Tortious Civil Liability in Environmental Law

Tort liability consists in the obligation of the one who has committed an injury to indemnify the injured party. Tort liability is a legal operation which, according to the Civil Code, when an unlawful act causing damage is committed, the reverse means compensating the injured party. In the case of the environment, the one who harms is not always sanctioned, so in the case of this issue the legislator has developed a rather broad legislative framework. The common law has become applicable in the field of the environment based on the provisions of art. 135 para. (2) lit. e) of the Constitution, which stipulates that , which stipulates that , which stipulates that, the environment is an area that must have a legal protection so that the state maintains a permanent ecological balance. Rehabilitation of the environment is done by applying sanctions to those concerned. So the institution of tort liability is an instrument in the gear of environmental protection.

Electromechanical and Robotic Devices for Gait and Balance Rehabilitation of Children with Neurological Disability: A Systematic Review

In the last two decades, a growing interest has been focused on gait and balance robot-assisted rehabilitation in children with neurological disabilities. Robotic devices allow the implementation of intensive, task-specific training fostering functional recovery and neuroplasticity phenomena. However, limited attention has been paid to the protocols used in this research framework. This systematic review aims to provide an overview of the existing literature on robotic systems for the rehabilitation of gait and balance in children with neurological disabilities and their rehabilitation applications. The literature search was carried out independently and synchronously by three authors on the following databases: MEDLINE, Cochrane Library, PeDro, Institute of Electrical and Electronics Engineers, ScienceDirect, and Google Scholar. The data collected included three subsections referring to clinical, technical, and regulatory aspects. Thirty-one articles out of 81 found on the primary literature search were included in the systematic review. Most studies involved children with cerebral palsy. Only one-third of the studies were randomized controlled trials. Overall, 17 devices (nine end-effector systems and eight exoskeletons) were investigated, among which only 4 (24%) were bore the CE mark. Studies differ on rehabilitation protocols duration, intensity, and outcome measures. Future research should improve both rehabilitation protocols’ and devices’ descriptions.

Efficacy of Virtual Reality and Exergaming in Improving Balance in Patients With Multiple Sclerosis: A Systematic Review and Meta-Analysis

Multiple sclerosis (MS) is one of the most common causes of neurological progressive disease and can lead to loss of mobility, walk impairment, and balance disturbance. Among several rehabilitative approaches proposed, exergaming and virtual reality (VR) have been studied in the recent years. Active video game therapy could reduce the boredom of the rehabilitation process, increasing patient motivation, providing direct feedback, and enabling dual-task training. Aim of this systematic review was to assess the efficacy of exergaming and VR for balance recovery in patients with MS. PubMed, Scopus, and Web of Science were systematically searched from the inception until May 14, 2021 to identify randomized controlled trials (RCTs) presenting: patients with MS as participants, exergaming and VR as intervention, conventional rehabilitation as comparator, and balance assessment [Berg Balance Scale (BBS)] as outcome measure. We also performed a meta-analysis of the mean difference in the BBS via the random-effects method. Out of 93 records, this systematic review included and analyzed 7 RCTs, involving a total of 209 patients affected by MS, of which 97 patients performed exergaming or VR and 112 patients underwent conventional rehabilitation. The meta-analysis reported a significant overall ES of 4.25 (p < 0.0001), showing in the subgroup analysis a non-significant ES of 1.85 (p = 0.39) for the VR and a significant ES of 4.49 (p < 0.0001) for the exergames in terms of the BBS improvement. Taken together, these findings suggested that balance rehabilitation using exergames appears to be more effective than conventional rehabilitation in patients affected by MS.

