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EMG-Based Biofeedback to Improve Motor Control in Children with Dystonia The scarcity of effective treatment options for children with dystonia represents an important clinical challenge. In this framework, biofeedback training is a promising non-invasive treatment candidate. Indeed, rehabilitation tools able to provide augmented sensory information may be used by children to better calibrate and modulate muscle activations to attain improved motor control. Recently, biofeedback paradigms based on surface electromyographic activity of task-related muscles have been developed and tested. These studies, by leveraging different sensory channels, such as visual and haptic modalities, showed that children with dystonia have the ability to gain partial control over muscle activations, resulting in clinical improvements. Future studies should adopt more sensitive and accurate outcome measures with the ability of capturing small motor changes, in order to quantitatively and reliably assess the benefits of biofeedback training in children with dystonia.

BackgroundDifficulties in handwriting, such as dysgraphia, impact several aspects of a child’s everyday life. Current methodologies for the detection of such difficulties in children have the following three main weaknesses: (1) they are prone to subjective evaluation; (2) they can be administered only when handwriting is mastered, thus delaying the diagnosis and the possible adoption of countermeasures; and (3) they are not always easily accessible to the entire community.ObjectiveThis work aims at developing a solution able to: (1) quantitatively measure handwriting features whose alteration is typically seen in children with dysgraphia; (2) enable their study in a preliteracy population; and (3) leverage a standard consumer technology to increase the accessibility of both early screening and longitudinal monitoring of handwriting difficulties.MethodsWe designed and developed a novel tablet-based app Play Draw Write to assess potential markers of dysgraphia through the quantification of the following three key handwriting laws: isochrony, homothety, and speed-accuracy tradeoff. To extend such an approach to a preliteracy age, the app includes the study of the laws in terms of both word writing and symbol drawing. The app was tested among healthy children with mastered handwriting (third graders) and those at a preliterate age (kindergartners).ResultsApp testing in 15 primary school children confirmed that the three laws hold on the tablet surface when both writing words and drawing symbols. We found significant speed modulation according to size (P0.28, 12 degrees of freedom). Importantly, the three laws were verified on symbols among 19 kindergartners. Results from the speed-accuracy exercise showed a significant evolution with age of the global movement time (circle: P=.003, square: PConclusionsThe designed app represents a promising solution for the screening of handwriting difficulties, since it allows (1) anticipation of the detection of alteration of handwriting principles at a preliteracy age and (2) provision of broader access to the monitoring of handwriting principles. Such a solution potentially enables the selective strengthening of lacking abilities before they exacerbate and affect the child’s whole life.

Background Dementia is a major and growing health problem, and early diagnosis is key to its management. Objective With the ultimate goal of providing a monitoring tool that could be used to support the screening for cognitive decline, this study aims to develop a supervised, digitized version of 2 neuropsychological tests: Trail Making Test and Bells Test. The system consists of a web app that implements a tablet-based version of the tests and consists of an innovative vocal assistant that acts as the virtual supervisor for the execution of the test. A replay functionality is added to allow inspection of the user’s performance after test completion. Methods To deploy the system in a nonsupervised environment, extensive functional testing of the platform was conducted, together with a validation of the tablet-based tests. Such validation had the two-fold aim of evaluating system usability and acceptance and investigating the concurrent validity of computerized assessment compared with the corresponding paper-and-pencil counterparts. Results The results obtained from 83 older adults showed high system acceptance, despite the patients’ low familiarity with technology. The system software was successfully validated. A concurrent validation of the system reported good ability of the digitized tests to retain the same predictive power of the corresponding paper-based tests. Conclusions Altogether, the positive results pave the way for the deployment of the system to a nonsupervised environment, thus representing a potential efficacious and ecological solution to support clinicians in the identification of early signs of cognitive decline.

Understanding how the CNS copes with the redundancy of the musculoskeletal system is a central aim in motor neuroscience and has important implications in the clinical scenario. A long-standing idea hypothesis is that motor control may be simplified by a modular organization, in which several a few muscle synergies are used to organize muscles in functional groups. In this chapter, we present the theory hypothesis of muscle synergies under from a simplified point of view and we describe its practical implications in the context of neurological pathologies. This chapter wants to be an intuitive and practical guide to those practitioners, new to the concept of muscle synergies, willing to understand how to perform such an analysis in typical clinical settings.

Digital neuropsychological tests self-Administered at home have the potential to detect early signs of cognitive decline in the elderlies, thus allowing to adopt preventive measures. Usability tests and clinical validation are required before computerized assessment could juxtapose traditional paper-And-pencil tests to spot early signs of decline. We have developed a tablet-based digitized version of two neuropsychological tests commonly used in screening for dementia: Trail Making Test (A and B versions) and Bells Test. We studied system usability and acceptance, and concurrent validity of the computerized assessment compared with the corresponding paper-And-pencil tests. Results show a very high system acceptance, notwithstanding the patients' low familiarity with technology. System validation reports a good ability of the digital tests to retain the same predictive power of the corresponding paper-based tests. Altogether, results suggest that computerized neuropsychological assessment may represent an adequate, ecological and cost-effective solution for home monitoring of the elder's cognitive status, thus supporting clinicians in the identification of early signs of cognitive decline.