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Imitation is a key socio-cognitive skill impaired in individuals with Autism Spectrum Conditions (ASC). It is known that the familiarity with an actor facilitates the appearance of imitative abilities. Here, we explore whether a highly familiar and socially relevant stimulus presented in the olfactory modality is able to improve spontaneous imitation as early as at the level of action planning. A group of 20 children with ASC and 20 controls observed their own mother or the mother of another child performing a reach-to-grasp action towards an object, under the exposure to their maternal odor, the odor of the mother of another child or no odor. Subsequently, children acted upon the same object with no specific instruction to imitate. Child's movement initiation time (MIT) served as an indicator of motor planning facilitation induced by action observation. Results suggest that for children with ASC (but not controls) MIT was significantly lower when exposed to the maternal odor both when interacting with a familiar or an unfamiliar model. In the former case, the performance is comparable to controls. The familiar model in the absence of any olfactory cue is able to induce a facilitation effect, but the maximal facilitation on MIT is evident when maternal odor and familiar model are paired. We hypothesize that for children with ASC the maternal odor provides relevant social motivation for taking advantage of others' actions when planning movements in an imitative context., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Background: A high prevalence of obstructive sleep apnea syndrome (OSAS) has been reported in severely obese patients with nonalcoholic fatty liver disease (NAFLD), but few studies have evaluated OSAS in non-morbidly obese NAFLD patients., Aims: To determine the prevalence of risk for OSAS with or without daytime sleepiness in non-morbidly obese patients with NAFLD and evaluate the association with the severity of liver damage., Methods: We considered 159 consecutive patients with histological NAFLD and body mass index (BMI) <35 Kg/m2, and 80 controls without ultrasonographic steatosis matched for age, sex, and BMI. OSAS risk was determined by positivity for Berlin questionnaire (BQ), and daytime sleepiness by the Sleepness Epworth Scale (ESS). Liver damage was evaluated according to the NAFLD activity score., Results: In NAFLD patients, BQ alone was positive in 39 (25%), ESS in 8 (5%), and both in 13 (8%, OSAS with sleepines); p = ns vs. controls without steatosis. In NAFLD patients at risk for OSAS with (but not in those without) sleepiness, we observed a higher prevalence of nonalcoholic steatohepatitis (NASH; 11/13, 85% vs. 72/146, 49%; p = 0.018), and of clinically significant fibrosis (stage>1; 9/13, 69% vs. 39/146, 27%; p = 0.003). At multivariate logistic regression analysis, OSAS with sleepiness was strongly associated with NASH and fibrosis>1 independently of known clinical risk factors such as age, gender, BMI, diabetes, and ALT levels (OR 7.1, 95% c.i. 1.7-51, p = 0.005 and OR 14.0, 95% c.i. 3.5-70, p = 0.0002, respectively)., Conclusions: A proportion of NAFLD patients without severe obesity is at risk for OSAS with daytime sleepiness, which is associated with the severity of liver damage independently of body mass and other cofactors.

Although there is a wealth of behavioral data regarding grasping movements in non-human primates, how posture influences the kinematics of prehensile behavior is not yet clearly understood. The purpose of this study was to examine and compare kinematic descriptions of grip behaviors while primates (macaque monkeys) were in a sitting posture or when stopping after quadrupedal locomotion (i.e., tripedal stance). Video footage taken while macaques grasped objects was analyzed frame-by-frame using digitalization techniques. Each of the two grip types considered (power and precision grips) was found to be characterized by specific, distinct kinematic signatures for both the reaching and the grasping components when those actions were performed in a sitting position. The grasping component did not differentiate in relation to the type of grip that was needed when, instead, the prehensile action took place in a tripedal stance. Quadrupedal locomotion affected the concomitant organization of prehensile activities determining in fact a similar kinematic patterning for the two grips regardless of the size of the object to be grasped. It is suggested that using a single kinematic grip patterning for all prehensile activities might be both the by-product of planning a grasping action while walking and a way to simplify motor programming during unstable tripedal stance.

