The TRAMA Project
Manuela Galli
1,2
, Veronica Cimolin
1
, Chiara Rigoldi
1
and Marcello Crivellini
1
1
Department of Electronics, Information and Bioengineering, Politecnico di Milano,
P.zza Leonardo Da Vinci 32, 20133 Milano, Italy
2
IRCCS ”San Raffaele Pisana”, Tosinvest Sanit´a, via della Pisana, Rome, Italy
{manuela.galli, veronica.cimolin, chiara.rigoldi,
Abstract. The Project TRAMA Network was born with the aim of training re-
searchers in the field of quantitative analysis of movement creating a Network
among all the Institutions involved in the Project. The aims of the Project were:
a) Training about the use of the equipment usually present in a Motion Analysis
Lab, about the use of new experimental set-ups for movement analysis and about
the development of new methodologies; b) Training via web and in practical ses-
sion in the Labs, about the evaluation of the data acquired in motion analysis
Labs and their clinical meaning; c) Network realization for a continue teaching
assistance within different Institutions involved in the Project. TRAMA Project
was one of the project of Programme αLFA (America Latina - Formacion Aca-
demica), a programme of co-operation between higher education institution of
the European Union and Latin America.
1 Introduction
Motion Analysis (MA), or computerized multifactorial and integrated analysis of hu-
man movement, is a rapidly expanding field of considerable interest from a clinical
perspective: the study of postural and motor changes in patients with movement dis-
orders can yield, in fact, crucial information in establishing the degree of functional
limitation, associated to a specific pathology, in identifying the rehabilitative program
specific for a particular patient, and in following its evolution over time. Furthermore,
posture and motion assessment can provide elements important for the evaluation of the
effectiveness of rehabilitative programs aimed at reducing the functional limitation due
to pathology.
In clinical settings, the movement evaluation is generally conducted using video
recording; however,this method has some limits, as it is only able to supply a qualitative
description of the movement. This approachis sufficient to evidence gross abnormalities
in movement;however, as functional limitation and movementcomplexity increase with
organic pathology, objective analysis becomes necessary. The availability of MA with
innovative techniques and advanced equipment for the description, quantification and
evaluation of motion achieves precisely this objective.
MA is in fact able to supply clinicians with quantitative, non-invasive,three-dimensi
-onal information relating both to kinematic and kinetic aspects of motion and to the
pattern of muscle activation during movement. Thanks to these features, MA has a great
Cimolin V., Crivellini M., Galli M. and Rigoldi C.
The TRAMA Project.
DOI: 10.5220/0006156900970112
In European Project Space on Computational Intelligence, Knowledge Discovery and Systems Engineering for Health and Sports (EPS Rome 2014), pages 97-112
ISBN: 978-989-758-154-0
Copyright
c
 2014 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
97

role in clinical applications: in fact, the quantitativeassessment of a patient’s movement
provides crucial informationof functional limitation related to the pathology.It provides
elements useful for the identification of rehabilitative and rehabilitative programs and
for the evaluation and monitoring of their effects over time, too.
The great importance of MA in clinical centres is demonstrated by the increasing
number of Motion Analysis Labs (MALs), placed in clinical settings; in recent years,
a large number of clinical centres, especially those involved in rehabilitation, have set
up MALs and carried out motion evaluations in different pathological situations, both
in Europe (EU) and in Latin America (LA).
Even though MA is a powerful tool in a clinical environment, its use requires the
clinicians and the operators working in a MAL to solve from a practical point of view a
lot of obstacles, which sometime limit the routine use of this methodology.Standardized
experimental sets-up, data representation and common data evaluation are more and
more required.
For this reason, a shared operational methodology is necessary to allow the MA to
spread throughout clinical centres and to overcome the existing difficulties related to
the use of different instruments and work practices. Furthermore, key managerial and
organizational skills are required to assure sustainability of MALs service role to clin-
ical centres. Competencies needed to manage and operate them effectively require the
establishment of devoted training programs.
In this panorama, our idea has been the realization of an international network aimed
to:
1. the training of specialized personnel able to operate in MALs
2. the exchange of data and methodologies to establish standardized working prac-
tices.
From this idea the TRAMA (TRAining in Motion Analysis) Project has been thought.
TRAMA Project was an international project, approved and financed by the European
Community in the field of Programme Alpha (a programme of co-operation between
higher education institutions of the European Union and Latin America; http://ec.e
uropa.eu/europeaid/where/latin-america/regional-cooperation/alfa
/index en.htm), lasting three years (from 2007 to 2010).
