosthetic human joint kinematics. This dissertation proposes innovative methodologies to improve the 3D fluoroscopic analysis reliability and usability. Being based on direct radiographic imaging of the joint, and avoiding soft tissue artefact that limits the accuracy of skin marker based techniques, the fluoroscopic analysis has a potential accuracy of the order of mm/deg or better. It can provide fundamental informations for clinical and methodological applications, but, notwithstanding the number of methodological protocols proposed in the literature, time consuming user interaction is exploited to obtain consistent results. The user-dependency prevented a reliable quantification of the actual accuracy and precision of the methods, and, consequently, slowed down the translation to the clinical practice. The objective of the present work was to speed up this process introducing methodological improvements in the analysis. In the thesis, the fluoroscopic analysis was characterized in depth, in order to evaluate its pros and cons, and to provide reliable solutions to overcome its limitations. To this aim, an analytical approach was followed. The major sources of error were isolated with in-silico preliminary studies as: (a) geometric distortion and calibration errors, (b) 2D images and 3D models resolutions, (c) incorrect contour extraction, (d) bone model symmetries, (e) optimization algorithm limitations, (f) user errors. The effect of each criticality was quantified, and verified with an in-vivo preliminary study on the elbow joint. The dominant source of error was identified in the limited extent of the convergence domain for the local optimization algorithms, which forced the user to manually specify the starting pose for the estimating process. To solve this problem, two different approaches were followed: to increase the optimal pose convergence basin, the local approach used sequential alignments of the 6 degrees of freedom in order of sensitivity, or a geometrical feature-based estimation of the initial conditions for the optimization; the global approach used an unsupervised memetic algorithm to optimally explore the search domain. The performances of the technique were evaluated with a series of in-silico studies and validated in-vitro with a phantom based comparison with a radiostereometric gold-standard. The accuracy of the method is joint-dependent, and for the intact knee joint, the new unsupervised algorithm guaranteed a maximum error lower than 0.5 mm for in-plane translations, 10 mm for out-of-plane translation, and of 3 deg for rotations in a mono-planar setup; and lower than 0.5 mm for translations and 1 deg for rotations in a bi-planar setups. The bi-planar setup is best suited when accurate results are needed, such as for methodological research studies. The mono-planar analysis may be enough for clinical application when the analysis time and cost may be an issue. A further reduction of the user interaction was obtained for prosthetic joints kinematics. A mixed region-growing and level-set segmentation method was proposed and halved the analysis time, delegating the computational burden to the machine. In-silico and in-vivo studies demonstrated that the reliability of the new semiautomatic method was comparable to a user defined manual gold-standard. The improved fluoroscopic analysis was finally applied to a first in-vivo methodological study on the foot kinematics. Preliminary evaluations showed that the presented methodology represents a feasible gold-standard for the validation of skin marker based foot kinematics protocols.

Analysis of the Slow Food movement impact on the farmers and rural areas’ sustainable development

The evaluation of the farmers’ communities’ approach to the Slow Food vision, their perception of the Slow Food role in supporting their activity and their appreciation and expectations from participating in the event of Mother Earth were studied. The Unified Theory of Acceptance and Use of Technology (UTAUT) model was adopted in an agro-food sector context. A survey was conducted, 120 questionnaires from farmers attending the Mother Earth in Turin in 2010 were collected. The descriptive statistical analysis showed that both Slow Food membership and participation to Mother Earth Meeting were much appreciated for the support provided to their business and the contribution to a more sustainable and fair development. A positive social, environmental and psychological impact on farmers also resulted. Results showed also an interesting perspective on the possible universality of the Slow Food and Mother Earth values. Farmers declared that Slow Food is supporting them by preserving the biodiversity and orienting them to the use of local resources and reducing the chemical inputs. Many farmers mentioned the language/culture and administration/bureaucratic issues as an obstacle to be a member in the movement and to participate to the event. Participation to Mother Earth gives an opportunity to exchange information with other farmers’ communities and to participate to seminars and debates, helpful for their business development. The absolute majority of positive answers associated to the farmers’ willingness to relate to Slow Food and participate to the next Mother Earth editions negatively influenced the UTAUT model results. A factor analysis showed that the variables associated to the UTAUT model constructs Performance Expectancy and Effort Expectancy were consistent, able to explain the construct variability, and their measurement reliable. Their inclusion in a simplest Technology Acceptance Model could be considered in future researches.