Highly efficient systems are needed to link perception with action in the context of the highly complex environments in which primates move and interact. Another important component is, nonetheless, needed for action: selection. When one piece of fruit from a branch is being chosen by a monkey, many other pieces are within reach and visible: do the perceptual features of the objects surrounding a target determine interference effects? In humans, reaching to grasp a desired object appears to integrate the motor features of the objects which might become potential targets - a process which seems to be driven by inhibitory attention mechanisms. Here we show that non-human primates use similar mechanisms when carrying out goal-directed actions. The data indicate that the volumetric features of distractors are internally represented, implying that the basic cognitive operations allowing for action selection have deep evolutionary roots.

The proper way to test the usefulness of hospitalization in syncope patients would be to conduct a randomized controlled trial. However, this approach is characterized by major theoretical and ethical limitations which make this procedure unfeasible. Data from observational studies indirectly show that hospitalization might help reduce the short-term risk of death and adverse events by promptly identifying and treating life-threatening events or conditions. Future research should focus on identifying which patients will benefit from hospitalization. In this regard, we should be able both to correctly risk-stratify patients and to analyze syncope observation units and protocols, which may provide a safe alternative for the evaluation of intermediate-risk patients.

Background: The aim of this longitudinal study was to investigate how the kinematic organization of upper limb movements changes from fetal to post-natal life. By means of off-line kinematical techniques we compared the kinematics of hand-to-mouth and hand-to-eye movements, in the same individuals, during prenatal life and early postnatal life, as well as the kinematics of hand-to-mouth and reaching-toward-object movements in the later age periods., Methodology/principal Findings: Movements recorded at the 14(th), 18(th) and 22(nd) week of gestation were compared with similar movements recorded in an ecological context at 1, 2, 3, 4, 8, and 12 months after birth. The results indicate a similar kinematic organization depending on movement type (i.e., eye, mouth) for the infants at one month and for the fetuses at 22 weeks of gestation. At two and three months such differential motor planning depending on target is lost and no statistical differences emerge. Hand to eye movements were no longer observed after the fourth month of life, therefore we compared kinematics for hand to mouth with hand to object movements. Results of these analyses revealed differences in the performance of hand to mouth and reaching to object movements in the length of the deceleration phase of the movement, depending on target., Conclusion/significance: Data are discussed in terms of how the passage from intrauterine to extra-uterine environments modifies motor planning. These results provide novel evidence of how different types of upper extremity movements, those directed towards one's own face and those directed to external objects, develop.

Background: Autism spectrum disorders comprise a range of neurodevelopmental pathologies characterized, among other symptoms, by impaired social interactions. Individuals with this diagnosis are reported to often identify people by repetitively sniffing pieces of clothing or the body odor of family members. Since body odors are known to initiate and mediate many different social behaviors, smelling the body odor of a family member might constitute a sensory-based action promoting social contact. In light of this, we hypothesized that the body odor of a family member would facilitate the appearance of automatic imitation, an essential social skill known to be impaired in autism., Methods: We recruited 20 autistic and 20 typically developing children. Body odors were collected from the children's mothers' axillae. A child observed a model (their mother or a stranger mother) execute (or not) a reach-to-grasp action toward an object. Subsequently, she performed the same action. The object was imbued with the child's mother's odor, a stranger mother's odor, or no odor. The actions were videotaped, and movement time was calculated post hoc via a digitalization technique., Results: Automatic imitation effects-expressed in terms of total movement time reduction-appear in autistic children only when exposed to objects paired with their own mother's odor., Conclusions: The maternal odor, which conveys a social message otherwise neglected, helps autistic children to covertly imitate the actions of others. Our results represent a starting point holding theoretical and practical relevance for the development of new strategies to enhance communication and social behavior among autistic individuals., (Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: MUNDUS is an assistive framework for recovering direct interaction capability of severely motor impaired people based on arm reaching and hand functions. It aims at achieving personalization, modularity and maximization of the user's direct involvement in assistive systems. To this, MUNDUS exploits any residual control of the end-user and can be adapted to the level of severity or to the progression of the disease allowing the user to voluntarily interact with the environment. MUNDUS target pathologies are high-level spinal cord injury (SCI) and neurodegenerative and genetic neuromuscular diseases, such as amyotrophic lateral sclerosis, Friedreich ataxia, and multiple sclerosis (MS). The system can be alternatively driven by residual voluntary muscular activation, head/eye motion, and brain signals. MUNDUS modularly combines an antigravity lightweight and non-cumbersome exoskeleton, closed-loop controlled Neuromuscular Electrical Stimulation for arm and hand motion, and potentially a motorized hand orthosis, for grasping interactive objects., Methods: The definition of the requirements and of the interaction tasks were designed by a focus group with experts and a questionnaire with 36 potential end-users., Results: The functionality of all modules has been successfully demonstrated. User's intention was detected with a 100% success. Averaging all subjects and tasks, the minimum evaluation score obtained was 1.13 ± 0.99 for the release of the handle during the drinking task, whilst all the other sub-actions achieved a mean value above 1.6. All users, but one, subjectively perceived the usefulness of the assistance and could easily control the system. Donning time ranged from 6 to 65 minutes, scaled on the configuration complexity., Conclusions: The MUNDUS platform provides functional assistance to daily life activities; the modules integration depends on the user's need, the functionality of the system have been demonstrated for all the possible configurations, and preliminary assessment of usability and acceptance is promising.