2 Participants
The Coordinator of the project has been the Bioengineering Department (now Depart-
ment of Electronics, Information and Bioengineering) of Politecnico di Milano (Italy)
(Fig. 1) and partners from EU (Italy, Sweden and Belgium) and from LA (Chile, Colom-
bia and Mexico) have been involved, both Higher Educational Centers (Full Partners)
and Clinical Centers (Associate Partners) (Fig. 2).
This international network has worked during these three years in order to train re-
searchers about the use of the equipment of MALs, the clinical use of MA data, the
use of new experimental technologies for movement analysis and their transferability
in clinical field and development of new methodologies. In particular, the Full Partners
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Fig.1. Politecnico di Milano.
Fig.2. Partners of the TRAMA project. In grey the Full Partners and in white the Associate
Partners are highlighted.
with valuable experiencesin MA have shared protocols and practices with the Associate
Partners already utilizing MALs. On the other hand, Associate Partners used the pro-
tocols and the learned concept in their daily clinical practice, improving their clinical
services.
The partner involved in the Project are described following, country by country.
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2.1 Italy
POLITECNICO DI MILANO
The Politecnico di Milano was established in 1863 by a group of scholars and en-
trepreneurs belonging to prominent Milanese families. Its most eminent professors over
the years have included the mathematician Francesco Brioschi (its first Director), Luigi
Cremona, and Giulio Natta (Nobel Prize in Chemistry in 1963). The Politecnico di Mi-
lano is now ranked as one of the most outstanding European universities in Engineering,
Architecture and Industrial Design, and in many disciplines is regarded as a leading re-
search institution worldwide. In Italy, the term ”Politecnico” means a state university
consisting only of study programmes in Engineering and Architecture. The Politecnico
di Milano is nowadays organized in 12 departments and a network of 6 Schools of
Engineering, Architecture and Industrial Design spread over 7 campuses over the Lom-
bardy region with a central administration and management. The 6 schools are devoted
to education whereas the 12 departments are devoted to research.
The number of students enrolled in all campuses is approximately 40.000, which
makes the Politecnico di Milano the largest institution in Italy for Engineering, Archi-
tecture and Industrial Design.
Inside the Politecnico di Milano, the Department of Electronics, Information and
Bioengineering is present. The mission of Bioengineering section (ex Bioengineering
Department) is to progress the knowledge of biomedical engineering through the mul-
tidisciplinary research, starting from the molecular and cellular level up to the complex
living organism, aiming at the design, realization and optimization of devices, equip-
ment and systems in the studying of different physiological and clinical aspects for
diagnosis, therapy and rehabilitation. Theoretical and practical contributions are also in-
tended to be dedicated towards the structures and services involved in the management
of health and environment. Further, it constitutes the coordination of the intellectual and
material resources of Polytechnic University in Milano for developing and providing
didactical and training activity at the level of Bachelor (3 year track), Master Degree
(overall 5 year track), Master Courses (generally 1 year track), PhD Courses (3 year
post-graduate course) and continuous training activity to students and professionals in
biomedical engineering, in other areas of engineering studies, in biology, medicine and
living sciences. Finally, the section fulfils the task of making available proper methods,
tools and knowledge to hospitals and private and public health organizations, both at
a national and international level, in technical supporting systems, advisory, consult-
ing, research and development as well as transfer of innovative products, systems and
technologies.
IRCCS ”SAN RAFFAELE PISANA”, TOSINVEST SANIT
´
A, ROMA
IRCCS ”San Raffaele Pisana” belongs to a select and distinguished circle of Institutes
(Tosinvest Sanit´a) which are highly specialized and represent a reference point at the
national level, capable of providing treatment to patients suffering from any type of
disabilities.
Thanks to the intense and distinguished clinical and research work it is carried out
for years in the area of the rehabilitation, it has been recognized by the Health Ministry
as a Scientific Institute for Research, Hospitalization and health Care (IRCCS).
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In a building surrounded by greenery and provided with 298 beds for inpatients as well
as outpatients, the following working units operate:
– cardiologic rehabilitation
– neuro-motor rehabilitation
– otolaryngologicalrehabilitation (for hearing, balance, voice, speech and deglutition
disorders)
– paediatric rehabilitation - Centre for Child Development
– respiratory rehabilitation
– internal medicine
The clinical and research activities are supported by the presence of the following lab-
oratories and services:
– Neuro-physiopathology laboratory
– Gait Analysis laboratory
– Cardiac functionality laboratory
– Audiology, vestibology, speech therapy and deglutition laboratory
– Respiratory functionality laboratory
– Clinical pathology lab oratory
– Hydrokinesitherapy service
– Occupational therapy service
– Functional educational service
– Diagnostic imaging service
The IRCCS ”San Raffaele Pisana” carries out intense and distinguished research
work in the area of rehabilitation and, more in general, of Neuroscience. For this rea-
son, it has equipped itself with a modern Research centre with clinical and basic re-
search laboratories which avail themselves of the most recent technologies and of the
collaboration of numerous Italian as well as foreign researchers.
