Abstract: Segmentation of anatomical components is a major step in creating accurate and realistic 3D models of the human body, which are used in many clinical applications, including orthopedics. Recently, many deep learning approaches have been proposed to solve the problem of manual segmentation, which is time-consuming and operator-dependent. In the present study, SegResNet has been adapted from other domains, such as brain tumors, for knee joints, in particular, to segment the femoral bone from magnetic resonance images. This algorithm has been compared to the well-known U-Net in terms of evaluation metrics, such as the Dice similarity coefficient and Hausdorff distance. In the training phase, various combinations of hyperparameters, such as epochs and learning rates, have been tested to determine which combination produced the most accurate results. Based on their comparable results, both U-Net and SegResNet performed well in accurately segmenting the femur. Dice similarity coefficients of 0.94 and Hausdorff distances less than or equal to 1 mm indicate that both models are effective at capturing anatomical boundaries in the femur. According to the results of this study, SegResNet is a viable option for automating the creation of 3D femur models. In the future, the performance and applicability of SegResNet in real-world settings will be further validated and tested using a variety of datasets and clinical scenarios.

Keywords: 3D modeling knee | automated segmentation | CNN | computer-aided design | deep learning | machine learning for engineering applications | MONAI framework | SegResNet | U-Net

Abstract: Introduction: Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach. Materials and methods: Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups. Results: Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: +32.9%), followed by Postural control (step width: +27.0%), Phases (stance time: +11.0%), and Pace (stride length: − 9.3%). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001). Conclusions: This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.

Keywords: Factor analysis | Gait analysis | Motion capture | Recovery of function | Surgical approach | Total hip replacement

Abstract: Total hip arthroplasty (THA) is a surgical procedure advised to treat end-stage osteoarthritis. There are several surgical approaches involving different biomechanical effects, potentially affecting the outcome. A possible consequence of THA is the Trendelenburg gait, which consists of a pelvis drop and trunk lean during walking due to a unilateral weakness of the hip abductors. Gait analysis can be useful in assessing the disorder. The purpose of the present research is twofold: i) to assess the Trendelenburg disease in patients undergoing THA through gait analysis; ii) to investigate the relationship between the disorder and surgical approaches. Patients’ gaits were recorded 7 days after THA surgery, using two Microsoft Kinect V2 sensors and virtual skeletons were reconstructed by iPi Soft software. A customized tool was developed to automatically identify walking phases and recognize characteristics compatible with the Trendelenburg gait. In addition to pelvic drop and trunk lean in the frontal plane, kinematic measurements are proposed for a more complete assessment of the Trendelenburg gait. These variables are found to be effective in highlighting the differences between surgical approaches.

Keywords: Gait Analysis | Motion Capture | Recovery of Function | Total Hip Arthroplasty | Trendelenburg Gait

Abstract: The logistics industry involves various processes in the warehouse work environment on a daily basis, such as handling, storage, and packing. Therefore, workers are often engaged in manual activities such as pushing, pulling and lifting loads. These types of movements are repetitive and, together with adverse physical factors of the environment, they affect employees’ health condition. The aim of this study is to test a proactive evaluation approach exploiting the potential of a professional virtual wall to simulate specific tasks performed in a warehouse to find the better solution in terms of working condition and productivity. The proposed framework includes the following steps: at first, it is required to design the virtual environment by means of 3D modelling tools; afterwards, simulation tests are performed by objectively assessing the physical working condition of the operator; finally, the valuable information are provided to improve the design of the workstation, based on the operator’s ergonomics. The framework is modular and can be scaled to complex industrial environments.

Keywords: Ergonomics | Logistics | Virtual Reality | Virtual Wall

Abstract: Background: Several studies have demonstrated the effectiveness of telerehabilitation. However, it remains unclear what proportion of people in need of rehabilitation can confidently use telecommunications networks and related devices. Objectives: The aim of this study is to estimate the proportion of patients who possess either the requisite digital literacy to perform telerehabilitation independently or have a family caregiver capable of providing effective support. Methods: Synthetic populations with a realistic kinship network (i.e. family trees) representative of European countries are built. Age, sex, and location-specific prevalence rates of rehabilitation needs and digital skills are combined to estimate the percentage of digitally literate patients and patients with digitally literate relatives. Results: In Europe, 86% of people in need of rehabilitation are potentially eligible for telerehabilitation. However, in four out of five cases, eligible patients over the age of 65 require caregiver support. Conclusion: Telerehabilitation has the potential to spread in Europe. Caregivers have an essential social role in ensuring sustainable access to telerehabilitation.

Keywords: Caregivers | Kinship Care | Sustainable Development | Telemedicine | Telerehabilitation

Abstract: Background: Heart failure (HF) is responsible for a high number of hospitalizations, caused by a progressive worsening quality of life. Telemedicine allows for better management of patients’ complex conditions, improving the care released. However, the risk of remaining at a testing stage often limits the integration of remote care in daily pathways for HF patients. The aim of this study is to outline the steps needed to integrate telemedicine activities into ordinary HF clinic practices. This methodology is applied to observe activities and trend improvements over a 12-month routine phase. Method: Three steps have been defined for an efficient introduction of remote care services in ordinary activities, integrating them with traditional in-person care: (i) introduction of temporary telemedicine projects, (ii) systematization of telemedicine pathways, and (iii) evaluation of monitoring phase. Observational data have been collected from structured interviews to show the rate of telemedicine activities achieved in clinical practice over the last year. Results: The methodology has been proposed in the HF clinic of the Italian hospital ASST Bergamo Est. After an initial testing phase, in which usability and user experience have been tested, four different remote activities were added: (i) telemonitoring for patients with an implantable device, (ii) follow-up televisits, (iii) nursing telephone support, and (iv) high-intensity telesurveillance pathways for patients after an HF acute event. During the last year, 218 telemonitoring pathways, 75 televisits, 500 telephone calls, and nine telesurveillance pathways have been performed. Success rates were high, and patients gave positive feedback. Conclusion: By integrating multiple telemedicine activities, it has been possible to better manage complex patients, keep track of disease progression, and improve their participation in care.

Keywords: daily practice | heart failure patients | remote care organization | telemedicine | telemonitoring | televisit | user experience

Abstract: Collaborative robots (cobots) are designed to directly interact with human beings within a shared workspace. To minimize the risk of musculoskeletal disease for the workers, a physical ergonomic assessment of their interaction is needed. Virtual reality (VR) and motion capture (Mocap) systems can aid designers in building low-hazard collaborative environments. This work presents a framework based on VR and Mocap systems for the ergonomic evaluation of collaborative robotic workstations. Starting from the 3D models of the cobot and workstation components, a virtual environment is built in Unity and ROS is employed to manage the cobot behavior. The physical ergonomics is evaluated by means of RULA methodology, exploiting the body tracking capabilities of the device Kinect Azure, a low-cost markerless Mocap system. The framework has been tested by building a virtual environment for collaborative control of flanges with different diameters. The worker interacts with a six-axis Nyro One to move parts on the workstation. The ergonomic assessment is performed in real-time, and a report is generated for later uses and evaluations. The proposed framework fosters the design of collaborative robotics workstations based on an objective assessment of ergonomics. The results of this research work allow planning future development steps for the emulation of more complex workstations with cobots and the use of augmented reality to evaluate how to modify existing workstations to introduce a cobot.

Keywords: Collaborative robots | Ergonomics | Motion capture | Virtual reality

Abstract: Anterior Cruciate Ligament (ACL) is one of the most injured ligaments. Various researches have studied the relationship between ACL rupture and the bony morphology attempting to understand why ACL rupture occurs. The most investigated predisposing factors in the scientific literature are mainly related to the femoral intercondylar notch and the tibial plateau. The aim of the present research is to create a semi-automatic tool for assessing the risk of developing an ACL injury. A package, named ACL Morsky, has been created in 3D Slicer to follow the entire workflow. The process starts with the load of DICOM data. Three-dimensional models are reconstructed by means of segmentation. Then, five parameters, considered risk factors for the ligament rupture, are measured both in 2D images and on 3D models. A specific algorithm compares the measured values with the range in literature to evaluate the probability of developing an ACL injury. The physician is provided with a report for the patient and his/her risk factors. Knowing in advance the risk of rupture can help in reducing it with preventive plans.

Keywords: 3D Slicer | Knee Injury | Knee Risk Assessment | Ligament Risk Factors | Morphological Parameters

Abstract: Digital human modeling and gait analysis are essential for improving hip replacement surgery (HRS). In this study, Convolution Neural Networks (CNN) are used as a machine learning method to extract the most accurate stick-model from videos captured on a simple camera to represent gait and body components. We developed and tested multiple approaches to create an equitable skeleton model from an image. This process consists of two main parts: defining the joint locations using a CNN network in different architectures, and defining the connections into the final skeletons. A CNN has been trained, validated, and tested using the OpenPose software, which combines two different networks that have been tested on three data-sets for learning and evaluation. The results were satisfactory, but MobileNetV1 was evaluated for optimization of OpenPose computations and definitions. Several hyper-parameters were investigated to provide better representations. As a result of utilizing OpenPose methodology in conjunction with heavily optimized network design and post-processing code, and implementing MobileNet, the proposed solution has provided improved accuracy ratios.

Keywords: 2D Joint profile | CNN | Deep Learning | skeleton feature extraction

Abstract: Background: The COVID-19 outbreak led to the diffusion of several telemedicine solutions. The choice of the correct platform is crucial for ensuring the release of effective assistance. However, there is a lack of an objective method for the assessment of technical features. Objective: This study proposes a methodology for the evaluation of functional requirements of telemedicine platforms. This approach also permits the comparison of solutions in the Italian market by means of defined parameters, thus directing the choice of health care professionals. Methods: The study is divided into three phases. First, a mapping of the telemedicine platforms operating in Italy is performed. Then, the available platforms are selected based on the offered telemedicine activity. Finally, a method for evaluating the investigated platforms is defined. Results: Thirty-three (n = 33) technological systems were identified through an accurate investigation on the web and interviews with IT companies. Fifteen parameters were defined and organized into three categories: (1) usability of the telemedicine platform, (2) security, and (3) technological and organizational aspects. A score between 1 and 4 was assigned to each parameter, proportionally to the completeness of the platform. In particular, 62.96% of platforms reached an average score between 3.01 and 4 points; 33.33% of them had scores between 2.01 and 3, while the remaining 3.70% of solutions obtained a result between 1.01 and 2. Conclusions: The study provides an evaluation approach that is easily usable by health professionals to select the most suitable platform. The number of solutions and quality of information could be updated to obtain a complete tool.