Many reports in the literature indicate that idiopathic Parkinson's disease (IPD) patients have substantial olfactory dysfunctions even before motor symptoms become evident. It has not yet been clarified, however, if some form of implicit olfactory processing is preserved in this population. An olfactory visuomotor priming paradigm, which detects implicit olfactory processing in neurologically healthy participants, was utilized to investigate motor control in relation to olfactory signals in a group of IPD patients. Two control groups were also considered: 12 vascular Parkinson's disease (VPD) in whom normal olfactory abilities are typically reported and 12 neurologically healthy participants. All of the participants were asked to perform reach-to-grasp movements toward large or small targets following olfactory cues delivered by a computer-controlled olfactometer. The odor was either 'size' congruent with the target (e.g., strawberry or apple, respectively) or incongruent (e.g., apple or strawberry, respectively). A bend sensor glove (CyberGlove) was used to measure the hand kinematics. Facilitation effects were noted in all the groups with regard to movement time. If a congruent rather than an incongruent odor was delivered, the movement time of the reach-to-grasp was shortened and facilitation effects in maximum grip amplitude were noted in both the IPD and the VPD groups. The maximum grip amplitude was smaller when no odor, as compared to a congruent odor, was delivered. The present results suggest that implicit olfactory processing affects motor control in IPD patients favoring less severe bradykinesia and hand movement hypometria. Once confirmed, these findings could be useful when rehabilitation strategies are being hypothesized for these patients., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Humans show a spontaneous tendency to increase the velocity of their movements depending on the linear extent of their trajectory in order to keep execution time approximately constant. Termed the isochrony principle, this compensatory mechanism refers to the observation that the velocity of voluntary movements increases proportionally with their linear extension. Although there is a wealth of psychophysical data regarding isochrony in humans, there is none regarding non-human primates. The present study attempts to fill that gap by investigating reach-to-grasp movement kinematics in free-ranging macaques. Video footage of monkeys grasping objects located at different distances was analyzed frame-by-frame using digitalization techniques. The amplitude of arm peak velocity was found to be correlated with the distance to be covered, and total movement duration remained invariant although target distances varied. Like in humans, the "isochrony principle" seems to be operative as there is a gearing down/up of movement velocity that is proportional to the distance to be covered in order to allow for a relatively constant movement duration. Based on a centrally generated temporal template, this mode of motor programming could be functional in macaques given the high speed and great instability of posture and joint kinematics characterizing their actions. The data presented here take research in the field of comparative motor control a step forward as they are based on precise measurements of spontaneous grasping movements by animals living/acting in their natural environment.