In particular,the Child Adult Aging DevelopmentCentre turns to children, teenagers
and adults with cognitive retard, motor coordination problems and behaviour-learning
difficulties. These symptoms could be caused by different inborn factors (i.e. genetic
syndrome) or acquired factors that act in pre, peri or post-natal age: patients are fol-
lowed in a longitudinal prospective, from childhood to adulthood during aging.
The Child Adult Aging Development Centre has a multidisciplinary staff dedicated
to the evaluation and spotting of a diagnosis and to the elaboration of a multilevel re-
habilitation program that involves therapists, psychologists, social assistants and care-
givers.
Inside this aim, Gait Analysis lab plays a fundamental role giving an important help
in decision-making process in term of quantitative movement analysis that, together
with biomechanical data, studies neuro-physiological parameters during movement.
2.2 Sweden
THE KAROLINSKA INSTITUTET, STOCKHOLM
Karolinska Institutet (KI) is a leading medical University, dedicated to improve peo-
ple’s health through research and higher education. It developed from a school of army
surgeons in 1810 to a medical university, celebrating 200 years anniversary 2010.
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KIs mission statement is ”to be Europe’s leading medical university and the Nordic
region’s foremost innovation centre in the life sciences, and as such, it comprises an
important driving force for the development of the country and the Stockholm region”.
According to an international ranking in December 2009, KI is the 30iest best university
in the world.
Karolinska Institutet has two main campuses, one in Solna and one in Huddinge.
A considerable amount of teaching and research is also carried out on other sites in
Stockholm in collaboration with the Stockholm County Council and the health care
sector. This includes primary health care facilities and the main hospitals: Karolin-
ska University Hospital in Solna and Huddinge, Danderyd Hospital, S¨oder Hospital, St
G¨oran’s Hospital and St Erik’s Eye Hospital. Some courses are also run in cooperation
with Stockholm University, The Royal Institute of Technology (KTH) and S¨odert¨orn
University College. Karolinska Institutet has two Science Parks, one at Campus Solna
and one at Campus Huddinge in Flemingsberg.
In keeping with Alfred Nobel’s testament, the Nobel Assemble at Karolinska Insti-
tutet selects the winner of the Nobel Prize in Physiology or Medicine. Actually, five of
eight Swedish Nobel Prize Laureates in Physiology or Medicine are from Karolinska
Institutet.
Research and education bridging from molecule to patient is carried out in 22 de-
partments with 9 research fields such as Cancer, Circulation and respiration, Infection,
Inflammation and immunology, Neuroscience, Public and international health, Repro-
duction, growth and development, and Tissue and motion. In 2008 researchers at KI
published 3.000 original articles and 1.000 other publications. External research fund-
ing accounts for 80 % of Karolinska Institutet’s total income. There are 3.600 employ-
ees and 600 research groups with 1.500 researchers/university teachers. About 2.100
PhD students are enrolled at the different departments and 5.300 students are enrolled
in higher education at KI stretching from undergraduate programs (Bachelor level), Ad-
vanced programs (Master level), Specialist nursing programs, Single-subject courses
and contract education. Karolinska Institutet has developed an integrated infrastructure
for health care, education, research and development with the Stockholm County with
the goal of increasing the caregivers’ competence and reducing the time from experi-
mental discovery to clinical application.
The University library is the largest medical library in the Nordic countries and has
premises in Huddinge and Solna. The mission of the university library is to support
scientific communication, support the learning process, manage scientific information
resources, and provide a forum for study, dialogue and networking. The library is visited
by an average of 3.000 people a day and provides access to over 10.000 journals and
periodicals, about 100 databases and a large number of e-books.
2.3 Belgium
THE UNIVESIT
´
E LIBRE DE BRUXELLES (ULB)
The city of Brussels is the capital of a federal state which has three different admin-
istrative regions based on language and has been at the heart of Europe since 1957. It
naturally follows that the city should have a university in keeping with its standing and
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the ULB, with its 21.000 students, 29 % of whom come from abroad, and its very cos-
mopolitan body of staff, is an intrinsically international institution open to both Europe
and to the whole world.