Keywords: technological assessment | telemedicine platforms | telemedicine solutions

Abstract: BACKGROUND: Rehabilitation plays a key role in the recovery of upper extremity function after breast cancer surgery. Motion capture (mocap) systems for serious gaming have shown the potential to enable home-based rehabilitation, but clinical accuracy needs to be examined. OBJECTIVES: Validation of markerless mocap systems for telerehabilitation after breast cancer surgical intervention. METHODS: The accuracy of the markerless mocap device Azure Kinect in detecting compensatory movements and postural disturbances has been compared to a gold standard Optitrack system in five volunteers. Subsequently, a serious game for mocap-based shoulder exercises has been developed and integrated into a telerehabilitation platform. RESULTS: The Azure Kinect shows good reliability for scapular elevation (ICC >0.80; MAE <2.1 cm) and trunk tilt (ICC=0.88; MAE=5°), moderate reliability for rounded shoulders (ICC=0.51; MAE=2.6cm) and poor reliability for kyphosis angle (ICC=0.22; MAE=18°). CONCLUSION: The Azure Kinect provides reasonable performance for shoulder rehabilitation. The proposed telerehabilitation platform has been tested by rehabilitation specialists and received positive feedback.

Keywords: Breast Neoplasms | Exercise Therapy | Exergaming | Motion Capture | Telerehabilitation

Abstract: Background: The emergency for the COVID-19 pandemic has led to greater use of home telemonitoring devices. The aim of this study was to assess the usability of continuous home-monitoring care with an oxygen saturation device on post-COVID-19 patients. Method: The system consists of a digital continuous pulse oximeter and a smartphone with an App, which were provided to patients. A survey composed of a standard Post-Study System Usability Questionnaire, and a satisfaction questionnaire was exploited to conduct a usability and feasibility analysis of the service. Results: A total of 29 patients (17.2% female) with a mean age of 65 ± 11.5 years were enrolled: 20 patients were smartphone users (69%) with a mean age of 60.2 ± 9.5 years, and 9 patients (31%) did not own a smartphone (mean age 76.8 ± 5.9). The monitoring period was 1 month: a total of 444 recordings were conducted, 15 recordings per patient averagely. In total, 82% of the recordings performed did not require any intervention, while 18% led to the production of a report and subsequent intervention by a nurse who verified, together with the specialist, the need to intervene (i.e. the patient accessed the clinic for medical control and/or modification of oxygen therapy). A total of 17 patients compiled a usability questionnaire. The service was perceived as useful and well-structured, although it often required caregiver support. Conclusions: Using continuous home-monitoring care with an oxygen saturation device seems feasible and useful for patients who could be followed at home avoiding going back to the hospital every time a trend oximetry is needed. Further improvements in connections, data flow processes, and simplifications, based on patients’ feedback, are needed to scale up the service.

Keywords: COVID-19 | digital oximeter | Telemonitoring | usability | wearable sensors

Abstract: Total knee arthroplasty (TKA) is the surgical procedure of choice for end-stage osteoarthritis. Even if it is widely performed, there is still dissatisfaction with the surgical procedure in about 20-30% of patients. Factors such as malalignment of the implant and the size of the components have been reported as the most common reasons for post-operative complaints. Custom-made prostheses have been introduced to replicate each individual joint geometry and kinematics. In this study, a novel approach is proposed to automate custom-made knee implant design. The aim is to create a pipeline, where customized implants can be designed automatically for a large number of patients, reducing the time for design. Firstly, a manual procedure for designing the implant is defined. The lower part of the femur is extruded with a thickness that matches with the natural anatomy of the patient and cut planes are used to design the customized femoral implant. Then, an automatic procedure is developed. For the purpose, a statistical shape model of femur, based on 33 patients, is created and employed. The procedure is tested with 5 study cases showing the potential of the methodology. Results will be furtherly validated on a larger scale.

Keywords: 3D Modelling | Customization | Human Modelling | Personalized | Statistical Shape Model | Total Knee Arthroplasty

Abstract: Logistic activities can cause long-term musculoskeletal problems due to repetitive and incorrect movements, heavy loads, and uncomfortable positions. Ergonomic evaluations are conducted to prevent these risks, optimize workstations, and work processes. Some studies use automatic evaluation of ergonomic indices or frameworks for optimizing workstations and logistics reorganization. However, optimization is often disconnected from real-world case studies. This research work validates a new approach that integrates an automatic ergonomic evaluation and optimization in real-world scenarios, comparing this analysis with traditional manual evaluation method. Our approach is applied to a real logistics case study using a wearable motion capture system and an interactive interface that displays the Digital Twin of the analyzed task. Results show that our approach provides a more accurate evaluation of the ergonomics and an evident time-saving.

Keywords: Ergonomics | Optimization | Warehouse Logistic

Abstract: Segmentation of anatomical components is a critical step in creating accurate and realistic 3D models of the human body, which are employed in a wide range of clinical applications, particularly in orthopedics. Recently, many deep learning approaches have been proposed to solve the problem of manual segmentation. Among the available software for automatic segmentation, MONAI Label is a free open-source tool, which allows for the creation of annotated datasets and the development of AI-based annotation models for clinical assessment. In this context, the present study is designed to compare the performance of two well-known neural networks in segmenting knee bones. In spite of the fact that several studies have investigated the use of deep learning techniques for knee reconstruction, there is no consensus regarding the most effective method. In the present study, validation metrics are selected in order to assess the accuracy of the automated segmentation models in comparison with the ground truth data. Magnetic resonance images of 31 patients have been employed for the study. As result, U-Net shows better performance than the SegResNet in the automatic femur segmentation task.

Keywords: 3D Modelling Knee | Automated Segmentation | Deep Learning | SegResNet | U-Net

Abstract: Background: In Italy, the administration of COVID-19 vaccines began in late 2020. In the early stages, the number of available doses was limited. To maximize the effectiveness of the vaccine campaign, the national health agency assigned priority access to at-risk individuals, such as health care workers and the elderly. Current vaccination campaign strategies do not take full advantage of the latest mathematical models, which capture many subtle nuances, allowing different territorial situations to be analyzed aiming to make context-specific decisions. Objectives: The main objective is the definition of an agent-based model using open data and scientific literature to assess and optimize the impact of vaccine campaigns for an Italian region. Specifically, the aim is twofold: (i) estimate the reduction in the number of infections and deaths attributable to vaccines, and (ii) assess the performances of alternative vaccine allocation strategies. Methods: The COVID-19 Agent-based simulator Covasim has been employed to build an agent-based model by considering the Lombardy region as case study. The model has been tailored by leveraging open data and knowledge from the scientific literature. Dynamic mobility restrictions and the presence of Variant of Concern have been explicitly represented. Free parameters have been calibrated using the grid search methodology. Results: The model mimics the COVID-19 wave that hit Lombardy from September 2020 to April 2021. It suggests that 168,492 cumulative infections 2,990 cumulative deaths have been avoided due to the vaccination campaign in Lombardy from January 1 to April 30, 2021. Without vaccines, the number of deaths would have been 66% greater in the 80–89 age group and 114% greater for those over 90. The best vaccine allocation strategy depends on the goal. To minimize infections, the best policy is related to dose availability. If at least 1/3 of the population can be covered in 4 months, targeting at-risk individuals and the elderly first is recommended; otherwise, the youngest people should be vaccinated first. To minimize overall deaths, priority is best given to at-risk groups and the elderly in all scenarios. Conclusions: This work proposes a methodological approach that leverages open data and scientific literature to build a model of COVID-19 capable of assessing and optimizing the impact of vaccine campaigns. This methodology can help national institutions to design regional mathematical models that can support pandemic-related decision-making processes.

Keywords: Agent-based model | Covasim | COVID-19 | Epidemiologic model | Vaccination | Variants of concern

Abstract: This article presents a software platform to design serious games for the rehabilitation of severe memory loss by means of virtual reality (VR). In particular, the focus is on retrograde amnesia, a condition affecting patient’s quality of life usually after brain stroke. Currently, the standard rehabilitation process includes showing pictures of familiar environments to help memory recover, while the proposed rehabilitation solution aims at developing patient-specific serious games for memory loss starting from 3D scanning of familiar environments. The Occipital Structure sensor and the Skanect application have been used for the virtualization of the real objects and the environment. Instead of following the traditional approach to design a video game during which the game logic is specifically developed for a virtual scene and the software code is not meant to be recombined, a modular procedure has been designed using Unity to interface the virtual objects of each acquired environment without modifying the game logic. In addition, the developed solution makes available a set of software modules for patient’s monitoring and data management to automatically generate medical reports, which can be easily connected to each new serious game. A test has been performed to assess the main features of the VR platform and its usability recruiting ten testers. Medical personnel evaluated positively the platform, and they highlighted the importance of objective data to improve the ecological validity of the cognitive rehabilitation for retrograde amnesia.

Keywords: Neurological disorders | Serious game | Virtual reality

Abstract: Background: Tele-rehabilitation is gaining importance due to the increasing need for objectiveness in the evaluation of patients with impaired motor functions. Low-cost marker-less motion capture systems are becoming key enabling technologies as support in the treatment of musculoskeletal diseases. Objectives: The goal of this work is to investigate the use of the Microsoft Azure Kinect device to develop a tele-rehabilitation platform for shoulder motor function recovery. The platform comprehends a set of serious games, which are fundamental to increase the patients' engagement in shoulder rehabilitation. Methods: Starting from a set of functionalities identified together with the medical personnel of an Italian hospital, the Azure Kinect device has been used as motion capture system to interact with the serious games. Mobile applications for patients and physicians have been developed to manage the rehabilitation process. Results: The solution has been tested by the involved medical personnel. It has been considered interesting and promising. Further improvements in the design of the virtual environment of the serious games are required. Conclusion: The presented platform is a starting point to develop a complete IT solution for the daily shoulder rehabilitation.