The prehensile hand is one of the major traits distinguishing primates from other mammal species. All primates, in fact, are able to grasp an object and hold it in part or entirely using a single hand. Although there is a wealth of behavioral data regarding grasping movements in humans and apes, there is relatively little material on macaques, the animal model often used to investigate neuronal mechanisms responsible for grip control in humans. To date, evidence regarding free-ranging macaques is confined to observational data, while quantitative reports describe studies carried out in laboratory settings or in captivity. The purpose of the present study was to provide the first kinematic descriptions of basic grip behavior with regard to precision and power grips in free-ranging macaque monkeys. Video footage of those animals grasping objects was analyzed frame-by-frame using digitalization techniques. The results revealed that the two types of grips considered are each characterized by specific kinematic signatures. It was also found that hand kinematics was scaled depending on the type of grasp needing to be adopted and the intrinsic properties of the object to be grasped. In accordance with data concerning humans, these findings indicate that the intrinsic features of an object affect the planning and control of reach-to-grasp movements even in free-ranging macaques. The data presented here take research in the field of comparative reach-to-grasp kinematics in human and non-human primates another step forward as they are based on precise measurements of spontaneous grasping movements by animals living/acting in their natural environment.

Research on multisensory integration during natural tasks has revealed how chemical senses contribute to plan and control movements. An aspect which has yet to be investigated regards whether the motor representations evoked by chemosensory stimuli, once established for a particular movement, can be used to control different effectors. Here, we investigate this issue by asking participants to drink a sip of flavored solution, grasp with the hand a visual target, and then bring it to the mouth, miming the action of biting. Results show that hand and lip apertures were scaled according to the size of the object evoked by the flavor. Maximum hand and lip apertures were greater when the action toward a small visual target (e.g., strawberry) was preceded by a sip of a "large" (e.g., orange) than a "small" (e.g., almond) flavor solution. Conversely, maximum hand and lip apertures were smaller when the action toward a large visual target (e.g., apple) was preceded by the presentation of a "small" (e.g., strawberry) rather than a "large" flavor solution. These findings support previous evidence on the presence of a unique motor plan underlying the act of grasping with-the-hand and with-the-mouth, extending the knowledge of chemosensorimotor transformations to motor equivalence.

Developmental coordination disorder (DCD) has been classified as a specific learning disability, nonetheless the underlying cognitive mechanisms are still a matter of discussion. After a summary of the main hypotheses on the principal neuromotor causes of DCD, this study applies a causal model framework to describe the possible coexistence of more than one deficit in this disorder. For this purpose, kinematic analysis was applied to an ecological task, the reach-to-grasp action, introducing the manipulation of three variables: vision, distance and object size. After a thorough neurological and neuropsychological evaluation, 9 children with DCD (7-9 years old) were selected and compared to 27 age-matched control children. The results suggest that children with DCD have a normal neurological characterization of the reaching and grasping movements, in terms of proximal to distal action, but their grasping aperture (MGA) was always wider with respect to controls, particularly when vision was not allowed. In addition, the performance of children with DCD was always slower, more dependent on vision and more variable than that of controls. The MGA of children with DCD could be explained by a deficit in the internal construction of movement for a forward model, while slowness could be related to a control problem in the neuronal firing of the muscles. The idea of a possible coexistence of these two deficits is discussed in accordance to a causal model framework and also addressed considering recent neurophysiologic evidences., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Background: Newborns come into the world wired to socially interact. Is a propensity to socially oriented action already present before birth? Twin pregnancies provide a unique opportunity to investigate the social pre-wiring hypothesis. Although various types of inter-twins contact have been demonstrated starting from the 11(th) week of gestation, no study has so far investigated the critical question whether intra-pair contact is the result of motor planning rather then the accidental outcome of spatial proximity., Methodology/principal Findings: Kinematic profiles of movements in five pairs of twin foetuses were studied by using four-dimensional ultrasonography during two separate recording sessions carried out at the 14(th) and 18(th) week of gestation. We demonstrate that by the 14th week of gestation twin foetuses do not only display movements directed towards the uterine wall and self-directed movements, but also movements specifically aimed at the co-twin, the proportion of which increases between the 14(th) and 18(th) gestational week. Kinematic analysis revealed that movement duration was longer and deceleration time was prolonged for other-directed movements compared to movements directed towards the uterine wall. Similar kinematic profiles were observed for movements directed towards the co-twin and self-directed movements aimed at the eye-region, i.e. the most delicate region of the body., Conclusions/significance: We conclude that performance of movements towards the co-twin is not accidental: already starting from the 14th week of gestation twin foetuses execute movements specifically aimed at the co-twin.