It was at the heart of the creation of a network of major universities from different
European capitals - UNICA - and is involved in international programs for research and
development and for mobility. ULB is a multicultural institution, which has 8 faculties
and a range of schools and institutes and is, at the same time, a comprehensive uni-
versity providing academic tuition in all disciplines and study cycles. With its 3 Nobel
Prize winners, a Fields medal, three Wolf Prize, two Marie Curie Prizes and 29 % of the
Francqui prizes awarded, the university is also a major research centre which is recog-
nized by the academic community the world over. Nor does it shirk its social, societal
and scientific commitments, which it meets through combining broad access to higher
education with excellent quality research and through its role in furthering economic
development in the regions where it is located (Brussels and Wallonia). ULB also has
a teaching hospital - Hˆopital Erasme, a specialist institute for studying cancer - Institut
Bordet, and an extensive hospital network.
For about a decade now the university has been actively involved in maximizing re-
search potential in both Brussels and Charleroi, where it has set up a biotechnologypark
around its renowned Institute for Biology and Molecular Medicine (IBMM) & Institute
of Medical Immunology (IMI) In terms of partnerships, it is part of the Alliance for
Higher Education and Research, together with the Mons University and, in conjunction
with 5 Hautes ´ecoles, the Royal military school, 2 institutes for architectural studies
and 2 colleges for fine arts, it also makes up the Brussels partners of the Alliance. As a
private university, which is recognized and subsidized by the Belgian authorities, ULB
receives government funding today to the tune of 58 % of its overall budget. Founded
on the principle of freethinking analysis that advocates independent reasoning and the
rejection of dogma in all its forms, ULB has remained true to its original ideals - an
institution free from any form of control which is committed to defending democratic
humanist values, an approach it also extends to the way that it is run.
HOSPITAL UNIVERSITAIRE DES ENFANTS REINE FABIOLA (HUDERF),
BRUXELLES
Inaugurated in 1986, the HUDERF is the only Belgian university hospital entirely re-
served for children’s medicine: all is conceived for them and for their parents. From
birth to adolescence, the children receive there the most complete care in respect of the
charter of hospitalized child’s rights. As a medico-surgical hospital of 168 beds, the
HUDERF accommodates more than 11.000 children per annum in hospitalization. The
ambulatory sector (consultations and emergencies) is one of most important in Belgium
and receives more than 100.000 patients per annum. HUDERF is also a public hospital
(Brussels network IRIS) guaranteeing quality care and modern medicine accessible to
all children. HUDERF is a reference centre for children with cerebral palsy. This centre
is called ”CIRICU”. The goal of CIRICU is to optimize the follow-up of the children
with cerebral palsy by elaborating an individualized treatment plan. It is necessary to
have a good communication between the centre, the patient, his family and all the ther-
apists in charge of the child. The intervention of CIRICU is organized in this way:
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– Elaboration of a multi-disciplinary assessment, which is the base for the treatment
plan;
– Regular evaluations and upgrade of this treatment plan;
– Occasional advises in the field of communication, adaptations ...
2.4 Chile
UNIVERSIDAD DE CHILE, SANTIAGO DE CHILE
The University of Chile with more than three centuries of history is a Public University
founded in 1842 as a continuation of the Universidad Real de San Felipe (1738). Its
first Rector, Don Andr´es Bello, Chilean-Venezuelan humanist, knew how to give a seal
guarantor of classical culture, humanist and secular. The history of the University of
Chile is parallel to the country’s history. It has become progressively until our days, in
one of the main and largest Universities in the country. In their classrooms have been
formed most of Chilean Presidents, their National Awards and two Nobel Prizes we
have had in our country.
Originally had five Faculties; currently has fourteen Faculties, four Institutes and a
Clinical Hospital, covering all the areas of knowledge.
Its nearly 30.000 students are divided into Pregraduate, Magister and Doctor De-
grees.
Ranks in first or second place in virtually all national and international rankings,
according to the parameters used. It has the largest number of accredited doctoral pro-
grams in the country, in all disciplinary areas, currently training more than 900 doctors
in 30 accredited programs.
It is the first University in research in our country, representing 37 % of the ISI
index of the country and 40 % of research competitive funds.
Faculty of Medicine:
The Faculty of Medicine creation goes back to the opening of
the University of Chile, being one of the five Faculties that gave origin.
With about 5,200 pre-graduate students, has in our days eight careers in health area:
Medicine, Nursing, Nutrition and Dietetics, Medical Technology, Physical Therapy,
Speech therapy, Obstetrics Nurse and Occupational Therapy.