Keywords: Rehabilitation research | Shoulder rehabilitation | Telerehabilitation | Virtual reality exposure therapy

Abstract: Background: Effective communication is a key factor in healthcare, essential for improving process efficiency and quality of care. This is particularly true in new services, e.g., the 3D printing service inside the hospital. Objectives: A web platform, called 3DSCT, has been developed to act as an interface between the three categories of operators involved in 3D printing: physicians, radiologists and engineers. Methods: The 3DSCT platform has been designed using Microsoft Visual Studio Code, enclosing.js scripts and HTML pages with the relative CSS formats. Results: When applied to a real 3D printing service, the 3DSCT platform provided an effective solution that streamlined the process of designing and manufacturing 3D-printed artifacts, from physician's request through development to printing. Conclusion: By incorporating the platform into the hospital management system, it will be possible to reduce the overall lead time and decrease the waste of time for the operators involved in 3D printing inside the hospital.

Keywords: 3D-Printing | Clinical Decision Support System | Communication

Abstract: Background: With the spread of COVID-19, telemedicine solutions became crucial to release continuous and remote assistance to chronic patients. The rapid transition to telemedicine solutions did not allow a complete assessment of the user experience by both patients and medical personnel. Despite the well-known benefits in remote care, the lack of usability evaluation of already existing technologies for the vital signs measurement has emerged. A telemedicine platform must match video communication between patients and the medical staff with the possibility to measure vital parameters. Furthermore, technological assistance may overcome the unfamiliarity with telemedicine and drastically reduce the learning time for both patients and medical personnel. Objectives: The research work presents a method to improve the user experience of a telemedicine service based on the combination of televisits and telemonitoring with wearable sensors for heart failure patients. Skilled technological staff is proposed by the presented method to lead the learning process of both medical personnel and patients in order to reach a high level of usability in less than 6 months. Methods: The proposed method is composed of 5 steps: identification of technological staff and end users; selection of the telemedicine platform; design of questionnaires for usability analysis; training of clinicians and patients; final usability evaluation of the telemedicine platform by means of customized satisfaction questionnaires and Post-Study System Usability Questionnaires (PSSUQs). The methodological approach has been tested in collaboration with a heart failure clinic by involving 5 physicians, 5 nurses, 15 heart failure patients, a research engineer and 4 technicians. A platform with 3 wearable sensors has been chosen: a wireless thermometer, a finger pulse-oximeter and an undershirt have been used for the detection of ECG trace. While these devices allowed asynchronous measurements of physiological data, scheduled televisits have been used for direct communication between physicians and patients. Results: Satisfaction questionnaires of patients and clinicians reached respectively 65.18% and 65.83%, while PSSUQ scores were respectively 91.73% and 81.70%. Both groups of end users confirmed a good level of usability and their satisfaction about the ease of use and the perceived quality of the instrumentation. Moreover, 73% of patients did not require help from caregivers to use the kit of sensors. The results have been reached in 5.5 months according to the aim defined initially. Research engineers have played a crucial role in helping clinicians and patients to improve the user experience with the telemedicine platform. Conclusions: The high level of usability and satisfaction confirmed that the proposed methodological approach helps to learn the technological features of the telemedicine platforms, which are based on different types of technology, such as web applications, wearable sensors and virtual calls. The positive results with heart failure patients encouraged to plan further research studies by using the designed method with other categories of chronic patients.

Keywords: Health informatics | Heart failure patients | Telemedicine | Televisit | Usability analysis | Wearable sensors

Abstract: Total Knee Arthroplasty (TKA) is a widely performed surgical procedure, which is advised to treat knee osteoarthritis. However, the literature reported that 25% of the patients are unsatisfied by the functional outcomes after the intervention. The main causes seem to be the prosthesis malalignment and the anatomical mismatch between the prosthetic components and the different people anatomy. Even if there exist several commercial solutions, whose aim has always been to provide a reliable prosthesis with high survivorship, the most recent scientific literature is focusing its aim to improving the patients’ clinical outcome, kinematics and satisfaction. For this reason, three approaches have been experimented and then discussed with an orthopedic surgeon. Open-source software applications for 3D modelling have been exploited, such as 3D Slicer and Meshmixer. Starting from medical images, through the segmentation process, the 3D model of the knee has been reconstructed. For the first approach, standard off-the-shelf prosthesis have been used for the virtual planning of the intervention. To overcome the limits of this method, two more customized approaches have been experimented. The first one is based on the patient-specific resurfacing prosthesis that fits the patient’s anatomy, preserving the femur and maintaining the natural joint line. The third approach allows to create a customized prosthesis, that is a compromise between the two previous methods. Among the three previous procedures, the most suitable one can be chosen according to the patient’s anatomy, knee size and articular cartilage damage.

Keywords: 3D modelling | Customized knee prosthesis | Total knee arthroplasty planning

Abstract: Virtual Reality (VR) opens new frontiers in the rehabilitation field. Low-cost head mounted displays and motion capture systems are available and easily integrated in consumer technologies, such as laptops, smartphones, and tablets. The main limit of VR is related to its acceptance because the technologies are usually considered too complex for patients' daily rehabilitation. Furthermore, available VR hardware solutions are usually designed for generic categories of users and there is a considerable margin to specific pathologies or patients. This chapter presents the development of VR platforms for both cognitive and motor skills rehabilitation starting from physicians' requirements and usability issues. Three VR applications are described: a platform for cognitive rehabilitation of patients with severe memory loss, an application to test the level of extra-personal neglect, and a web platform for hand motor skill rehabilitation.

Keywords: Cognitive rehabilitation | Motor skills rehabilitation | Tele-rehabilitation | User-centered design | Virtual reality

Abstract: In manufacturing, ergonomic and productivity benefits may result from combining the sensing and dexterity of the human workers with the strength of collaborative robots (cobots). Anyway, manual tasks requiring repetitive motion or working with robots can cause musculoskeletal disorders especially of the hands. In such a context, this paper proposes a novel solution that includes both a full body inertial system and a dedicated solution for hand tracking. This allows implementing the standard methods for assessing ergonomic indexes and to introduce new advanced task analyses based on gesture evaluation. The benefits reached by the integrated system for body and hand tracking can be exploited in the virtual prototyping of collaborative workstation in the manufacturing domain. Different software packages have been considered to model and simulate the collaboration between the operator and the cobot. In particular, Unity and ROS are used to develop the virtual scene and control the cobot behavior and the HTC Vive Head Mounted Display (HMD) to interact with the virtual environment. Physical ergonomics is evaluated by using both a full body suit (XSENS) and sensorized gloves (MANUS). The solution has been applied to the simulation of a virtual production line where the operator collaborates with a six-axis cobot (NIRYO ONE). Test tasks require the operator to move and manage different objects and tools by simulating different types of grasping. Real-time feedback about ergonomics, in terms of posture evaluation and alerts in case of critical condition, is shown to the operator as well as the automatic generation of reports for the post-process evaluation of the entire process. The results show how the use of these tools can be effective in the ergonomic evaluation of a collaborative robotic workstation which requires manual tasks.

Keywords: collaborative robot | hand-tracking | motion capture | Physical ergonomics | wearable devices

Abstract: Background: Telerehabilitation represents a new cutting-edge method in the treatment of patients suffering from motor and cognitive disorders caused by stroke. Even if there exist dedicated devices able to track patients' movements to evaluate the performed rehabilitation exercises, they require specific settings necessary for a correct and simple use at the patient's home. If we consider the recent pandemic situation and the lockdown condition, which made difficult the access to these products, post stroke patients may be not able to perform home rehabilitation. Objectives: the goal of this work is the design of a specific method to develop a tele-rehabilitation platform for post-stroke patients using consumer technologies without involving ad-hoc devices. Method: Open-source tools have been investigated for speeding up the development starting with the medical knowledge. Results: a group of four healthcare technologies engineering students with no specific skills about computer science has developed a platform in four months using the design method. Conclusion: the presented method allowed the development of a clinical knowledge-based web platform for post-stroke patients totally based on consumer technology.

Keywords: Rehabilitation Research | Stroke rehabilitation | Telerehabilitation | Virtual Reality Exposure Therapy

Abstract: The rehabilitation process after stroke may exhibit some limits regarding physical therapy adherence and there could be a lack of patients’ motivation and trust impacting on the quality of the rehabilitation procedure. This research work aims at introducing a specific interactive design method to develop rehabilitation tools based on the medical knowledge and VR devices to recover motor skills of patients’ hands after stroke and to increase the patients’ adherence. The method we propose consists of three main steps: medical requirement analysis, identification of ICT tools, and medical data management. A case study related to hand rehabilitation is also presented.

Keywords: Hand-tracking devices | Leap motion device | Stroke rehabilitation | Virtual reality

Abstract: Collaborative robotics, or Human-Robot Collaboration (HRC), is a challenging topic characterized by multidisciplinary approaches. Many researchers are facing this innovative manufacturing system studying several aspects such as task allocation, facility layout problem and timing. Above all, one of the most important issues in collaborative robotics is the wellbeing of the operator collaborating with the robot system during the different phases of the process. The added value of a collaborative workplace respect to the manual and automatic workplaces is strictly correlated to a safe and ergonomic interaction between the operator and the robot. Indeed, the combination of robot and operator skills lead to a higher level of accuracy and flexibility. Thus, assessing operator's working conditions requires the acquisition, eventually in real time, of relevant parameters such as posture, movements, and interactive tasks. This may require the adoption of existing metrics proposed by standard evaluation guidelines, as well as the introduction of new or modified prescription to consider the presence of the robot. The ergonomics analysis in collaborative robotics is evaluated by considering both physical and cognitive aspects of the operator during the interaction with the robot. The research work aims to carry out a scientific bibliometric literature review (BLR) about the ergonomics analysis of collaborative workplaces, and to identify methods and tools for the physical and cognitive ergonomics assessment that can be adopted in collaborative robotics. The search has been accomplished using the Scopus database by means of a set of key words specifically defined to investigate the ergonomics in the collaborative robotics. The review provides a sharp classification, a critical analysis of the most relevant contributions in this field so that emerging trends for future development can be defined and discussed.