Deglutition syncope refers to an uncommon cause of neurally mediated syncope induced by swallowing. We briefly review a case of a 66-year-old man who experienced recurrent syncope episodes during ingestion of beverages, mainly water. Our investigations documented several short asymptomatic episodes of asystole and one prolonged complete atrioventricular block of around 15 seconds associated with the syncopal events, during swallowing. Barium x-ray and manometry evaluations revealed only a nonspecific esophageal dysmotility. An underlying sick-sinus syndrome was found on electrophysiologic study. A DDD pacemaker implantation was performed leading to total disappearance of patient's symptoms.

Four experiments investigated the influence of a sudden social request on the kinematics of a preplanned action. In Experiment 1, participants were requested to grasp an object and then locate it within a container (unperturbed trials). On 20% of trials, a human agent seated nearby the participant unexpectedly stretched out her arm and unfolded her hand as if to ask for the object (perturbed trials). In the remaining 3 experiments, similar procedures were adopted except that (a) the human was replaced by a robotic agent, (b) the gesture performed by the human agent did not imply a social request, and (c) the gaze of the human agent was not available. Only when the perturbation was characterized by a social request involving a human agent were there kinematic changes to the action directed toward the target. Conversely, no effects on kinematics were evident when the perturbation was caused by the robotic agent or by a human agent performing a nonsocial gesture. These findings are discussed in the light of current theories proposed to explain the effects of social context on the control of action., (PsycINFO Database Record (c) 2009 APA, all rights reserved.)

The aim of the present study was to compare the characteristics of patients referred to our heart failure outpatient clinic with those of patients enrolled in clinical trials on heart failure pharmacological treatment. Thus, we estimated the proportion of patients admitted to our heart failure outpatient clinic who would have been included in randomized controlled trials evaluating the effects of medical treatments on heart failure mortality, published over a 10 years period (1993-2003). Sixteen studies (n = 45276) and 299 consecutive outpatients, were included. On average, only 34% of the outpatients would have been included in at least one of the 16 trials (8-71%). The main reasons for exclusion were: NYHA class (70% were in NYHA class II), ejection fraction (29% had EF > 35%), co-morbidity (51% had co-morbidity, mainly renal failure, COPD, and disthyroidism), age (22% were older than 80 years), and occurrence of a recent acute event (50% experienced an ischemic coronary syndrome, revascularization, pulmonary edema, or stroke in the prior 6 months). These results underline the crucial role of patient selection in clinical trials, raising uncertainties about the complete applicability of trial results to clinical practice.

Evidence exists that action observation activates the same cortical motor areas that are involved in the performance of the observed actions. An untested idea is whether subcortical structures such as the basal ganglia play a role in the coding of other people's actions. This study used kinematics to examine how Parkinson's disease patients react to the observation of an action which they were subsequently requested to perform. In each trial a model and an observer, which could be either a Parkinsonian patient or a neurologically healthy participant, were seated facing each other. The model was requested to grasp a stimulus (action condition), to perform a kicking action towards the stimulus (control-action condition), and to not perform any action (control condition). The task for the observer was always to grasp the stimulus after having watched the model performing her task. Results show that Parkinson's disease patients did show facilitation effects only when the model was a Parkinsonian patient. Whereas, neurologically healthy participants' movements were facilitated following the observation of either the Parkinsonian and the healthy model grasping the object. No facilitation effects were found for both the control and the control-action conditions. The fact that normal visuomotor priming takes place in PD patients when the observed action matches with what they can perform suggests that basal ganglia might not be necessary for it. However, damage to the basal ganglia might become relevant when such a match does not occur. In such circumstances, a damage to these structures might prevent the deployment of additional activity which might be necessary to influence cortical functions related to the representations of observed actions.