His extensive postgraduate activity is represented with five accredited doctoral pro-
grams, several Magister and more than 60 programs of Medical Specialties. Currently
are now 1.100 physicians in training, representing 51 % of the country’s medical train-
ing. It has the only specialist-training program in Physical Medicine and Rehabilitation
of the country; since 1964 more than 150 physicians have acquired this specialty. Re-
search is one of the largest institutional missions of the Faculty of Medicine that has the
largest trajectory of research in the country. Currently has multiple work lines, numer-
ous laboratories and a scientific productivity of front line.
Hospital Clinico Universidad de Chile:
Founded in 1952, is the main University
Hospital of the country. This is a highly complex hospital, with over 600 beds, 300
medical journey and 32 postgraduate programs, with 240 residents.
This place gives attention to 400.000 outpatients, 26.000 discharges and more than
23.000 surgeries every year. The University of Chile has no laboratory for motion analy-
sis. For the quantitative evaluation studies the MAL of the Telet´on centre is used, which
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is described in the next paragraph. Since many years, a scientific collaboration is active
between the University of Chile and Telet´on.
INSTITUTODE REHABILITACI
´
ON INFANTIL TELET
´
ON, SANTIAGODE CHILE
The ”Instituto de Rehabilitaci´on Infantil Telet´on Chile (IRI Telet´on Chile)”, is a non-
profit Institution, for the rehabilitation of children and young people up to the age of 20,
with motor disabilities. However, the upper age limit is 24 years for spinal cord injury
patients and other traumatic acute injuries. It was founded in 1947 in Santiago Chile,
and from 1978 it began to grow quickly due to large annual, televised fund raising event
known as TELET
´
ON Campaigns. Now they are ten Institutes around the country and
give medical rehabilitation assistance to around 26.000 (Dec 2008) patients throughout
the country, with approximately 3.500 new patients each year and the 52 % of patients
before 3 years old.
The most frequent diagnoses are Cerebral Palsy (9575 patients), Neuromuscular
Diseases, Congenital Spinal Cord Injuries (Mielomeningocele) and Amputees. The
socio-economic situation of our patients is 80 % low income families, 63 % are liv-
ing in conditions of extreme poverty. During the last year (2008) gave 122.565 medical
consultations and 961.339 therapeutic attentions.
The Mission is the ComprehensiveRehabilitation of children and youngpeople with
invalidating diseases. Our strong emphasis is on their independence and autonomy in
order to improve their integration into the family, school, social and work environment:
”To Rehabilitate in order to Insert into the Community”.
The Future Vision is to be the leader in Chile in Comprehensive Rehabilitation. The
strategic objectives are:
– Quality service
– Effective model of rehabilitation
– Modern and efficient administration
– To be an agent of change within the community
– Qualified human resources; continuous improvementspolicy performance manage-
ment
– To maintain community support through the Telet´on.
The main activity is the comprehensive rehabilitation, but work too, in academicals
activities at pre graduate and post graduate levels, clinical researches and community
activities. The therapeutic model is a Bio Psycho Social Model, with the followings
programs:
– Medical Programs: Diagnosis and Treatments
– Psycho-Social Education Programs
– High Motivation Programs Arts and Sports
The aims are to achieve the maximum development of functional, physical, psycho-
logical, emotional and social abilities, independence, autonomy, and familial and social
integration of our patients and, to establish support networks within the community.
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2.5 Colombia
COLEGIO MAYOR DE NUESTRA SE
˜
NORA DEL ROSARIO, BOGOT
´
A
The Universidad del Rosario is an autonomous, private, secular, non-profit institution
founded in 1653, accredited for its high quality and evaluated in 2006 for European
University Association. Since then it has fulfilled the mission of forming individuals
with a strong sense of responsibility in the benefit of society and has established five
fundamental purposes: the integral, ethical and humanistic education; the academic re-
quirements and academic quality; the investigation, the consolidation of the educative
community; and the social responsibility.
The organizational framework of the university consists of the Board of Trustees
(rector, vice-rector, counsellors, trustees, and the secretary general), Academic Board
(deans of respective schools) and the Executive Board (Chancellery). The Board of
Trustees and the Academic Board are responsible, with a participative model, for short,
medium and long term planning; the ExecutiveBoard is in chargeof applying the strate-
gies and programs defined by said planning. The University has a staff close to 1.500
people and is financed mainly (73%) by student tuitions.
The University has seven Schools: Jurisprudence; Medicine and Health Sciences
School; Natural Sciences, Economy; Political Science, Government and Foreign Af-
fairs; Business; and Human Sciences. Each School is in charge of undergrad programs
(22 in total), graduate programs (97 in total) and house research centers for 24 different
workgroups.
