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Goal: The experimental study of the stumble phenomena is essential to develop novel technological solutions to limit harmful effects in at-risk populations. A versatile platform to deliver realistic and unanticipated tripping perturbations, controllable in their strength and timing, would be beneficial for this field of study. Methods: We built a modular tripping-eliciting system based on multiple compliant trip blocks that deliver unanticipated tripping perturbations. The system was validated with a study with 9 healthy subjects. Results: The system delivered 33 out of 34 perturbations (a minimum of 3 per subject) during the desired gait phase, and 31 effectively induced a tripping event. The recovery strategies adopted after the perturbations were qualitatively consistent with the literature. The analysis of the inertial motion unit signals and the questionnaires suggests a limited adaptation to the perturbation throughout experiments. Conclusions: The platform succeeded in providing realistic trip perturbations, concurrently limiting subjects’ adaptation. The presence of multiple compliant obstacles, tunable regarding position and perturbation strength, represents a novelty in the field, allowing the study of stumbling phenomena caused by obstacles with different levels of sturdiness. The overall system is modular and can be easily adapted for different applications.

Background: The Motricity Index (MI) is a commonly used method of measuring muscle strength in post-stroke hemiparesis. This study aimed to produce the MI Italian version (MI-IT) and assess its reliability in subjects with stroke. Methods: Phase-1: stepwise approach to MI-IT production and pilot-testing with 10 health professionals to ensure clarity of each item and instructions for administration and scoring. Phase-2: evaluation of MI-IT reliability on stroke subjects, each independently assessed by 2 raters randomly selected from a group of 10 physiotherapists; the first rater re-administered the MI-IT 1–3 days later. Intraclass correlation coefficients, Spearman’s rho and, limited to the more affected side, non-parametric limits of agreement (LOA) were computed for total MI-IT scores, squared weighted kappa and percentage of observed agreement for individual item scores. Results: The back-translated versions showed no discrepancies with original MI, but 3 items were revised after pilot-testing. Complete data on 50 (test–retest) and 51 (inter-rater) participants demonstrated excellent reliability of all MI-IT total scores on the more affected side (Spearman’s rho range: test–retest 0.953–0.975; inter-rater: 0.965–0.970), with LOA ranging from 9–25%), but poor inter-rater reliability for some scores on the less affected side (Spearman’s rho range: test–retest, 0.816–0.976; inter-rater: 0.508–0.721). Moderate to almost perfect agreement was found for all individual item scores, except for 2 items on the less affected side. Conclusions: The MI-IT is sufficiently reliable to evaluate motor impairment of the more affected side after stroke, with acceptable measurement error for all scores.

Reducing energy consumption during walking is a critical goal for transtibial amputees. The study presents the evaluation of a semi-active prosthesis with five transtibial amputees. The prosthesis has a low-power actuator integrated in parallel into an energy-storing-and-releasing foot. The actuator is controlled to compress the foot during the stance phase, supplementing the natural compression due to the user’s dynamic interaction with the ground, particularly during the ankle dorsiflexion phase, and to release the energy stored in the foot during the push-off phase, to enhance propulsion. The control strategy is adaptive to the user’s gait patterns and speed. The clinical protocol to evaluate the system included treadmill and overground walking tasks. The results showed that walking with the semi-active prosthesis reduced the Physiological Cost Index of transtibial amputees by up to 16% compared to walking using the subjects’ proprietary prosthesis. No significant alterations were observed in the spatiotemporal gait parameters of the participants, indicating the module’s compatibility with users’ natural walking patterns. These findings highlight the potential of the mechatronic actuator in effectively reducing energy expenditure during walking for transtibial amputees. The proposed prosthesis may bring a positive impact on the quality of life, mobility, and functional performance of individuals with transtibial amputation.

BackgroundIntensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson’s Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients’ performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient’s satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles.MethodsSingle-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial–temporal gait parameters at T1 and T2, patients’ satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α