The aim of the present study was to investigate the effects of social intentions on action. Participants (N=13) were requested to reach towards, grasp an object, and either pass it to another person (social condition) or put it on a concave base (single-agent condition). Movements' kinematics was recorded using a three-dimensional motion analysis system. The results indicate that kinematics is sensitive to social intention. Movements performed for the 'social' condition were characterized by a kinematic pattern which differed from those obtained for the 'single-agent' condition. Results are discussed in terms of a motor simulation hypothesis, which assumes that the same mechanisms underlying motor intention are sensitive to social intentions.

The aim of the present study is to ascertain whether in a social context the kinematic parameters are influenced by the stance of the participants. In particular, we consider two basic modes of social cognition, namely cooperation and competition. Naïve subjects were asked either to cooperate or to compete with a partner (a professional female actor), whose attitude could be either congruent or incongruent with the task instructions. Thus, on congruent conditions, subjects cooperated or competed with a partner showing a congruent cooperative or competitive attitude. On incongruent trials, the partner assumed an attitude that was manifestly in contrast with the instruction: competitive for the cooperative task, cooperative for the competitive task. We hypothesized that this mismatch between partner's attitude and instruction would produce a sort of unexpected social situation, affecting the kinematics of reach-to-grasp movement performed by the agents. If cooperative and competitive kinematic patterns are sensitive to the partner's attitude, then we should expect that an incongruent attitude have the potency to determine a reversal in kinematic patterning. Results revealed that for the incongruent trials the specific kinematic patterns for cooperation and competition found for the congruent conditions where modified according to the incongruent attitude assumed by the model actor. We suggest that this 'attitude' contagion is part of a sophisticated system that allows us to infer about the intention to act in a social context.

Hyperthyroidism is a pathological condition characterized by an altered autonomic cardiovascular control, resulting in an increase of the sympathetic and a decrease of the parasympathetic modulation of heart rate variability. Recently, the entropy-based indices derived from short-term heart period variability have been proved to be helpful in evaluating the autonomic cardiovascular modulation. The aim of our study was to evaluate the autonomic cardiovascular modulation of hyperthyroid subjects at rest and during standing using spectral parameters and corrected conditional entropy indices derived from short-term heart period variability in 12 hyperthyroid (HYPTH) and 9 normal healthy (N) females. Mean heart period was significantly decreased by standing both in N and HYPTH and the LF power expressed in normalized units was increased. The respiratory rate was faster in the HYPTH group compared to N and complexity was significantly greater in HYPTH compared to N during standing. Results suggested an enhanced complexity of cardiovascular control in HYPTH, more evident in a condition of sympathetic activation. The increased complexity of the cardiovascular regulation is probably not completely due to autonomic control but also to other influences, such as metabolic effects of thyroid hormones impinging upon respiratory control mechanisms and, therefore, on cardiorespiratory coupling.

Degenerative changes in the knee joint after meniscectomy are well known. Although likely to be due to changed biomechanics, there is no evidence in the literature to identify the underlying biomechanical alterations. The aim of this study was to analyse lower limb gait biomechanics before and after meniscectomy. Ten patients who required partial medial meniscectomy for irreparable meniscal tear took part in motion analysis before surgery, then at 6 and 12 months post-operatively. A control group was also set up consisting of 10 healthy volunteers. Joint kinematics did not show significant alterations between pre-operative and 6 month post-operative evaluations. However flexion increases at the hip, knee and ankle joint were observed in late swing and early stance phase 12 months after surgery. Hip and knee flexion-extension moments were affected with knee moment altered both before and after surgery. Before surgery and at 6 months after, the changes occurred mainly at the point of push off, while at 12 months they occurred during the swing phase. Hip flexion-extension moment had also changed 12 months after surgery. When examining symmetry of gait patterns prior to surgery, there were differences between the flexion-extension moments of the healthy and of the injured knee at first impact and during late stance. After surgery, asymmetries were not more apparent at first impact, but in late stance phase a reduced knee extension moment in the injured limb was still present. Before surgery, the joint kinematics were not greatly altered and changes were mainly due to pain. After partial meniscectomy, the pain disappeared and new joint responses were observed. These could be caused by the altered mechanics and/or through proprioceptive mechanisms.