Keywords: Bibliometric literature review (blr) | Cognitive ergonomics | Human-robot interaction (hri) | Humanrobot collaboration (hrc) | Physical ergonomics

Abstract: The paper presents a method to develop Virtual Reality (VR) platforms based on serious games for the rehabilitation of severe memory loss. In particular, it is related to retrograde amnesia, a condition affecting patient's quality of life usually caused by brain stroke. Nowadays, the standard rehabilitation process consists in showing pictures of patient's familiar environments in order to recover the memory. Past research works have investigated the use of 3D scanners for the virtualization of real environment and virtual reality for the generation of more immersive interaction to design serious games for neurocognitive rehabilitation. Reached results highlighted a time-consuming development process to interface each new environment with the game logic specifically developed for the serious games. Furthermore, a complete VR platform must also consider the medical monitoring and the data management oriented to a more objective medical assessment. The proposed method allows the design of VR platforms based on patient-specific serious games for memory loss starting from the 3D scanning acquisition of familiar environments. The 3D acquisition is performed using the Occipital Structure Sensor and the Skanect application. A modular procedure has been designed to interface the virtual objects of each acquired environment with the modules of the game-logic developed with Unity. The immersive Virtual Reality is based on the use of the HTC Vive Pro head mounted display. Furthermore, the method permits to associate the patient-specific serious game to a set of software modules for the medical monitoring and the data management for the generation of reports useful for the evaluation. The solution has been evaluated by measuring the time needed to develop a whole VR platform for two different familiar environments. Less than 5 hours are required to complete the design process.

Keywords: 3D scanner | Brain stroke | Memory loss | Rehabilitation | Serious games | Virtual reality

Abstract: Marker-less motion capture (MOCAP) systems based on consumer technology simplify the analysis of movements in several research fields such as industry, healthcare and sports. Even if the marker-less MOCAP systems have performances with precision and accuracy lower than the marker-based MOCAP solutions, their low cost and ease of use make them the most suitable tools for full-body movements analysis. The most interesting category is relative to the use of RGB-D devices. This research work aims to compare the performances of the last two generations of Kinect devices as marker-less MOCAP systems: Microsoft Kinect v2 and Azure devices. To conduct the tests, a list of specific movements is acquired and evaluated. This work measures the improvements of the Azure in tracking human body movements. The gathered results are presented and discussed by evaluating performances and limitations of both marker-less MOCAP systems. Conclusions and future developments are shown and discussed.

Keywords: Accuracy | Kinect Azure | Kinect V2 | Marker-less MOCAP systems

Abstract: Retrograde amnesia is a severe memory loss dramatically affecting patient’s quality of life. Traumatic brain injuries, strokes, degenerative processes or metabolic disorders are the main causes. At present, rehabilitation tries to recover patients’ memory by means of neuro-cognitive exercises guided by a physiotherapist. Unfortunately, the adherence to these rehabilitation exercises drops when patients are discharged from hospital. Furthermore, conventional rehabilitation is usually performed using standard exercises, which are not customized to each patient. The reproducibility of real environments and situations is a crucial feature to guarantee the efficacy of neuro-rehabilitation and it is defined as ecological validity. Ecological validity is important for making the exercises useful to re-learn specific information and for performing daily activities with the lowest effort. Nowadays, the traditional rehabilitation for retrograde amnesia is based on a set of pictures shown to the patient to remember or learn familiar environments, such as his/her home. This approach is very limiting because the patient can see few points of view of the home without learning and memorizing how to move and get into a specific room. Therefore, the traditional approach has a low ecological validity. The advent of innovative technology, like 3D scanners and virtual reality, permit the design of innovative solutions that virtually replicate patient’s home. This research work presents a novel procedure to design serious games for neuro-cognitive rehabilitation for patient with retrograde amnesia. The proposed procedure exploits low-cost and free technologies; in particular, the Occipital Structure sensor has been chosen as 3D scanner to acquire the 3D indoor environments, which are used inside Unity to develop the game logic of the serious games. The HTC Vive Pro head mounted display has been used to interact with the serious games in an immersive way. The designed procedure makes available a set of Unity scripts to develop the serious game for new patients by changing only the 3D environment (i.e., patient’s house). The procedure has been tested by creating three different serious games and the total time to create them can be approximated to a working day. The obtained results have been shown to medical personnel who have evaluated the proposed approach with a high ecological validity and decided to plan future medical tests by involving patients.

Keywords: Blender | Ecological validity | Occipital Structure sensor | Rehabilitation | Retrograde amnesia | Unity | Virtual reality

Abstract: Background and Objective: The paper presents a novel procedure based on 3D scanning and 3D modelling to automatically assess linear and volumetric measurements of an arm and to be further applied to patients affected by post breast cancer lymphedema. The aim is the creation of a virtual platform easily usable by medical personnel to get more objective evaluations during the lymphedema treatment. Methods: The procedure is based on the 3D scanning of the arm using the Occipital Structure Sensor and an ad-hoc developed application, named Lym 3DLab. Lym 3DLab emulates the traditional measurement methods, which consist in taking manual circumference measurements or using the water displacement method. These measurements are also used to design the compression stockings, the typical orthopaedic device used for lymphedema treatment. A validation test has been performed to compare the measurements computed by Lym 3DLab with both water displacement and manual circumference measurements. Eight volunteers have been involved who are not affected by lymphedema. Furthermore, a specific usability test has been performed to evaluate the 3D scanning procedure by involving four physiotherapists. Results: The comparison between the volumes has highlighted how all the 3D acquired models have their volumes inside a range of acceptability. This range has been defined by considering the sensitivity error of the tape measure used to measure the water displacement. The comparison between the perimeters of cross sections computed with Lym 3DLab and the circumference measurements has shown results that are very accurate with an average difference of 2 mm. The measure errors have been considered negligible by the medical personnel who have evaluated the proposed procedure more accurate than the traditional ones. The test with physiotherapists has shown a high level of usability of the whole virtual environment, but the 3D scanning procedure requires an appropriate training of the personnel to make the 3D acquisition as fast and efficient as possible. Conclusions: The achieved results and the physiotherapists’ feedback allow planning a future test with patients affected by lymphedema in collaboration with the hospital. A further test has been planned to use the computed measurements to design orthopaedic compression stockings.

Keywords: 3D scanning | Arm Volume | Circumference Measurement | Lym 3DLab | Lymphedema | Occipital Structure Sensor

Abstract: The research work presents a specific procedure to evaluate the performance of soccer goalkeepers by means of a marker-less motion capture (Mocap) system based on a set of 8 GoPro active cameras. The layout of the sensors and the calibration phase have been defined to be easily replicated and not to interfere with athletes and trainers during the exercises. The proposed solution has been tested in collaboration with goalkeeper coaches, who made available the knowledge about conventional training exercise. The Mocap system has been tested by involving two goalkeepers and a coach. The results have been elaborated and the outcomes have been considered interesting by experts. Furthermore, the adopted technology for motion capture and elaboration could be evaluated for an application to the rehabilitation process of an athlete after an injury, to determine his stage of recovery and the most suitable work to be done.

Keywords: Active camera | Goalkeepers training | Kinematic data analysis | Marker-less motion capture | Outdoor motion capture | Sports technology

Abstract: In physical rehabilitation, motion capture solutions are well-known but not as widespread as they could be. The main limit to their diffusion is not related to cost or usability but to the fact that the data generated when tracking a person must be elaborated according to the specific context and aim. This paper proposes a solution including customized motion capture and data elaboration with the aim of supporting medical personnel in the assessment of spinal cord-injured (SCI) patients using a wheelchair. The configuration of the full-body motion capturing system is based on an asymmetric 3 Microsoft Kinect v2 sensor layout that provides a path of up to 6 m, which is required to properly track the wheelchair. Data elaboration is focused on the automatic recognition of the pushing cycles and on plotting any kinematic parameter that may be interesting in the assessment. Five movements have been considered to evaluate the wheelchair propulsion: the humeral elevation, the horizontal abduction of the humerus, the humeral rotation, the elbow flexion and the trunk extension along the sagittal plane. More than 60 volunteers with a spinal cord injury were enrolled for testing the solution. To evaluate the reliability of the data computed with SCI APPlication (APP) for the pushing cycle analysis, the patients were subdivided in four groups according to the level of the spinal cord injury (i.e., high paraplegia, low paraplegia, C7 tetraplegia and C6 tetraplegia). For each group, the average value and the standard deviation were computed and a comparison with similar acquisitions performed with a high-end solution is shown. The measurements computed by the SCI-APP show a good reliability for analyzing the movements of SCI patients’ propulsion wheelchair.

Keywords: Automatic pushing analysis | Markerless motion capture | RGB-D sensors | SCI patients

Abstract: Motion capture (Mocap) is applied to motor rehabilitation of patients recovering from a trauma, a surgery, or other impairing conditions. Some rehabilitation exercises are easily tracked with low-cost technologies and a simple Mocap setup, while some others are extremely hard to track because they imply small movements and require high accuracy. In these last cases, the obvious solution is to use high performing motion tracking systems, but these devices are generally too expensive in the rehabilitation context. The aim of this paper is to provide a Mocap solution suitable for any kind of exercise but still based on low-cost sensors. This result can be reached embedding some artificial intelligence (AI), in particular a convolutional neural network (CNN), to gather a better outcome from the optical acquisition. The paper provides a methodology including the way to perform patient's tracking and to elaborate the data from infra-red sensors and from the red, green, blue (RGB) cameras in order to create a user-friendly application for physiotherapists. The approach has been tested with a known complex case concerning the rehabilitation of shoulders. The proposed solution succeeded in detecting small movements and incorrect patient behavior, as for instance, a compensatory elevation of the scapula during the lateral abduction of the arm. The approach evaluated by medical personnel provided good results and encouraged its application in different kinds of rehabilitation practices as well as in different fields where low-cost Mocap could be introduced.

Keywords: Artificial intelligence | Engineering informatics | Human computer interfaces/Interactions

Abstract: Mobile devices and laptops are the main ICT tools to exchange information among people in the world. All the applications are designed by following a specific interaction style based either touchscreen or mouse and keyboard, which can be performed only with detailed movements of hands and fingers. Traditional interaction becomes difficult for elderly who have diseases limiting the hand motor skills, such as arthritis and brain stroke. The use of simple air gestures can be adopted as alternative interaction style to interact with smartphones, tablets and laptops. The aim of this research work is the development of an application that allows text writing using air gestures for people with limited hand motor skills. The application embeds several computer vision algorithms and convolutional neural networks software modules to detect and drawn alphanumeric characters and recognizing them using both mobile devices and laptops. The preliminary results obtained show that the approach is robust, and it can easily detect the alphanumeric characters written with the movement of the wrist..

Keywords: Elderly | Hand Motor Skills | OpenPose | TesserAct-OCR.

