ANAMNESIS

If you learn this lesson well,

you can start behaving like
doctors,
you can correctly communicate,
educate,
provide the first essential
guidelines
about health protection
to those around you
What is
anamnesis? • It is the ordered collection of all patient
history data

• The objectives of the anamnesis are making

the diagnosis as accurate as possible, and
establishing a relationship with the patient

• anamnesis requires in-depth clinical

knowledge but also communication skills to
understand what the patient wants to say
• Patients who must be helped to speak: they give
Patient types
brief answers but with patience; all useful and
important information is collected.

• Patients who speak easily are often well-educated

and know how to describe their stories well.

• Patients who talk too much: they must be

managed, otherwise they tell useless details and
omit important things; the doctor must guide them.
History collection

• General data

• Family history

• Personal and physiological history

• History of any previous illnesses

• History of a suspected new disease in

progress
Medical records

• Name, surname, sex, age, religion, gender

• Place of birth: it is important for possible diseases characteristic of a
place
• Place of residence: it is important, for example, for environmental
diseases
• Blood group and Rh factor
• Any pharmacological treatments and supplements the patient is
taking and any vaccinations carried out
Family history
The collection of family data is very useful:
• to find possible heredity for diseases,
• possible specific risk of developing infections,
• possible environmental risk factors,
• tumors,
• or possible complex psychological situations.
• Heredity must be sought for genetic diseases or tumors but
also for all complex multifactorial diseases, such as Type two
Diabetes.
• The health status or possible causes of death of
grandparents, parents, brothers, sisters, sons and daughters
must be investigated.
Personal and physiological history

• Birth: learn about full-term or premature

birthchild, cesarean delivery, or normal delivery;
if possible, it is important to know the weight at
birth.

• Neonatal nutrition: breastfeeding or bottle

feeding; duration of breastfeeding
First acts of childhood life: if possible,

• age of appearance of the first tooth,

• age of the patient when he started to talk and

when he took his first steps;

• growth in weight and height during the

developmental stage, to find out if the
values ​were within the average for children;

• experiences in kindergarten, to find out if

learning or relationship problems occurred
• Puberty: learn about age of onset of male
secondary sexual characteristics (i.e.: change of
voice, distribution of hair, lengthening of the
limbs); as for the females, age of onset of the first
menstrual cycle, cycle frequency and amount of
menstrual flow.
• Pregnancy: ask if the patient has ever become
pregnant; spontaneous or assisted pregnancies;
completed or non-term pregnancies; possible aborted
pregnancies and reasons for it; possible problems
during the pregnancy or at the time of childbirth.

• Menopause: age of onset of menopause and type of

related problems
• Educational qualifications and job: this
information is useful to understand the patient’s
quality of life and possible damages caused by
work activity and work environment, such as
stress, burnout, skeletal problems, skin or vision
problems, and others.
• Marital status: unmarried, married, divorced,
cohabiting, widowed, single. Knowledge of this
condition serves to better understand the lifestyle and
any stress factors.
Motor activity:
• if patient plays or has played sports, what type, for how long;
• if he/she walks, for how many minutes, how often and how fast;
• if he/she carries out the regular motor activity at home or if he
dances, when and for how long;
• if during motor activity there are cardiac arrhythmias or
shortness of breath or muscle cramps
Bowel functionality:

• regular functionality or constipation or tendency to diarrhea and

how often it occurs;

• shape and color of the feces and frequency of evacuations;

• possible occurrence of abdominal swelling related to meals;

• possible pain during defecation

Sleep:
• possible sleep irregularities, hours of sleep
at night on average,
• any difficulty falling asleep or possible restless sleep,
• possible repeated awakenings, possible early awakening,
• possible bruxism phenomena (gritting of teeth)
• involuntary movements of the legs (restless legs syndrome)
• sleepwalking or nightmares or feeling abnormal heartbeats
Digestion:

• normal digestion or feeling of slowed gastric

emptying;

• correct chewing or insufficient chewing related to

dental problems or a bad chewing habit (too fast)
Diuresis:
• frequency of urination on average,
• possible problems such as difficulty holding urine
(impudence)
• or involuntary loss of urine (incontinence)
• or painful emission (stranguria)
• or difficulty passing urine (neurological bladder)
• or prevalence of urination at night (nicturia)
• or need for continuous urination in small quantities
(pollakiuria) or in large quantities (polyuria)
Eating habits:

• mixed diet or vegetarian or vegan or conditioned by

diseases;

• number of daily meals, average amount of food

ingested, meal times, type of foods normally chosen,

• average amount of water intake per day and at what

times
Voluptuous habits:
• exciting drinks such as coffee, tea and/or
ginseng;
• smoke (what kind, for how long, and how
much);
• alcohol type of drink and quantity;
• any drugs
Ludic activities practiced:

• playing music, painting, acting, singing, reading, studying, board

gaming, dancing, telematic gaming, and more. This information is
useful to deeply understand the lifestyle and the psychological
condition
Past pathological history