The aim of the present study was to investigate whether foetal hand movements are planned and how they are executed. We performed a kinematic analysis of hand movements directed towards the mouth and the eyes in the foetuses of eight women with normally evolving pregnancies. At 14, 18 and 22 weeks of gestation, eight foetuses underwent a 20-min four-dimensional-ultrasound session. The video recordings for these movements were then imported into in-house software developed to perform kinematic analysis. We found that spatial and temporal characteristics of foetal movements are by no means uncoordinated or unpatterned. By 22 weeks of gestation the movements seem to show the recognizable form of intentional actions, with kinematic patterns that depend on the goal of the action, suggesting a surprisingly advanced level of motor planning.

Many instruments have been employed in recent years in order to quantify the posture and motion of the head in normal and pathological subjects. Evaluations of this type present many difficulties related to the influence of individual and external factors and to the accuracy of the system used. In patients with cervical dystonia (CD) the only rating scales currently used are semi-quantitative and subjective. More precise information on disease severity and response to the treatment is needed. Posture and motion of the head were evaluated by means of ELITE motion analyser (BTS, Milan, Italy) in 6 patients with the left laterocollis form of CD undergoing treatment with botulinum toxin (BTX). The method emerged as very useful for the quantification of the therapeutic response (which was more marked in motion than in posture). We found an inverse relationship between the degree of motion improvement and the restriction of motion before treatment.

The purpose of this study was to assess the reliability of a 3D kinematic method of evaluating movements of the cervical spine. Range of motion (ROM) of the cervical spine was evaluated in 8 control subjects during flexion-extension, rotation and lateral bending movements. The test was repeated on two separate occasions. The ROM test-retest difference ranged from 1.42 degrees for right axial rotation to 9.11 degrees for left axial rotation. The test showed good reliability, with an intraclass correlation coefficient which was higher than 0.74 in extension movement and excellent in flexion, axial rotation and lateral bending. In conclusion, the method proposed for the 3D kinematic analysis of neck movement proved to be useful and non-invasive and to show good-excellent reproducibility. Furthermore the method is easily applicable in clinical practice to evaluate neck function in cervical spine disorders.

Postural control depends on the integration of vestibular, somatosensory and visual orientation signals. The otolith contribution to postural control is achieved by the integration of otolith inputs and peripheral afferent inputs involved in crossed reflex pathways. This study shows that a functional linkage between otolith signals and activity in lower limb muscles is detectable in normal human gait. The otolith input appears to dominate particularly the neck proprioceptive and gaze motor influences during normal gait. This is demonstrated by an increase of tibialis anterior muscle activity during retroflexion of the head/neck, leading to an increased stability and counteracting possible perturbations. It is also shown by decrease of coordination during the movement caused by larger displacement of the centre of gravity demonstrated in vector diagrams.

An investigation was made on the relationship between music practice and musculo-skeletal disorders among piano students, with the main aim of developing health education programmes that would improve the performance and health of the students. The investigation covered three areas: (a) Analysis of study organization and main musculo-skeletal complaints achieved by a questionnaire distributed to all piano students at the Milan Conservatory. (b) Vocational electromyographic analysis of the effort exerted by the various muscle groups of the trunk, of the shoulder and shoulder blade girdle, and of the arm during performance of a standard set of piano exercises, an unseen passage and a passage of maximum difficulty. This analysis was made on a sample of six subjects. (c) A series of preventive measures was developed on the basis of a critical assessment of the results (38% of the students practised for excessively long periods without breaks; 62% had from 1 to 5 complaints, the most affected sites being the spine and the trapezius muscles). These consisted largely of a health education programme aimed at helping the students to suitably organize practice and rest periods and in instructing them in appropriate exercises for relaxation and stretching of overused muscle groups and strengthening the supporting muscle groups. Changes in lifestyle were also suggested.