In the present Integral Development Plan 2004-2015, the vision expresses three
emphases: growth, which refers to the qualitative and quantitative development of the
University; identity; strengthening the differentiating characteristics of the institution;
and quality, understood on the basis of global, national and institutional referents and
elaborated under the principle of university autonomy with social responsibility.
Since the middle of the XX century, the University has concentrated its activities
in the social, human and health sciences. The present PID foresees the fact that the
university should give priority to, strengthen and consolidate the existing facts, and,
at the same time, opens up new action fronts in natural and exact sciences. For the
beginning, these will help impelling the current programs, and in the next future, it will
constitute options to broaden the offer of academic programs. This qualitative growth
will lead to a more comprehensive realization of the ”being of the University”.
Concerning the investigation areas that the University emphasizes, each School
works in the definition and consolidation of the priority and strategic areas of their
own investigation groups and lines. Seen under a wider perspective, the most salient
developments in investigation are found in jurisprudence, medicine and economy.
The Universidad del Rosario’s School of Medicine and Health Sciences, created the
Health Sciences Research Centre to develop, to adapt and transfer new knowledge in
the field of the health sciences with a commitment towards promoting, encompassing
and developing research projects and looking for the resolution of high-priority health
problems fulfilling the most demanding national and international research regulations
regarding research with human beings.
The GiSCYT research group is attached to the Health Sciences Research Centre, the
GiSCYT research group studied the problematic of health in work environments from
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a dual approach: health and work. First, it is necessary to adopt an external perspective
that explains the dynamics of this relation, integrated at the same time the point view
that emerges from the logic of the worker, from the collective and the organization
productive.
We can then consider what health and work results of a co-construction of two
opposing logics: the first which refers to the pursuit of productive efficiency through
the involvement of the workers (the logic of productivity)and the other hand the pursuit
of health in the middle of changes the tasks and activities (the logic of work) which
raises a questions concerning the consequences of this involvement of the worker. It is
therefore necessary to know how the sense of the individual involvement in the pursuit
of productive efficiency (requested) from exposure of every worker to the risks in the
work (defined by each worker).
The GiSCYT research group, have the motion laboratory ”ergomotion” to apply
the motion analyses in work environments. This is a research unit oriented to study
of human movement in productive activity from an ergonomics and biomechanics per-
spective; the laboratory is responsible for producing models and protocols for the study
of human movement in work activities. These models can contribute to development of
theories about the action strategies for manage occupational hazards and also to design
tools for prevention of lesions associated with human movement and demand intensive
joint structures.
INSTITUTO DE ORTOPEDIA INFANTILE ROOSEVELT, BOGOT
´
A
The Institute of Pediatric Orthopaedics Roosevelt is a hospital open to children since
50 years ago; at the beginning it was built to help children with orthopaedic diseases
mainly poliomyelitis, a frequent disease at the middle of the last century. When po-
liomyelitis began to disappear as result of vaccination campaigns, the next in frequency
neurological disease was cerebral palsy. Soon we notice that the knowledge about this
disease and the results was not what we expected; eighteen years ago the study of cere-
bral palsy and of the gait disease produced by this pathology took our team to follow
publications by Dr James Gage, who strongly recommended the use of gait laboratories
to analyse these patients and to have diagnosis and a plan of treatment. The most inter-
ested physician at that time was Dr Camilo Turriago, who started, 20 years ago, to use
gait analysis and multilevel orthopaedic surgery following Dr Gage concepts.
2.6 Mexico
CINVESTAV, ELECTRICAL ENGINEERING DEPARTMENT, BIOELECTRONICS,
MEXICO
The Centre for Research and Advanced Studies of IPN (CINVESTAV) is a public or-
ganism dedicated to promoting, developing and teaching scientific investigation. The
Institution counts 37 Academic Departments, separated in 4 areas of research: Exact
Sciences, Biology and Medicine, Technology and Engineering and Social Sciences &
Humanities.
CINVESTAV is integrated by 9 Centres across the country, offering 53 Academic
programsand more than 500 research topics. All the Academic Programs are considered
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by the Mexican National Council of Science and Technology with high level and twenty
one programs are classified as competent at an International level.