Abstract: In the last years, the advent of low-cost markerless motion capture systems fostered their use in several research fields, such as healthcare and sport. Any system presents benefits and drawbacks that have to be considered to design a Mocap solution providing a proper motion acquisition for a specific context. In order to evaluate low-cost technology, this research work focuses on the evaluation of the accuracy of two categories of devices: The RGB active cameras and the RGB-D, or depth sensors devices. In particular, GoPro Hero 6 active cameras and Microsoft Kinect v2 devices have been selected as representative of the two categories. In particular, this work evaluates and compares the performances of the two systems used to track the position of human articulations. The two devices have been chosen among those available on the market after a state of the art has been completed. Before starting with the campaign of acquisition, the number of sensors and their layout have been designed to optimize the acquisition with both mark-less Mocap systems. Their comparison is based on a list of specific movements of upper and lower limbs. Each movement has been acquired simultaneously, to guarantee the same test conditions. The results have been organized, compared and discussed by evaluating performances and limitations of both solutions related to specific context of use. Conclusions highlight the best candidate technology..

Keywords: Accuracy | active cameras | GoPro | Markerless Mocap systems | Microsoft Kinect

Abstract: Total Knee Arthroplasty is one of the most commonly performed orthopedic procedures and it is expected to grow in the next future . In the last past years, computer-assisted procedures represent one of the trends that are transforming the way of practicing medicine. Cornering the Total Knee Arthroplasty, digital models of the joints have been used to carry out simulation of their kinematics and mechanical performance. Whilst for the 3D digital reconstruction of the patient geometry several studies have been conducted, an approximated geometry of the prosthesis has been several times employed, with undeniable consequences on the final results. This paper aims at comparing two non-contact reverse engineering technologies to acquire the shape of femoral components employed for total knee arthroplasty. A high-level device (Konika Minolta Vivid 9i) and a mid-low cost laser (NextEngine) has been compared. For the comparison, a systematic procedure of acquisition and elaboration of the results has been adopted in order to have as unbiased as possible results. The procedure involves the use of the proprietary software of the scanners for the elaboration of the raw data and the meshing procedure has been kept the same for all the models. Since the as-is acquired mesh is of high-resolution, a decimation procedure has been carried out in order to make the 3D models lighter and easier to be handled. Once the decimation procedure has been evaluated comparing the original and the simplified models to one another, the digitalized models have been compared with the measurements taken from a coordinate measuring machines. As a preliminary result, the two lasers seem to be adequate to accomplish the reverse engineering process as required by this application. Of course, the mid-low cost laser would be preferable whether the performance will be confirmed to be (statistically) equal.

Abstract: The research work presents a preliminary study to create a virtual reality platform for the medical assessment of spatial extrapersonal neglect, a syndrome affecting human awareness of a hemi-space that may be caused by cerebral lesions. Nowadays, the extrapersonal neglect is assessed by using real objects positioned in the space around the patient, with a poor capability of repetition and data gathering. Therefore, the aim of this research work is the introduction of a virtual reality solution based on consumer technology for the assessment of the extrapersonal neglect. By starting from the needs of the involved medical personnel, an online serious-game platform has been developed, which permits to perform a test and a real-time evaluation by means of objective data tracked by exploited technologies, i.e. an HTC Vive Pro head mounted display and ad-hoc IT solutions. The test is based on a virtual environment composed by a table on which twenty objects have been placed, ten on the right side and ten on the left side. The whole 3D virtual environment has been developed using low-cost and free development tools, such as Unity and Blender. The interaction with the virtual environment is based on voice recognition technology, therefore the patient interact with the application by pronouncing the name of each object aloud. The VR application has been developed according to an online gaming software architecture, which permits to share the 3D scene by exploiting a Wi-Fi hotspot network. Furthermore, the on-line gaming software architecture allows sending and receiving data between the doctor's laptop and the VR system used by the patient on another laptop. The therapist can see through his/her personal computer a real time faithful replica of the test performed by the patient in order to have a fast feedback on patient’s field of view orientation during the evaluation of 3D objects. A preliminary test has been carried out to evaluate the ease of use for medical personnel of the developed VR platform. The big amount of recorded data and the possibility to manage the selection of objects when the voice commands are not correctly interpreted has been greatly appreciated. The review of the performed test represents for doctors the possibility of objectively reconstructing the improvements of patients during the whole period of the rehabilitation process. Medical feedback highlighted how the developed prototype can already be tested involving patients and thus, a procedure for enrolling a group of patients has been planned. Finally, future tests have been planned to compare the developed solution with the Caterine Bergero Scale to define a future standardization.

Keywords: Extrapersonal neglect | Head mounted display | Neglect assessment | Virtual reality

Abstract: This research work presents a preliminary study for the assessment of lymphedema using low-cost 3D scanning and modelling technology. The aim is to develop a methodology to measure the anatomical key features of the upper limbs lymphedema using a 3D scanning technology and an ad-hoc developed application, named Lym 3DLab. The application is able to automatically measure both perimeters of cross sections and volumes of arm segments for medical evaluation and design of compression stockings using the upper limb polygonal mesh. The scanning procedure is based on a Microsoft Kinect v1 as scanner and the low-cost Skanect tool, which creates the polygonal mesh of the 3D acquisition. Lym 3DLab has been developed using open-source Software Development Kits, such as Qt and Visualization Toolkit. The acquired volumes have been compared with the water displacement method, which is considered the gold standard for measuring volumes of limbs affected by lymphedema. A preliminary test has been performed to compare volumes measured using the developed procedure with the gold standard. Five volunteers have been involved who are not affected by lymphedema. The arm volume measured with water displacement have been compared with the volume computed using 3D model of arm in Lym 3DLab. The range of differences is between −6,75 cm3 and 9,40 cm3. Reached results are the base for planning further test with a large number of patients affected by lymphedema in collaboration with a hospital.

Keywords: 3D scanning | Automatic measurement of arm volume | Breast cancer | Lymphedema | Microsoft Kinect | Upper limb modeling

Abstract: Motion capture (Mocap) systems are considered more and more interesting for the assessment of rehabilitation processes. In fact, medical personnel are increasingly demanding for technologies (possibly low-cost) to quantitatively measure and assess patients’ improvements during rehabilitation exercises. In this paper, we focus the attention on the assessment of rehabilitation process for injured shoulders. This is particularly challenging because the recognition and the measurement of compensatory movements are very difficult during visual assessment and the movements of a shoulder are complex and arduous to be captured. The proposed solution integrates a low-cost Mocap system with video processing techniques to allow a quantitative evaluation of abduction, which is one of the first post-surgery exercises required for shoulder rehabilitation. The procedure is based on a set of open-source software tools to measure abduction and evaluate the correctness of the movement by detecting and measuring compensatory movements according to the parameters commonly considered by the physicians. Finally, a preliminary results and future works are presented and discussed.

Keywords: Embedded Knowledge | Medical assessment | Microsoft Kinect v2 | Motion Capture | Post-surgery shoulder

Abstract: Among rising technology in medical field, methods and solutions of reverse engineering have a high impact as a new possibility for improving the traditional processes to design prosthesis and orthoses. Furthermore, reverse engineering solutions allows managing a big amount of patient's data, which can be also exploited for making the medical assessment during rehabilitation activities more objective and measurable. In particular, innovative technologies permit to manage big amount of data coming from several IT devices in order to better understand the correlation between technical aspects and human factors. These IT devices can be exploited through customized software applications, which are able to combine many data types (e.g. 3D scanners, motion capture systems and pressure sensors). In this research work, the attention is focused on the design of lower limb prosthesis around the digital human model of the patient. We present a virtual platform composed by an ad-hoc developed application for customizing the prosthesis according to patients' life style and medical knowledge as well as for visualizing pressure on patient's limb while evaluating his/her gait in a unique virtual knowledge-guided environment. Such applications are conceived to be usable by non IT experts, and all information are directly visualized on the digital human model of the amputee. The first part of the paper introduces the whole platform to design lower limb prosthesis using low-cost technologies. Then, the virtual gait analysis tool is described. Finally, tests and conclusion are discussed.

Keywords: 3D modelling | Health informatics | Marker-less motion capture system | Pressure data | User centered design

Abstract: This scientific work aims at developing an innovative virtual platform to design lower limb prosthesis centered on the virtual model of the patient and based on a computer-aided and knowledge-guided approach. The main idea is to develop a digital human model of the amputee to be used by the prosthetist in a full virtual environment in which a platform provides a set of interactive tools to design, configure, and test the prosthesis. This virtual platform permits to design and configure the whole prosthesis, in particular, the 3D model of the assembled prosthesis, crucial to define the prosthesis setup and patient’s walking performance. An ad-hoc computer-aided design system has been developed in house to design the 3D model of the socket according to traditional operations made by technicians during traditional manufacturing process. Moreover, a finite element model has been defined to study the contact between residual limb and socket. The resulting 3D model of the socket can be realized by exploiting multimaterial additive manufacturing technology. Finally, the developed platform also permits to handle contact pressures and patient’s gait data in a unique application through the use of a low-cost motion capture (MOCAP) system. The whole platform has been tested with the help of an Italian orthopedic laboratory. The developed platform is a promising solution to develop the check socket, and the application may be used also for training purpose for junior orthopedic technicians.

Keywords: Low-cost MOCAP system | Lower limb prosthesis | Pressure analysis | Socket design and 3D modeling

Abstract: Nowadays, healthcare centers are not familiar with quantitative approaches for patients’ gait evaluation. There is a clear need for methods to obtain objective figures characterizing patients’ performance. Actually, there are no diffused methods for comparing the pre- and post-operative conditions of the same patient, integrating clinical information and representing a measure of the efficiency of functional recovery, especially in the short-term distance of the surgical intervention. To this aim, human motion tracking for medical analysis is creating new frontiers for potential clinical and home applications. Motion Capture (Mocap) systems are used to allow detecting and tracking human body movements, such as gait or any other gesture or posture in a specific context. In particular, low-cost portable systems can be adopted for the tracking of patients’ movements. The pipeline going from tracking the scene to the creation of performance scores and indicators has its main challenge in the data elaboration, which depends on the specific context and to the detailed performance to be evaluated. The main objective of this research is to investigate whether the evaluation of the patient's gait through markerless optical motion capture technology can be added to clinical evaluations scores and if it is able to provide a quantitative measure of recovery in the short postoperative period. A system has been conceived, including commercial sensors and a way to elaborate data captured according to caregivers’ requirements. This allows transforming the real gait of a patient right before and/or after the surgical procedure into a set of scores of medical relevance for his/her evaluation. The technical solution developed in this research will be the base for a large acquisition and data elaboration campaign performed in collaboration with an orthopedic team of surgeons specialized in hip arthroplasty. This will also allow assessing and comparing the short run results obtained by adopting different state-of-the-art surgical approach for the hip replacement.