Development and Validity of a Serious Game (VirtualTer) for Postural Balance Rehabilitation in Older Adults

Background Physiological changes resulting from aging can impair postural balance. Exergames have been used to treat balance disorders, enabling sensory-motor training due to their content, and with targeted goals and purposes beyond entertainment. Aim The aim of this investigation was to describe the development of a serious game, VirtualTer, and to test content validity. Methods A Brazilian group from the Federal University of Rio Grande do Norte developed a serious game called VirtualTer for postural balance rehabilitation in older adults. In game navigation, the avatar needed to save the environment from catching harmful energy that destroys nature. The avatar performs stationary walking, lateral reaching, and climbing up and down steps to capture the energies. Content validity was determined using content matter experts by the Delphi method. Eleven content matter experts played the game and expressed their opinions using the assessment instruments: VirtualTer Dimensions (VD) and System Usability Scale (SUS). Results VirtualTer was designed with regard to variability in practice, since the game was constructed under three levels and offers continuous and terminal feedback. The participants needed to achieve at least 70% of the total score to advance to the next phase. The limits of stability for lateral reach test were right 23.2 ± 4.77 cm and left 22.9 ± 4.86 cm, which was applied in the game. The content validity index of the VD was 0.8, and Cronbach’s alpha coefficient was 0.924. The content matter experts reported the game as having a 67.73 satisfaction with the SUS. Conclusion This game has good usability, low-cost investment, and supports access to innovative and valid technology for rehabilitation in countries with little investment in technology for health.

Architecture of a Spatial Disorientation Platform and Serious Game

In recent years there have been several applications for the study of stabilometric mainly in the analysis of disorder, using mechanical structures of one or two degrees of freedom. An architecture of a stabilometric platform is proposed, which can acquire data through a virtual environment, in this case, a Snowboarding environment, since this sport provides greater balance, increases flexibility and strength in the muscles, and strengthens the lower limbs since it can have a displacement movement in one direction. Thanks to this environment, an architecture is proposed to execute several applications, focused on balance rehabilitation. As a result of this proposal, mathematical models were made by applying the Euler Lagrangian theory, and architecture was obtained that can acquire data in real-time, allowing to visualize this data through a sensor, which shows the position of the person with its respective movement. Also, with the implementation of the Self-Assessment Manikin (SAM) a preliminary study was conducted with 10 people in which 70% presented a discussion of different errors in the design and development stage in the virtual environment, also, 10% of the study population showed greater spatial disorientation to one side of the platform. Thanks to this, it was possible to modify the virtual environment and obtain a more efficient response by implementing this method. As future work, it is proposed to develop variable control systems on the platform and a trajectory variation in the virtual environment.

Downcycling and Upcycling in Rehabilitation and Adaptive Reuse of Pre-Existing Buildings: Re-Designing Technological Performances in an Environmental Perspective

The abandonment of the built heritage, as a result of functional or technological obsolescence or as a consequence of cultural, social, and economic trends, is steadily increasing. This great number of buildings, worldwide spread, offers a huge opportunity to reduce the environmental impacts related to the construction industry. Nonetheless, the recovery and reuse interventions that require the implementation of residual technological performance, to accommodate new uses, are not always environmentally neutral. Therefore, a new design approach needs to be developed so as to improve the buildings’ technological performance and enhance resources and energy already incorporated in buildings. The circular economy principles in the building sector, performance-based building design together with downcycling and upcycling theories are applied to develop a methodology aiming to reduce the environmental impacts within the rehabilitation and refurbishment design process. Starting from the building analysis phase (historical, material, construction) residual performance is evaluated; then the design phase demonstrates that, according to downcycling and upcycling design strategies applied on building components and materials, it is possible improving the building to the required new uses while minimizing transformations and effectively reducing related environmental impacts. The reduction of environmental impacts depends on a careful assessment of the residual technological and structural performance that the building still provides, by involving limited performance implementations to balance rehabilitation needs and environmental protection goals.