CENTRO DE REHABILITACION INFANTIL TELET
´
ON, MEXICO CITY
The Children’s Rehabilitation Center Telet´on of the State of Mexico (CRIT-EM) pro-
vides care to disabled children carriers of neural-muscle-skeletal diseases. The main
goal of the CRIT-EM is to offer an integral rehabilitation program for the patients of
the centre, promoting their development and integration into the society. To achieve
this goal the medical model of the CRIT-EM is based in the follow premises: preven-
tion, interdisciplinary care and attention in a process, which includes the patient, family,
school and social environments. Within this model, the use of high technology has had
a prominent place as a tool for functional assessment and treatment.
The CRIT-EM is part of system rehabilitation centres of the Fundacion Teleton,
which consists of 13 rehabilitation centres. The centres of Fundacion Teleton are located
in different cities of the Mexican Republic and actually give attention to more of 18.200
children with ages ranging from 0 to 18 years old. Only the CRIT-EM provides services
to 3.500 (19%) children.
CENTRO DE REHABILITACI
´
ON INFANTIL TELET
´
ON OCCIDENTE,
GUADALAJARA
The Centro de Rehabilitacion Infantil Telet´on offers integral management for the reha-
bilitation of children with neuromuscular problems. The attention model is based in the
management by clinical groups, where children with pathologies as: light to moderate
cerebral palsy, severe cerebral palsy, neuromuscular diseases, osteoarticular diseases,
congenital and genetic diseases and spinal cord injury are treated.
It counts with auxiliary studies for Diagnosis in Specialized Radiology, Electroneu-
rophysiology, Urodynamic and Gait Analysis and Human Movement Laboratory.
3 Activities
As concerns the activities of the three years of the project, courses and seminars devoted
to training specialized MA personnel and to share the knowledge about the use of MA
for clinical applications have been conducted. In addition, the mobility of researchers
between European (EU) and Latin American (LA) countries has been promoted.
In particular, the Grant Holders (GH) - i.e. researchers involved in a MAL activity
in a Full or Associate Partner, with an experience in the field of rehabilitation or with
a technical education, like medical doctors, physiotherapists, engineers... - have been
selected, at the beginning of the project, 3 for each LA country, 1 for each EU country.
During the three years, as the interest for the project increased more and more, the
number of the GHs involved in the project rose, mainly in LA, and many people took
part to the actions proposed during the project.
They were mainly involved in the didactical activity, both theoretical and practical.
They were trained not only in the basic technical and clinical competencies needed
for everyday operation of MALs, but also in advanced technical topics, including the
definition and implementation of new protocols. Both EU and LA GHs spent a period
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in LA and EU Labs respectively, to take part in everyday MALs activity, to learn and
share the practical management of experimental session and data interpretation. All the
activities and the meetings are summarized in Table 1.
Table 1. Summary of all the activities of the TRAMA Project year by year.
MEETING PLACE PERIOD
F IRST Y EAR
Start-up meeting Milan 11th May 2007
Basics in Motion Analysis Milan 10th-12th September 2007
Practical session Milan 13th-22nd September 2007
Motion Analysis and clinics Bruxelles 14th-17th January 2007
Motion Analysis Lab set up and
running
Chile 10th-14th March 2008
SECON DY EAR
The role of Motion Analysis in re-
habilitation: decision making and
treatment outcomes evaluation
Rome 21st-23rd May 2008
MALs management and organiza-
tion
Milan 4th-6th June
Practical sessions in EU MALs
May, June, September 2008
(1 month)
Practical sessions in each own
MAL
Own MAL
September 2008-February
2009
T HI RDY EAR
Final practical activity in LA MALs Mexico City,
Bogot´a, Santi-
ago
June 2009
MAL business plan simulation Milan, Mexico
City
September/October 2009
Final meeting Bogot´a 10th-12th March 2010
In particular, the training program of the project had a three-year schedule, compro-
mising of alternating theoretical courses and practical sessions. The first year courses
were focused mainly on training LA GHs in the basic skills of MA in the clinical set-
ting. The aim was to supply the EU and LA GHs with a common background of basic
competencies needed to establish a MAL from a technical point of view and to perform
MA evaluations. At the beginning of the first year a start-up meeting was organized in
May 2007 in Italy with all the partners’ coordinators for in-depth analysis of required
competencies and expertise for GHs selection and to agree on basic course contents.
In the first year of training, there were three theoretical courses. The first two courses
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were held in EU countries (in Italy, September 2007; in Belgium, January 2008) with
two practical staying in EU after each course; the third course was held in LA (Chile).
Table 2. Summary of the theses prepared by Grant Holders during the TRAMA Project.
Name of the Institution Title of the thesis
IT ALY
Politecnico di Milano - IRCCS ”San Raf-
faele Pisana”,Roma
Postural control in children, teenagers
and adults with Down Syndrome.