Abstract: In the last years, the advent of innovative technologies for tracking human motions is increasing the interest of physicians and physiotherapist, who would like to introduce new instruments for a more objective assessment of the rehabilitation processes. At present, many motion tracking systems have been developed and their ease of use and low-cost may represent the key aspects for which these systems could be really adopted both in rehabilitation centers and in rehabilitation programs at home. Several research studies confirmed the importance of continuing rehabilitation programs at home with the aim to maintain patients’ health condition at a suitable level for daily life activities. Physicians and physiotherapists need methods and tools, which can be simply adaptable for each type of patients’ category and type of rehabilitation according to the assessed pathology. For achieving this need, the technology has to be suitable for both the patient side and medical personnel side. The most suitable technology for the patients are motion tracking devices which can be used through traditional IT, such as laptops, smartphones and tablets. Also for medical personnel the ease of use is very important, physicians would like to check the patient’s rehab exercises according to their medical knowledge by exploiting daily life technology. This research work investigates on which are the best user-friendly programming tools and low-cost technology for 3D hand and finger tracking for the development of a serious game for rehabilitation exercises. The tasks are designed according to physiotherapists’ recommendations, in order to be customizable for any single user. The following sections will describe the method, the tools adopted, and the application developed.

Keywords: Hand tracking | Leap motion device | Low-cost technology | Post-stroke rehabilitation | Unity

Abstract: Low cost marker-less motion capture (Mocap) systems can be considered an interesting technology for the objective assessment of rehabilitation processes. In particular, this paper presents a feasibility study to introduce a Mocap system as a tool to assess shoulder rehabilitation. The movements of a shoulder are complex and challenging to be captured with a marker-less system because the skeleton avatar usually oversimplifies shoulder articulation with a single virtual joint. The designed solution integrates a low-cost Mocap system with image processing techniques and convolutional neural networks to automatically detect and measure potential compensatory movements executed during an abduction, which is one of the first post-surgery exercises for shoulder rehabilitation. First, we introduce the main steps of a reference roadmap that guided the development of the Mocap solution for rehab assessment of injured shoulder. Then, the acquisition of medical knowledge is presented as well as the new Mocap solution based on the integration of convolutional neural networks and 2D motion tracking techniques. Finally, the application which automatically evaluates abductions and makes available the measurements of the scapular elevations is described. Preliminary study and future works are also presented and discussed.

Keywords: Blender | Marker-less Motion capture system | Open source SDK | OpenPose | Shoulder rehabilitation

Abstract: The rehabilitation process of patients after spinal cord injury (SCI) is usually based on subjective visual assessment by medical staff of rehabilitation centers. During the process, the medical personnel train patients to manage wheelchair and they learn how to use their sensible body parts in order to have a satisfactory life-style. Furthermore, physiotherapists and physicians have to control patients to prevent wrong postures that could cause further disorders. This paper describes how a low-cost marker-less motion capture system can be exploited to create an objective assessment procedure. Three Microsoft Kinect v2 sensors have been used to track patients using their wheelchairs along a straight path. The three sensors are arranged to optimize the acquisition. Thanks to the collaboration with the medical staff, we identified the set of parameters necessary to monitor patients’ performance. An ad hoc application has been developed to provide the physicians with the right set of data easy readable to assess the patients along the rehabilitation process. The application has been tested involving twenty volunteers. Finally, results reached so far and further developments are summarized and discussed.

Keywords: Assessment of rehabilitation processes | Low-cost marker-less motion capture system | Microsoft Kinect v2 | Spinal cord injury

Abstract: This paper presents an approach for monitoring exercises of hand rehabilitation for past stroke patients. The developed solution uses a Leap Motion controller as hand-tracking device and embeds a supervised Machine Learning methodology. Support Vector Machine (SVM) is used in order to assess the correctness of a set of simple rehabilitation exercises performed with a single hand. The basic SVM model was extended with particular interest for defining feature vectors in a continues environment. The proposed method incorporated leap motion data, normalization of angles and gesture recognition. A software system was developed to provide patients with a set of exercise corrections and guidance for rehabilitation.

Keywords: Hand Rehabilitation | Leap Motion Controller | Stroke Patients | Support Vector Machines

Abstract: Over recent years, various virtual prototyping technologies have been developed to innovate apparel industry. For each step of the garment design process one can find dedicated tools (from body acquisition to garment modelling and simulation) with the aim of making the process easier and faster. However, most of them are based on expensive solutions both for hardware and software systems. In this paper, we focus the attention on the first step of the made-to-measure garment design, i.e. customer’s measures acquisition. We present a plug-in, named Tailor Tracking, which permits to get the measurements by interacting with the customer’s avatar using hands as in the traditional way. Tailor Tracking has been developed using low cost devices, such as Microsoft Kinect sensor, Leap motion device and Oculus Rift, and open source libraries, such as Visualisation Toolkit (VTK) and Qt. The proposed approach is based on the use of multiple Kinect v2 to simultaneously acquire both customer’s body and motion. This permits to emulate the customer’s postures required to take the correct measurements. In addition, a virtual measuring tape is made available to replicate the one commonly used by the tailor. A men shirt has been considered as case study and a tailor and 14 people with no skills in garment design and different levels of experience in virtual reality technology have been involved to preliminary test Tailor tracking. Finally, tests as well as results reached so far are presented and discussed. Results have been considered quite good; however, some critical measures have been identified as well as future developments. Anyway, Tailor Tracking can represent an alternative solution to the existing approaches that automatically extract anthropometric measures from the customer’s avatar.

Keywords: Clothing design | garment measurements | hand-tracking device | head mounted display | Kinect sensors | motion capture | virtual reality

Abstract: The effectiveness of custom-made prostheses or orthoses heavily depends on the experience and skills of the personnel involved in their production. For complex devices, such as lower limb prosthesis, a conventional manual approach affects the process at the point that the result is frequently not acceptable at the first trial. The paper presents a computer-aided environment, named socket modelling assistant2 (i.e., SMA 2) , to interactively design the socket of lower limb prosthesis by implementing a set of design rules extrapolated from the traditional development process. The new computer-aided environment has been implemented embracing a low-cost philosophy and using open source libraries to provide a solution affordable also by small orthopaedic laboratories. The system permits to modify and interact with the 3D model of residual limb to create the socket geometric model ready to be manufactured by means of additive manufacturing. SMA 2 embeds medical knowledge related to the device functioning, the conventional process and the way orthopaedic technicians work so that it can be much more reliable and repeatable compared to the conventional process, but still enough similar to it to be accepted by the involved personnel. In the paper, the new 3D design procedure is described in detail, from the acquisition of patient’s data to preliminary and customized modelling, and new geometric tools to perform context–related operations are shown. A case study is used to clarify the way the system works and to provide an example of the outcome.

Keywords: Additive manufacturing | Custom medical devices | Geometric modelling | Interactive design

Abstract: Rising reverse engineering applications require the use of 3D models based on polygonal meshes and a set of modeling operations to shape the final product. Usually, 3D modeling tools do not exploit existing software development kits for developing custom virtual applications. This approach can be very useful for reverse engineering process in the medical field. The paper describes the software development of local mesh modeling algorithms as an extension of the open source library VTK with the aim of shaping 3D triangulated meshes. Then, a case study has been considered to create virtual modeling tools supporting the design process of custom-fit products and, in particular, of lower limb prosthetic socket for amputees. The application has been tested to design a socket for a patient with an above knee amputation. Results reached so far provide a positive feedback on the quality of the designed process and outcome, mainly thanks to the use of the virtual tools based on the developed software modules for 3D mesh modeling.

Keywords: medical devices | Polygonal 3D modeling | prosthesis design | VTK

Abstract: Using a wheelchair can be a challenging task for people with reduced force and control of muscles of abdomen or lower back. Spinal cord injured (SCI) people are the majority of those who are spending most of the day on a wheelchair and a proper training and chair setup is mandatory to reach a good level of functionality and to avoid harms and side effects. In order to assess the complex motion of a person self-pushing a wheelchair, a motion capture (Mocap) system has been arranged and a group of SCI patients has been acquired in a hospital gym. The Mocap system uses three Microsoft Kinect RGB-D sensors and iPisoft to perform the recording of the 3D motion. The main goal of the research is to provide therapists with a quantitative method to define a preliminary configuration in an objective way once is given the user's medical conditions and his/her way of using the wheelchair. Working side by side with physiotherapists, the main parameters to be evaluated (e.g. pushing angles) have been identified and algorithms have been identified to automatically extract them from the 3D digital avatar model data coming from the Mocap system. The performance of the patients is then analyzed taking into account the wheelchair setup (e.g. position and inclination of the seat and of the back). The influence of geometric parameters on patients' motion is analyzed so that design guidelines for configuration can be found. The overall outcome is to maximize performance and minimize side effects and fatigue, providing users with a better experience on the wheelchair.

Abstract: The Natural User Interface (NUI), which permits a simple and consistent user’s interaction, represents a meaningful challenge for developing virtual/augmented reality applications. This paper presents a set of guidelines to design optimal NUI as well as a software framework, named FrameworkVR, which encapsulates the rules of presented guidelines. FrameworkVR allows developing NUI for VR/AR reality applications based on Oculus Rift, Leap Motions device and on the VTK open source library. An example of VR application for prosthesis design developed using FrameworkVR, is also described. Tests have been carried to validate the approach and the designed NUI and results reached so far are presented and discussed.