The Dynamics of Passive Torsional Fatigue Test Rigs: Innovative Applications of Universal Joints

The dynamics of a passive back-to-back test rig have been characterised, leading to a multi-coordinate approach for the analysis of arbitrary test configurations. Universal joints have been introduced into a typical pre-loaded back-to-back system in order to produce an oscillating torsional moment in a test specimen. Two different arrangements have been investigated using a frequency-based sub-structuring approach: the receptance method. A numerical model has been developed in accordance with this theory, allowing interconnection of systems with two-coordinates and closed multi-loop schemes. The model calculates the receptance functions and modal and deflected shapes of a general system. Closed form expressions of the following individual elements have been developed: a servomotor, damped continuous shaft and a universal joint. Numerical results for specific cases have been compared with published data in literature and experimental measurements undertaken in the present work. Due to the complexity of the universal joint and its oscillating dynamic effects, a more detailed analysis of this component has been developed. Two models have been presented. The first represents the joint as two inertias connected by a massless cross-piece. The second, derived by the dynamic analysis of a spherical four-link mechanism, considers the contribution of the floating element and its gyroscopic effects. An investigation into non-linear behaviour has led to a time domain model that utilises the Runge-Kutta fourth order method for resolution of the dynamic equations. It has been demonstrated that the torsional receptances of a universal joint, derived using the simple model, result in representation of the joint as an equivalent variable inertia. In order to verify the model, a test rig has been built and experimental validation undertaken. The variable inertia of a universal joint has lead to a novel application of the component as a passive device for the balancing of inertia variations in slider-crank mechanisms.

From inverted pendulum to N-link chain: inertial sensors-based assessment of movement kinematics and dynamics for functional evaluation and rehabilitation

Despite several clinical tests that have been developed to qualitatively describe complex motor tasks by functional testing, these methods often depend on clinicians' interpretation, experience and training, which make the assessment results inconsistent, without the precision required to objectively assess the effect of the rehabilitative intervention. A more detailed characterization is required to fully capture the various aspects of motor control and performance during complex movements of lower and upper limbs. The need for cost-effective and clinically applicable instrumented tests would enable quantitative assessment of performance on a subject-specific basis, overcoming the limitations due to the lack of objectiveness related to individual judgment, and possibly disclosing subtle alterations that are not clearly visible to the observer. Postural motion measurements at additional locations, such as lower and upper limbs and trunk, may be necessary in order to obtain information about the inter-segmental coordination during different functional tests involved in clinical practice. With these considerations in mind, this Thesis aims: i) to suggest a novel quantitative assessment tool for the kinematics and dynamics evaluation of a multi-link kinematic chain during several functional motor tasks (i.e. squat, sit-to-stand, postural sway), using one single-axis accelerometer per segment, ii) to present a novel quantitative technique for the upper limb joint kinematics estimation, considering a 3-link kinematic chain during the Fugl-Meyer Motor Assessment and using one inertial measurement unit per segment. The suggested methods could have several positive feedbacks from clinical practice. The use of objective biomechanical measurements, provided by inertial sensor-based technique, may help clinicians to: i) objectively track changes in motor ability, ii) provide timely feedback about the effectiveness of administered rehabilitation interventions, iii) enable intervention strategies to be modified or changed if found to be ineffective, and iv) speed up the experimental sessions when several subjects are asked to perform different functional tests.

Movement Analysis by means of inertial sensors: from bench to bedside

in the everyday clinical practice. Having this in mind, the choice of a simple setup would not be enough because, even if the setup is quick and simple, the instrumental assessment would still be in addition to the daily routine. The will to overcome this limit has led to the idea of instrumenting already existing and widely used functional tests. In this way the sensor based assessment becomes an integral part of the clinical assessment. Reliable and validated signal processing methods have been successfully implemented in Personal Health Systems based on smartphone technology. At the end of this research project there is evidence that such solution can really and easily used in clinical practice in both supervised and unsupervised settings. Smartphone based solution, together or in place of dedicated wearable sensing units, can truly become a pervasive and low-cost means for providing suitable testing solutions for quantitative movement analysis with a clear clinical value, ultimately providing enhanced balance and mobility support to an aging population.