COLOM BI A − SW EDEN
Universidad Colegio Major de Nuestra
Se˜nora del Rosario, Bogot´a, Colombia
Movement analyses in load lifting
tasks-comparison of two methods for
capturing and analyses of trunk
kinematics.
Karolinska Institutet, Stockholm, Sweden
Instituto de Ortopedia Infantil Roosevelt,
Bogot´a, Colombia
Intertrochanteric extension osteotomy to
treat hip flexion deformity in walking
children with spastic cerebral palsy.
CHI LE
Faculdad de Medicina, Univerisad de Chile,
Santiago
Description of kinematic characteristics
in children with lumbar and lumbosacral
mielomeningocele and calculation of new
indexes for a comprehensive evaluation.
Sociedad pro ayuda del Ni˜no Lisiado Insti-
tuto de rehabilitaci´on infantil Telet´on Santi-
ago
M EX ICO
Centro de Investigacin y de Estudios Avan-
zados del IPN - CINVESTAV, Mexico City
Falling risk in elderly.
Centro de Rehabilitaci´on Infantil
TELET
´
ON CRIT, Mexico City
Kinematic upper limb assessment of
children with hemiparetic CP during a
reaching functional task.
Centro de rehabilitacion infantil Teleton
Occidente, Guadalajara
Analysis of trunk mobility in children
with scoliosis.
The second year was characterized by two theoretical courses in Italy (in Rome,
May 2009; in Milano, June 2009) and by repeated practical sessions both in EU and
LA labs for training in selected MA experimental set-ups and performance. The first
course was aimed to give more detailed information about the use of motion analysis
for clinical application to the LA GH; the second one was aimed to produce trained
staff able to manage each aspect of MAL organization from fund-rising through to
experimental sessions organization. The LA GHs spent their practical staying in Italy
and in Sweden.
The third year was focused on checking the outcomes of previous years teaching
and practical training. In particular, the activities were mainly dedicated to prepare ed-
ucational material to give a scientific and didactical support to the GHs, as well as to
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disseminate the results of the Project, and to prepare the GHs’ theses, which were pre-
sented during the Final Meeting and included in the final hand book of the project. The
GHs were involved in two practical sessions: the first one focused on completing their
training in data collection and interpretation and the second one focused on simulating
business plan to assure sustainability of a MAL. Both of sessions were aimed to the pro-
duction of their personal thesis. The year was closed by a Final Meeting in Colombia
in March 2010 where all the GHs presented their thesis.
During the period spent in their own MALs, all the GHs worked on new protocols
and the results of this activity have been presented in theses (Table 2), collected in a
book [1].
During the Final Meeting the general satisfaction for the three years project has
been investigated by the TRAMA Project satisfaction, a questionnaire asked to be filled
by all the participants (both professors and GHs) at the end of the Final Meeting; the
same questionnaire was sent by e-mail to the TRAMA Project’s participants not present
at the event.
Following the questions were reported (score 1= poor, 2= adequate, 3=good, 4=
excellent):
1. Which is your opinion regarding the TRAMA Project organisation ( staff, travel
booking, residence)?
2. Which is your opinion regarding the contents and the argument of the Project?
3. Were the argumentsof Courses/practical sessions/Seminars adequate for your knowl-
edge level?
4. Will be the contents learned during the Project useful for your activity in your
Institution?
5. Are you generally satisfied of the Project?
6. If in the future there is a new opportunity of an international project on Movement
Analysis, are interesting in being involved and taking part to it?
Following the results of the TRAMA Project satisfaction (Fig. 3)
Fig.3. Results of the TRAMA Project satisfaction questionnaire.
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4 Conclusion
In conclusion, all the planned activities of the three year have been conducted and com-
pleted and a general satisfaction was present, by the Coordinator of the project and by
the Partners.
We think that, thanks to TRAMA project, the knowledge about the use of Motion
analysis and about MAL management is increased producing a more efficient use of
Motion analysis for clinical applications.
In this way, MAL can improve the support service to clinical centers and so patients
will benefit in diagnosis and follow up evaluations.
All the details about the Project program during these three years are summarized
in the website www.biomed.polimi.it/trama/.
Acknowledgement. This document has been produced with the financial assistance
of the European Union. The contents of this document are the sole responsibility of
Bioengineering Department - Politecnico di Milano (ITALY) and can under no circum-
stances be regarded as reflecting the position of the European Union.
References
1. Crivellini, M., Galli, M.: The TRAMA Project. Poliscript, Milano, ISBN:9788864930015
(2010) 1–303
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