Abstract: A number of pathologies impact on the way a patient can either move or control the movements of the body. Traumas, articulation arthritis or generic orthopedic disease affect the way a person can walk or perform everyday movements; brain or spine issues can lead to a complete or partial impairment, affecting both muscular response and sensitivity. Each of these disorder shares the need of assessing patient’s condition while doing specific tests and exercises or accomplishing everyday life tasks. Moreover, also high-level sport activity may be worth using digital tools to acquire physical performances to be improved. The assessment can be done for several purpose, such as creating a custom physical rehabilitation plan, monitoring improvements or worsening over time, correcting wrong postures or bad habits and, in the sportive domain to optimize effectiveness of gestures or related energy consumption. The paper shows the use of low-cost motion capture techniques to acquire human motion, the transfer of motion data to a digital human model and the extraction of desired information according to each specific medical or sportive purpose. We adopted the well-known and widespread Mocap technology implemented by Microsoft Kinect devices and we used iPisoft tools to perform acquisition and the preliminary data elaboration on the virtual skeleton of the patient. The focus of the paper is on the working method that can be generalized to be adopted in any medical, rehabilitative or sportive condition in which the analysis of the motion is crucial. The acquisition scene can be optimized in terms of size and shape of the working volume and in the number and positioning of sensors. However, the most important and decisive phase consist in the knowledge acquisition and management. For each application and even for each single exercise or tasks a set of evaluation rules and thresholds must be extracted from literature or, more often, directly form experienced personnel. This operation is generally time consuming and require further iterations to be refined, but it is the core to generate an effective metric and to correctly assess patients and athletes performances. Once rules are defined, proper algorithms are defined and implemented to automatically extract only the relevant data in specific time frames to calculate performance indexes. At last, a report is generated according to final user requests and skills.

Abstract: The improvement and the massive diffusion of additive manufacturing (AM) techniques have fostered the research of design methods to exploit at best the feature introduced by these solutions. The whole design paradigm needs to be changed taking into account new manufacturing capabilities. AM is not only an innovative method of fabrication, but it requires a new way to design products. Traditional practices of mechanical design are changing to exploit all potential of AM, new parameters and geometries could be realized avoiding technologies constrains of molding or machine tooling. The concept of "manufacturing for design" increasingly acquires greater importance and this means we have the chance to focus almost entirely on product functionality. The possibility to confer inhomogeneous properties to objects provides an important design key. We will study behavior and structure according to desired functions for each object identifying three main aspects to vary: infill type, external topology and shape, and material composition. In this research work, we focus on fused deposition modeling (FDM) technology of three dimensional (3D) printing that easily allows to explore all previous conditions. We present a new way to conceive design process in order to confer variable properties to AM objects and some guidelines to control properties of deformation and elasticity using classic infills. The ultimate aim is to apply new design rules provided by AM in the prosthetic field of lower limb amputees. The socket of the prosthesis represents a deformable interface between the residual limb and the artificial leg that must be optimized according to geometry and loads distribution of patient. An application for a transfemoral patient will be discussed.

Abstract: In fashion industry, 2D and 3D CAD systems to design garments already exist; however, some tasks of the process are neglected. We refer to made-to-measure garments and focus the attention on the first step of garment design, i.e. acquisition of customer’s measurement. In this paper we present an application based on mixed reality, named Tailor LABoratory (TLAB), which permits to take measures for clothing design as traditionally done by the tailor. TLAB has been developed using open source libraries (e.g., VTK and Blender) and low cost devices, such as Microsoft Kinect v2 to scan the human body, Oculus Rift v2 to create the 3D virtual reality and Leap Motion device to track hands motion. In particular, a virtual tape measure is made available to take measures interacting with the human avatar. To replicate the customer’s posture with her/his digital model, Blender has been adopted. It permits to manage body animations and automatic association of an animation to the 3D human avatar. Finally, preliminary tests are illustrated as well as results reached so far and future development.

Keywords: Leap Motion | mixed reality | Oculus Rift | tailor’s work | virtual garments design

Abstract: This paper concerns the design and manufacture of medical devices, such as lower limb prosthesis, integrating low cost industrial technologies. In particular, it focuses the attention on the custom-fit component of a lower limb prosthesis, i.e., the socket, that is the interface with the residual limb. The considered process starts from the 3D reconstruction of patients’ limb and ends with the manufacture of the socket with a 3D printer using a multi-material approach. The process counts three steps: 3D modeling, testing (both experimental and numer-ical) and manufacturing. For each step adopted solutions and tools are described. Finally, conclusions are drawn mainly concerning the challenge of multi-material 3D printing of the socket.

Keywords: 3D printing | Lower limb prosthesis | Socket Modelling Assistant

Abstract: Additive Manufacturing (AM) is not only an innovative approach of fabrication but it fosters a new paradigm to design products. The possibility to confer inhomogeneous properties to the product provides an important design key. This paper concerns the design and manufacture of medical devices that require a high level of customization. We focus the attention on lower limb prosthesis and in particular on the prosthetic socket. The proposed method is centered on the virtual modeling of patient's residual limb and the virtual process is highly integrated and the data flow is as fluid as possible. Three main phases can be identified: design, validation and manufacture of the socket. Firstly, the technician uses the Socket Modeling Assistant (SMA) tool to design the socket shape. Then, a numerical simulation is run to check pressure distribution and validate the socket shape. Finally, a multi-material 3D printer is used to build the socket. Preliminary results are presented and conclusions are drawn concerning the challenge of multimaterial 3D printing of the socket.

Abstract: The way a person moves, either in a plain walk or performing a specific task, tells a huge quantity of information about his/her physical and, eventually, neurologic condition. A large part of a physiotherapist work of assessment is based on the qualitative evaluation, mainly visual, of a person's movements, in terms of balance, speed, control, force and other parameters. This research work aims at providing personnel involved in the rehab process with a quantitative method to assess the way movements are performed. A numerical measure of the performance, actually, allows easier and more precise assessment, eliminating bias due to subjectivity. To accomplish this goal two steps are required: 3D acquisition of the movement using a Motion Capture (Mocap) system, and analysis of collected data to extract or elaborate the final outcome in the form requested by the medical staff. The paper shows the way Mocap acquisition are performed and data are analyzed in the application with people having a complete spinal cord injury and using a wheelchair. The method has been tested with eight volunteers in the rehabilitation department of the Hospital Papa Giovanni XXIII in Bergamo, Italy.

Abstract: This paper presents an overview of main open source software, low-cost devices and related SDKs (Software Development Kits) that can be used to develop custom applications based on virtual and augmented reality. At present, the high modularity of the open source software for computer graphics allows developing custom applications with high quality for several research and industrial fields. To this end, we introduce a general-purpose software framework, which permits to manage the synchronization among the SDKs of different low-cost devices. Mentioned devices and software modules have been exploited to develop three applications in different fields.

Keywords: Low-cost devices | Open-source software | Virtual reality

Abstract: The Italian fashion industry is nowadays subject to radical transformation; therefore, it needs to remain competitive and, at the same time, innovate itself, in order to strengthen its position in the global market. An important opportunity of innovation can be the introduction of ICT technologies in the garment design process, which today is based on traditional methods and tools. Moreover, this innovation could be particularly important for online sales, in order to reduce the customers’ doubts during purchasing. The research presented in this paper describes a framework for designing clothes as realistic 3D digital models and for allowing customers to evaluate the designed clothes by using realistic virtual mannequins of their bodies instead of the standard ones. A case study will be presented in the paper. The obtained results show that the framework can innovate the traditional garment design process and it could have a huge impact on fashion industry and customers behaviours.

Keywords: Body scanning | Cloth simulation | Design process | Motion capture | Virtual prototype

Abstract: This paper presents a Mixed Reality environment, named Virtual Orthopedic LABoratory (VOLAB), which permits to emulate an orthopedic lab and design lower limb prosthesis, in particular, the socket component. The proposed solution is based on low cost devices (e.g., Microsoft Kinect) and open source libraries (e.g., OpenCL and VTK). In detail, the hardware architecture consists of three Microsoft Kinect v2, Oculus Rift for 3D environment visualization and Leap Motion device for hand/fingers tracking. The software development has been based on the modular structure of the prosthetic CAD system, named Socket Modelling Assistant (SMA) and modules have been developed to guarantee the communication among the devices and the performance. Finally, preliminary tests are illustrated as well as results reached so far and future development.

Keywords: Augmented Interaction | Human body devices | Low Cost Hand-Tracking devices | Mixed Reality | Prosthesis design | Socket Modelling Assistant

Abstract: Digital Human Modelling (DHM) is becoming a simple way to study the ergonomic behaviour of devices interacting with the human body. In particular, innovative technologies per- mit to manage big amount of data coming from several IT devices in order to better understand the correlation be- tween technical aspects and human factors. In the medical field DHM can be exploited to combine in a unique applica- tion many data types coming from several inputs (e.g. 3D scan, motion capture). In this research work, the attention is focused on the design of lower limb prosthesis around the digital human model of the patient. We present an appli- cation, which allows visualizing pressure on patient's limb while evaluating his/her gait in a unique virtual knowledge- guided environment. Such application is conceived to be usable by non IT experts, and all information are directly visualized on the digital human model of the amputee. The first part of the paper describes the platform to design lower limb prosthesis with particular attention on the use of low- cost technologies. Then, the virtual gait analysis tool is described. Finally, tests and conclusion are discussed.

Keywords: Digital human modelling | Gait analysis | Lower limb prosthesis | Pressure mapping

Abstract: This paper presents a methodology and tools to improve the design of lower limb prosthesis through the measurement of pressure analysis at the interface residual limb-socket. The steps of the methodology and the design tools are presented using a case study focused on a transfemoral (amputation above knee) male amputee. The experimental setup based on F-Socket Tekscan pressure system is described as well the results of some static loading tests. Pressure data are visualized with a colour pressure map over the 3D model of the residual limb acquired using an optical low cost scanner, based on MS Kinect. Previous methodology is useful to evaluate a physical prototype; in order to improve also conceptual design, the Finite Element (FE) Analysis has been carried and results reached so far have been compared with experimental tests. Pressure distributions are comparable, even if some discrepancies have been highlighted due to sensors placements and implemented FE model. Future developments have been identified in order to improve the accuracy of the numerical simulations.

Abstract: The socket for lower limb prosthesis is the central element of artificial leg that needs to be optimize with the aim to increase comfort and reduce pain. Nowadays, the modeling of this part is completely manual and based on prosthetist skills. The key parameter determining if the socket is properly designed is the pressure distribution in the interface between the skin of residual limb and the internal surface of the socket. In this paper, we expose a method to measure this pressure thought resistive pressure sensors and we illustrate a case study of a transfemoral amputee patient. A visualization tool has been developed to dynamically show pressure data on the 3D model of the residual limb during topic moments of the gait by a color scale. Achieved results and future work will be discussed in the paper.

