The Nice Project Start –up meeting Santiago November 10 th - 11 th 2010

Start –up meeting Santiago November Agenda

The NICE project Presentation NICE = New Italian Chilean Excellence The project started from the collaboration between Italy and Chile

A project supported by

The partners Teleton Gait Analysis Lab

A long collaboration: from 2002 Teleton Gait Analysis Lab

A long collaboration based on gait and movement analysis

The aim of the project Definition of protocols for the evaluation of the functional limitation and cerebral activity in children with disability before and after specific rehabilitative treatments. MOVEMENT BRAIN

The labs “Luigi Divieti” Movement analysis Lab Laboratory EDSB

Why? Actually the literature introduces new studies focused on the relationship between mental function and motor evaluation. OUTPUT: MOVEMENT INPUT: BRAIN

From a clinical point of view? It is important to study the movement and the brain activity in children with CP and in particular in pre and post treatment MOVEMENT IMPROVEMENT BRAIN: ??? Cerebral palsy PRE and POST Quantified with motion Labs

Partner presentation Chilean partner presentation “Luigi Divieti” Gait Analysis Lab EDSB Lab

Detailed description of the project Beginning of the activities: July 2010

The project is focused on Children with CP before and after treatments Quantitative movement analysis Brain quantitative analysis

The project is divided in the following points: 1) the definition of the experimental protocol (set up of the equipments); 2) the identification of tasks and parameters for the characterization of the motor gesture and of the associated cerebral activity; 3) the realization of dedicated reports; 4) the application of the defined protocols to a group of subjects without disability in order to obtain the reference parameters related to a control population; The main activities of the project

5) the transfer of the protocols to the clinics, in particular to the Chilean partner. The considered treatments are the principal treatments for the reduction of the spasticity, that is a consequence of cerebral palsy, for instance botulinum toxin, treatments for the functional recovery like orthopaedic surgery, specific rehabilitative treatments with orthesis and rehabilitative exercises; The main activities of the project

Timetable 1) A1 Start Up meeting November Involved staff: staff of the Bioengineering Department/University of Chile/Rehabilitation Centre Teleton. Place: Santiago del Chile Duration: 2 days 2) A2 activity – realization of the project web site Involved staff: staff of the Bioengineering Department Place: Bioengineering Department, Politecnico di Milano DONE Work in progress

timetable 3) A3 activity – Equipment set up Involved staff: Bioengineering Department staff. Place: Laboratory “Luigi Divieti” and Laboratory “EDSB”, Bioengineering Department Synthetic description of the activity: equipment set up and purchase of the consumable materials necessary for the realization of the project. Work in progress

Timetable 4) A4 activity – set up of protocols for the patients’ evaluation Place: Laboratory “Luigi Divieti” and Laboratory “EDSB”, Bioengineering Department Synthetic description of the activity: definition of protocols for the movement acquisition and for the recording of cerebral activity. The employed resources are the instrumental resources already present in the laboratories “Luigi Divieti “ and “EDSB” of the Bioengineering Department and the staff of the Bioengineering Department. The Chilean partner will also be involved for the definition of these protocols. Inside this activity attention will be paid to the definition of the kind of movement to be evaluated, that be particularly significant for the evaluation of the functional limitation in the paediatric patient, to the modality of the experimental trials, to the definition of models for the biomechanical evaluation of the movement, to the identification of clinical parameters useful for the characterization of the movement. December-January For the discussion: which tasks??

Timetable 5) A5 activity – selection of the patients Place: University of Medicine, Santiago del Chile Synthetic description of the activity: Paediatric subjects will be selected. Based on the single patient the specific treatment to be applied will be identified (pharmacological treatment, surgery, orthesis, rehabilitation,…) together with the schedules of the post treatment acquisitions (depending on the typology of treatment). December-January For the discussion: Subjects selection criteria??

Timetable 6) A6 activity – transfer of the protocols for the evaluation of movement and EEG activity to the Chilean partner Involved staff: staff of the Bioengineering Department, staff of the Medicine University Place: Santiago del Chile. Laboratory of Movement and EEG Analysis of the Teleton Rehabilitation Centre. Synthetic description of the activity:Acquisition on subjects before (pre) treatment. Once the protocols have been defined they will be transferred to the Chilean partner during a visit of the Bioengineering Department researchers to the university and the clinical centre (Teleton rehabilitation centre). The instrumental resources to be used will be the ones located in the Movement Analysis Laboratory of the Teleton clinical centre. The staff from the Bioengineering department will follow both with in loco visits and remotely the application of the protocols to the patients, with an in loco presence of one month, guaranteeing a remote support in the following period. March 2011 For the discussion: availability of an EEG system in Chile??

timetable 7) A7 activity – normality of reference Participants: staff of the Bioengineering Department Place: “Luigi Divieti” and Laboratory “EDSB”, Bioengineering Department Duration: 6 months Synthetic description: the staff of the Bioengineering Department will work, in the laboratories, to the acquisition of normal subjects in order to create a reference normality. Involved staff: staff of Politecnico di Milano 8) A8 activity – application of the rehabilitative treatments Place: Santiago del Chile Duration: 6 months Involved staff: staff of the University of Medicine Synthetic description of the activity: the Chilean partner will apply the selected treatments to the patients. March –September 2011 For the discussion: how many subjects/patients??

timetable 9) A9 activity – post-treatment evaluation Place: Laboratory of Movement Analysis, Teleton centre, Chile Involved staff: staff of the University of Medicine and of Politecnico di Milano Synthetic description of the activity: the protocols will be applied after the treatment (post treatment) and the data will be collected by the staff of Politecnico, who will attend to some of the post treatment acquisitions and will transfer the data to Politecnico di Milano. 10) A10 activity – data elaboration and analysis The Bioengineering Department will attend to the elaboration of the normal and pathological subjects’ (pre and post treatment) data. The Bioengineering Department will look after the analysis of the EEG signal acquired at the clinical centres. Involved staff: staff of the Bioengineering Department September December 2011

Timetable 11) 11 activity – presentation of the results and final meeting Place: Santiago del Chile Involved staff: the whole participants to the project Via web meetings between the coordinators will be organized in order to verify the progress of the scheduled activities, as indicated by the management plan. Jan or March 2012

Discussion 1. availability of EEG equipment in Chile; 2.selection criteria for the pathological subjects; 3.which task (gait, posture, upper limb)? 4.how many subjects? 5.rehabilitative treatments considered.

timetable

Motion analysis and EEG

MA and EEG Place  University Lab EEG and touch screeen provided by Politecnico Staff for the acquisition  Politecnico and Chilean staff Treatment  Botulinum Toxin injection Movement  Upper limb

Numberof patients at least 20 patients (before and after injectionor before and after CIMT) PRE  April 2010 POST  September 2011 Selection criteria Functional limitation of upper limbs in program for Botulinum Toxin injection for upper limb Hemiplegic and diplegic patients Age: homogeneous age MA and EEG Patients

Movements Reaching movement (just touch and go back, with touch screen) In hemiplegic patients movement required with the plegic and non-plegic side In diplegic patients movement required with the both sides MA and EEG

Clinical evaluations Ashworth GMFM Questionnaire MA and EEG

Motion analysis

MA Place  Teleton Lab Staff for the acquisition  Chilean staff Movement pre and post Treatment Gait  34 Botulinum Toxin injection (7Botox vs 7 chinese),already done STS  Strenght training and FSE and Physioterpahy, … Posture  Lokomat,?? vibratory platform (110 patients) already done