Tra pacifismo e ambientalismo: il Nuclear Freeze Movement e la risposta dell'amministrazione Reagan

Negli anni Ottanta si assiste tanto nel vecchio quanto nel nuovo continente alla rinascita del movimento antinucleare. Mentre in Europa l’origine di questa ondata di proteste antinucleari è collegata alla “doppia decisione” NATO del 1979, negli Stati Uniti la genesi si colloca nel contesto dalla mobilitazione dei gruppi ambientalisti in seguito all’incidente alla centrale nucleare di Three Mile Island. Dopo l’elezione di Ronald Reagan, alle proteste contro le applicazioni pacifiche dell’atomo si affiancarono quelle contro la politica nucleare del Paese. La retorica di Reagan, il massiccio piano di riarmo, unitamente al rinnovato deteriorarsi delle relazioni tra USA e URSS contribuirono a diffondere nell’opinione pubblica la sensazione che l’amministrazione Reagan, almeno da un punto di vista teorico, non avesse escluso dalle sue opzioni il ricorso alle armi nucleari nel caso di un confronto con l’URSS. I timori legati a questa percezione produssero una nuova ondata di proteste che assunsero dimensioni di massa grazie alla mobilitazione provocata dalla Nuclear Weapons Freeze Campaign (NWFC). Il target della NWFC era l’ampio programma di riarmo nucleare sostenuto da Reagan, che secondo gli attivisti nucleari, in un quadro di crescenti tensioni internazionali, avrebbe fatto aumentare le possibilità di uno scontro atomico. Per evitare lo scenario dell’olocausto nucleare, la NWFC proponeva «un congelamento bilaterale e verificabile del collaudo, dell’installazione e della produzione di armi nucleari». L’idea del nuclear freeze, che era concepito come un passo per fermare la spirale del riarmo e tentare successivamente di negoziare riduzioni negli arsenali delle due superpotenze, riscosse un tale consenso nell’opinione pubblica americana da indurre l’amministrazione Reagan a formulare una risposta specifica. Durante la primavera del 1982 fu, infatti, creato un gruppo interdipartimentale ad hoc, l’Arms Control Information Policy Group, con il compito di arginare l’influenza della NWFC sull’opinione pubblica americana e formulare una risposta coerente alle critiche del movimento antinucleare.

Staphylococcus aureus bones and joints infections: in vivo studies and host immune response

Abstract The aim of this work was the development of a murine model of septic arthrosynovitis and osteomyelitis caused by Staphylococcus aureus, which could mimic the natural disease occurring in humans and which could be suitable for testing preventive and therapeutic interventions. This model could be particularly useful since S. aureus-mediated joints and bones infections are relevant in humans, both in terms of frequency and severity. Our attention focused in tracking bacterial infiltration in joints and bones over time using different microbiological and hystopathological tools, which allowed us to have a complete overview of the situation and to evaluate the immunological actions undertaken by the host to contain or eradicate the bacterial infection. Antibodies and cytokines profiles, as well as recruitment of host immune cells at joints of immunized and infected mice were therefore monitored for a time period that allowed us to study both the acute and the chronic phases of the disease in situ. Finally the Novartis vaccine formulation proposed against S. aureus infections was tested for its capacity to protect immunized mice from joints infections, and the preventive immunization was compared to a standard antibiotic prophylaxis. The availability of powerful tools to study specific bacterial-mediated diseases is nowadays an important requirement for the scientific community to shed light on the complex interactions between host and pathogens and to test treatments for preventing or contrasting infections. We believe that our work significantly contributes to the overall knowledge in the field of S. aureus-dependent pathologies, opening the possibility for further investigations in several fields of study.

The reconstruction of skeletal movement: the soft tissue artefact issue

In 3D human movement analysis performed using stereophotogrammetric systems and skin markers, bone pose can only be estimated in an indirect fashion. During a movement, soft tissue deformations make the markers move with respect to the underlying bone generating soft tissue artefact (STA). STA has devastating effects on bone pose estimation and its compensation remains an open question. The aim of this PhD thesis was to contribute to the solution of this crucial issue. Modelling STA using measurable trial-specific variables is a fundamental prerequisite for its removal from marker trajectories. Two STA model architectures are proposed. Initially, a thigh marker-level artefact model is presented. STA was modelled as a linear combination of joint angles involved in the movement. This model was calibrated using ex-vivo and in-vivo STA invasive measures. The considerable number of model parameters led to defining STA approximations. Three definitions were proposed to represent STA as a series of modes: individual marker displacements, marker-cluster geometrical transformations (MCGT), and skin envelope shape variations. Modes were selected using two criteria: one based on modal energy and another on the selection of modes chosen a priori. The MCGT allows to select either rigid or non-rigid STA components. It was also empirically demonstrated that only the rigid component affects joint kinematics, regardless of the non-rigid amplitude. Therefore, a model of thigh and shank STA rigid component at cluster-level was then defined. An acceptable trade-off between STA compensation effectiveness and number of parameters can be obtained, improving joint kinematics accuracy. The obtained results lead to two main potential applications: the proposed models can generate realistic STAs for simulation purposes to compare different skeletal kinematics estimators; and, more importantly, focusing only on the STA rigid component, the model attains a satisfactory STA reconstruction with less parameters, facilitating its incorporation in an pose estimator.