Keywords: Gait | Lower limb prosthesis | Pressure mapping

Abstract: This paper presents an application, named TLAB (i.e., Tailor’s LABoratory) to support virtual clothing design. In particular, it focuses the attention to the first step of garment design process, i.e., customers’ measure acquisition. TLAB is based on low-cost innovative technology (e.g., Oculus Rift SDK 2, Leap Motion device and Microsoft Kinect v2) to permit the interaction by hand and emulate the work traditionally done by tailors to manufacture a garment. In this paper, firstly we present the technology used for creating TLAB by describing hardware and software solutions adopted. Then, the design of a Natural User Interface (NUI) is depicted. The NUI design allows simplifying the interaction with hands through the use of the Leap Motion device as hand-tracking device. Finally, preliminary tests are discussed and conclusion presented.

Keywords: Augmented interaction | Garment design | Mixed reality

Abstract: Custom-fit products, such as artificial prostheses, often require the development of hoc modeling tools and procedures. In such a context, this paper describes an open source library, named Simply NURBS, developed for NURBS modeling in medical and health-care domains. This new suite makes available a development kit that integrates the key features of existing open source libraries and new ones to fulfill the requirements of the considered domain. First, the paper introduces the library requirements with particular attention to the prosthetic field as well as pros and cons of current NURBS modeling libraries (both commercial and open sources). Then, the software architecture of Simply NURBS and the basic libraries (e.g., OPENCASCADE and NURBS++) used for its implementation are illustrated enhancing differences and improvements. Finally, a socket modeling tool, named Virtual Socket Laboratory (VSL) developed using SimplyNURBS is described as well as results of tests carried out to evaluate the new system performances.

Keywords: Nurbs | Open source libraries | Prosthetic socket

Abstract: The paper shows a research activity aimed at integrating low cost industrial technologies in the design, test and man- ufacture of medical devices. This work focuses on lower limb prosthesis and in particular on the custom-fit compo- nent interacting with the residual limb, i.e. the socket. The process going from the 3D reconstruction of patients' limb to the manufacture of the socket by means of a 3D printer has been designed. Moreover, this must be as automatic as possible and should not require the presence of a design and simulation expert. This implied a deep involvement of physicians and orthopaedic technicians in order to embed rules and procedures in the system. The process is divided in three steps: design, test and manufacture. For each step some details are shown and at last some conclusions are drawn mainly concerning the challenge of multi-material 3D printing of the socket.

Keywords: 3D printing | Lower Limb Pros-thesis | Socket Modelling Assistant

Abstract: This paper presents a software module, named tracking plug-in, developed to automatically generate the source code of software interfaces for managing the interaction with low cost hand-tracking devices (e.g., Leap Motion and Intel Gesture Camera) and replicate/emulate manual operations usually performed to design custom-fit products, such medical devices and garments. The proposed solution is based on the Eclipse platform, a free integrated development environment (IDE), that allow us to manage the automatic code generation in a simple way after having defined the target application using a meta-model language, in our case the UML class diagram. First, we describe the background as well as the main problem, then, the software solution and adopted tools (i.e., Eclipse and Acceleo). Finally, the preliminary tests carried out for two applicative contexts (prosthetic and textile/clothing) are presented.

Abstract: This paper presents a novel method for measuring with great precision the stereoacuity, that is the smallest depth difference that can be detected in binocular vision. The proposed technique is implemented by a software program that runs on a PC with 3D capabilities. The 3D technology is exploited to provide two different images to the two eyes. The measurement is performed by a classical random dot test, but differently to other tests printed on paper or plastic, the images shown to the patient can vary and the disparity between the two images can be set in order to exactly measure the stereoacuity. Moreover, thanks to the exploited 3D technology, the test does not present any monocular clue. These features allow delivering the test also in groups (instead of individuals) like school classes, and to reduce the risk of undetected amlyopia. The system can be easily operated also by not specialized personnel and this may further increase the cost efficiency of the test. We present the experiments carried on with a large set of children of age between five and seven years. We discuss the results and compare our technique with some traditional approaches.

Keywords: 3D | Amblyiopia | Randomdot test | Stereopsis

Abstract: This paper concerns the development of a Natural User Interface (NUI) for lower limb prosthesis design. The proposed solution exploits the Leap Motion device to emulate traditional design tasks manually performed by the prosthetist. We first illustrate why hand-tracking devices can be adopted to design socket of lower limb prosthesis using virtual prototyping tools. Then, we introduce the developed NUI and its features mainly with regards to ergonomics and ease of use. Finally, preliminary tests are illustrated as well as results reached so far.

Keywords: Augmented interaction | Hand-tracking devices | SMA

Abstract: The research work presented in this paper is part of an innovative framework that deals with the design process of lower limb prostheses. The quality of the whole prosthesis depends on the comfort of the socket, which realizes the interface between the patient body and the mechanical parts. We developed a CAD system, named Socket Modelling Assistant that guides the user during the design of the socket, exploiting domain knowledge and design rules. In this work we present a preliminary study that describes the implementation of a software module able to automatically identify the critical areas of the residuum to adequately modify the socket model and reach the optimal shape. Once the critical areas have been identified, the Socket Modelling Assistant can apply proper geometry modifications, in order to create the load and off-load zones for a good pressure distribution over the residual limb.

Keywords: CAD | Lower limb prosthesis | Neural network | Prostheses socket

Abstract: The research paper concerns the development of a new mobile application emulating measurements of stereoacuity using Google Cardboard. Stereoacuity test is based on binocular vision that is the skill of human beings and most animals to recreate depth sense in visual scene. Google Cardboard is a very low cost device permitting to recreate depth sense of images showed on the screen of a smartphone. Proposed solution exploits Google Cardboard to recreate and manage depth sense through our mobile application that has been developed for Android devices. First, we describe the research context as well as the aim of our research project. Then, we introduce the concept of stereopsis and technology used for emulating stereoacuity test. Finally, we portray preliminary tests made so far and achieved results are discussed.

Abstract: This paper presents a novel stereo acuity test that is realized by a software program on a PC with 3D capabilities. The 3D technology is used to provide two separate images to the two eyes. The test is a classical random dot test, but differently to other test printed on paper, the images shown to the patient can vary and there is no monocular clue. These features allow to deliver the test also in groups (instead of individuals) like school classes, and to increase the sensitivity. The system can be easily used also by not specialized personnel and this may further increase the cost efficiency of the test. Experiments carried on with a large set of children of age between five and seven years are presented. The obtained results are discussed through some comparisons between traditional approach and our innovative idea.

Keywords: 3D | Amblyiopia | Randomdot test | Stereopsis

Abstract: This paper refers to the design of prosthetic socket adopting a computer-aided approach. The main goal is to make available a modeling tool, named SMA-Socket Modeling Assistant, which permits to replicate/emulate manual operations usually performed by the prosthetist. Typically, s/he also relies on the sense of touch; therefore the underlying idea has been to develop and experiment haptic devices. The paper presents a haptic mouse at low-cost to make it affordable also by small orthopedic labs. It is essentially a traditional mouse device enhanced with a servomotor and a pressure sensor pad integrated with Arduino board and SMA. The application within SMA is described as well as the haptic interaction with physically-based model of the residual limb. Finally preliminary tests are illustrated. © 2014 Springer International Publishing Switzerland.

Keywords: Arduino | haptic devices | low cost haptic mouse | prosthesis socket modelling

Abstract: Amblyopia (also called lazy eye) is a condition in which the eye and the brain do not work properly together; this condition causes poor vision in the lazy eye. It involves around 4% of the children. We have devised a system for the diagnosis and treatment of amblyopia by using 3D technology. To be successful, the proposed treatment must be enjoyable and suitable for domestic use (for instance by watching TV) and carried out with a constant supervision by the doctors. We present a system in which patients and doctors exchange information about the prescribed activities. © 2014 Springer International Publishing Switzerland.

Abstract: This paper presents a research work on the augmented interaction applied to an innovative platform to design lower limb prosthesis, in particular the prosthetic socket. The underlining idea is to experiment low-cost hand-tracking devices, to manipulate the 3D virtual model of the socket using hands as traditional done by the prosthetist. The goal is to make available a modeling tool, named Socket Modeling Assistant-SMA that permits to replicate/emulate manual operations usually performed by the prosthetist during the traditional development process. Two devices have been considered and compared: the Leap Motion device and the Intel Gestures Camera. To this end a set of gestures has been identified to make more natural the interaction with SMA. Preliminary tests and results reached so are described and discussed.

Abstract: This work is part a new design platform for lower limb prosthesis centered on the patient's digital model and based on the integrated use of virtual prototyping tools. In particular, 3D detailed model of residual limb, that includes not only the external skin but also bones and soft tissues, is needed for socket design and finite element analysis to study the socket-residual limb interaction. In this paper, we present a procedure for 3D automatic reconstruction of the residual starting from MRI images. The output is a 3D geometric model, in a neutral format (IGES), which permits CAD information exchange among the modules composing the design platform. The reconstruction procedure consists of three different phases: image pre-processing, voxel segmentation, 3D models generation. Results have been considered promising and future activities to enhance the algorithm performance have been planned. © 2013 Springer-Verlag.

Keywords: 3D automatic reconstruction | Lower limb prosthesis design | MRI | segmentation

Abstract: We have developed an application based on binocular vision for amblyopia treatment. It is founded on stereo vision of objects with different contrast. Fellow eye occlusion does not allow a binocular vision but only a monocular one. This approach causes brain skills loss like the perception of depth. Our system increases visual acuity for amblyopic patients using binocular vision. Binocular vision shows an object to each eye with different contrast. In fact, if we apply a right contrast ratio between amblyopic eye and lazy eye, then amblyopic patient is able to perceive both. © 2013 IEEE.

Keywords: 3D technologies | Amblyopia | Binocular vision | Contrast-based measurement | Motion coherence threshold

Abstract: This paper concerns a research project that aims at developing an innovative platform to design lower limb prosthesis. The platform is centered on the virtual model of the amputee and is based on a computer-aided and knowledge-guided approach. In particular, the paper focuses on the module, named Socket Modeling Assistant-SMA, conceived to design the socket, the most critical component of the whole prosthesis. The underlining idea is to experiment low-cost devices, such the Leap Motion, to manipulate the 3D virtual model of the socket using hands as traditional done by the prosthetist. The goal is to make available a modeling tool that permits to replicate/emulate manual operations usually performed by the prosthetist during the traditional development process. First, we first describe the traditional socket development process; then the SMA software architecture and the guidelines used to develop the interaction algorithms (integrated within SMA) that exploit the Leap Motion and Falcon devices. Finally preliminary tests and results will be illustrated. © 2013 ACM.

Keywords: 3D modeling | hand tracking | haptic interaction | lower limb prosthesis