Effect of Incorporating Short-Foot Exercises in the Balance Rehabilitation of Flat Foot: A Randomized Controlled Trial

Effective balance rehabilitation is essential to address flat foot (pes planus) which is closely associated with reduced postural stability. Although sensorimotor training (SMT) and short-foot exercise (SFE) have been effective for improving postural stability, the combined effects of SMT with SFE have not been evaluated in previous studies. The aim of this study was to compare the lone versus combined effects of SMT with SFE on postural stability among participants with flat foot. This was a single-blinded, randomized controlled trial. A total of 32 flat-footed participants were included in the study (14 males and 18 females) and assigned to the SMT combined with SFE group and SMT alone group. All participants underwent 18 sessions of the SMT program three times a week for six weeks. Static balance, dynamic balance, and the Hmax/Mmax ratio were compared before and after the interventions. Static and dynamic balance significantly increased in the SMT combined with SFE group compared with the SMT alone group. However, the Hmax/Mmax ratio was not significantly different between the two groups. Therefore, this study confirms that the combination of SMT and SFE is superior to SMT alone to improve postural balance control in flat-footed patients in clinical settings.

Progressive resistance power training for gait and balance rehabilitation in multiple sclerosis: a pilot single-arm study.

Aims: The aim of the study was to evaluate the effectiveness of 4-weeks inpatient power training protocol on parameters of gait and balance in pwMS. Materials and methods. 26 subjects aged 18 65 years and Expanded Disability Status Scale (EDSS) score 2.0 to 6.5 Receiving standard rehabilitation with PRT was applied for 30 minutes, 5 days a week for 4 weeks in addition to other rehabilitation methods. The primary endpoint was the time of 6-minute walking test (6MWT) at week 4 (W4) compared to week 1 (W1). Secondary outcomes included the time in Timed 25-foot walking test (T25FW), Timed Up-n-Go test (TUG), 5 times sit-to-stand test (5TSST), Expanded disability status scale score (EDSS), muscle strength. Results. After the 4-week course of rehabilitation a significant improvement was reached in all tests. The most prominent was the improvement in the 6MWT with 20/25 (80%) patients showing the increase in the distance walked above the minimal clinically important difference (MCID). Changes in other tests were less manifest: 3/25 (12%) of patients improved above MCID in both TUG and 5TSST, 6/25 (24%) patients - in T25FW. After a 4-week course of rehabilitation, a significant improvement was acquired in the 6MWT. Changes in other tests were significantly less manifest. Muscle in hip flexors improved significantly on the left side (mean (SD) at W1 - 3,96 (0,67) vs W4 - 4,72 (0,46), p=0,04)) and showed the trend to significance of the right side: W1 - 3,68 (0,8); W4 - 4,52 (0,65), p=0,08. Conclusions: The most significant effect was achieved in the primary outcome that was the distance walked in 6MWT. Less disabled patients can show better improvement in further studies, as was defined by T25FW test. Regular exercise can improve daily activity using a program that patients can easily do at home on their own.

Balance Measurement Using Microsoft Kinect v2: Towards Remote Evaluation of Patient with the Functional Reach Test

To prevent falls, it is important to measure periodically the balance ability of an individual using reliable clinical tests. As Red Green Blue Depth (RGBD) devices have been increasingly used for balance rehabilitation at home, they may also be used to assess objectively the balance ability and determine the effectiveness of a therapy. For this, we developed a system based on the Microsoft Kinect v2 for measuring the Functional Reach Test (FRT); one of the most used balance clinical tools to predict falls. Two experiments were conducted to compare the FRT measures computed by our system using the Microsoft Kinect v2 with those obtained by the standard method, i.e., manually. In terms of validity, we found a very strong correlation between the two methods (r = 0.97 and r = 0.99 (p < 0.05), for experiments 1 and 2, respectively). However, we needed to correct the measurements using a linear model to fit the data obtained by the Kinect system. Consequently, a linear regression model has been applied and examining the regression assumptions showed that the model works well for the data. Applying the paired t-test to the data after correction indicated that there is no statistically significant difference between the measurements obtained by both methods. As for the reliability of the test, we obtained good to excellent within repeatability of the FRT measurements tracked by Kinect (ICC = 0.86 and ICC = 0.99, for experiments 1 and 2, respectively). These results suggested that the Microsoft Kinect v2 device is reliable and adequate to calculate the standard FRT.