• From the neonatal age until the moment of the visit

• Possible surgical interventions: when, why, outcomes,
complications
• Possible clinical hospitalizations: when, why, outcomes,
complications
• Previous diagnosed diseases or current diagnosed diseases still in
progress as chronic; these diseases can be relevant in terms of
severity, in relation to: duration, cause, possible disability, treatments
and pharmacological therapies (drugs) performed or in progress (if
chronic diseases)

• Long-existing and previously undiagnosed complaints, symptoms or

signs of disorders or diseases already identified in the past

* "Drug" has the same meaning as "medicine", but it's more informal. It can also mean “an illegal drug”
Proximate pathological history

It represents the reason why the

patient turns to the doctor and it is
very useful to clarify the disturbances
that the patient reports.
• SIGN: it is what you see, which is objectifiable or
measurable (for example, fever or swelling)

• SYMPTOM: what is described (for example pain)

• Symptoms: the patient tends to give his own
interpretation of the disorder he feels, and his
description of symptoms can be misleading to
the doctor. It is often necessary to ask the
patient for several specific questions to be able
to identify the possible cause of the problem.
The doctor must always remember both that the
causes of a problem can be more than one and
that a single problem can manifest itself through
various symptoms
CHEST PAIN: it is a symptom; it can arise from the trachea, bronchi,
lungs, pleura, mediastinum, heart, pericardium, aorta, esophagus,
stomach, ribs, vertebrae, cutaneous nerves of the chest, drugs…

• Pinpoint where exactly it is located

• ask how long it has been felt
• ask if it is worse at night or during the day, or the same
• if it spreads with the movements and where
• if it increases or decreases with movement or assuming certain positions
• if it is dull (like a shot) or like a sting, or like a burn, or like an electric shock
• if it involves respiratory changes
• if it involves changes in heartbeat
• if the patient takes any medications and, if so, which ones
DRY COUGH: it is a reflex that can originate from the nose, pharynx, larynx,
esophagus, trachea, bronchi, lungs, pleura, central nervous system, drugs…

• Ask how long it has been manifesting

• ask if it is more pronounced during the day or at night
• if it changes in intensity whit the posture
• if it is accentuated by breathing through the nose or mouth
• if it comes with pain in the chest
• if there is a burning sensation in the throat and when
• if there are digestive disorders and/or retrosternal discomfort
• if the patient takes any medications and, if so, which ones
• If the patient suffers from any forme of allergy
• if there are any stressful conditions
ABDOMINAL SWELLING: it's a sign; it may depend on carbonated drinks,
mouth (chewing), esophagus, stomach, liver, small intestine, colon, uterus,
abdominal lymphatic and venous vessels, bladder, states of anxiety, drugs…

• Ask how long it has been manifesting

• ask if it is intermittent during the week or the seasons
• if it increases at particular times of the day or with meals or in periods of anxiety
and stress
• if there are chewing problems or chewing habits (chewing gum) or sucking
(cigarettes, sweets) or intake of carbonated drinks
• if there is constipation or diarrhea or stool alteration
• if there are digestive disorders and what kind exactly
• if there are urinary disorders
• if there are problems related to the menstrual cycle
• if the patient has been taking any medications or is currently taking them
FEELING OF AN ABNORMAL HEARTBEAT is a symptom; it may depend on
the thyroid, adrenal glands, heart, aorta, lungs, mediastinum, central
nervous system (anxiety or psychosis), blood system (anemia), drugs…

• Ask how long it has been manifesting

• if it occurs during exertion or at night or after meals or in conjunction with stress
• if it is associated with chest tightness
• if the breath changes
• if there is tremor, insomnia, weight loss
• if there is breathlessness while walking
• if there is a bleeding menstrual cycle (young women)
• If the patient takes any medications
URINARY IMPELLENCE: it is a symptom; it can depend on the kidneys,
bladder, prostate, uterus, ovaries, colon, hormones, testicles, stress,
allergies, drugs…

• Ask how long it has been manifesting

• ask if it is accompanied by fever
• if it changes during the day or night
• if it changes with posture or meals
• ask for quantities of each urination
• ask if the urine emitted has particular characteristics (color, odor, density)
• if it is related to the menstrual cycle (women) or sexual intercourse
• if it is accompanied by testicular or groin disorders
• if there are intestinal disorders
• if it is present in times of stress
• if the menstrual cycle is regular
• if there are allergies, especially food related allergies
• if the patient takes any medications
FEVER: it is a sign, corresponding to a body temperature above 37.5 degrees
Celsius; it can depend on inflammation, infections, hormones, drugs,
heatstroke, tumors…

• Ask how long it has been manifesting

• ask if it changes during the day or night
• if it is associated with heavy sweating
• if it is the result of a respiratory or urinary or cutaneous or intestinal infectious
disease
• if there are skin, teeth, upper and lower respiratory tract, abdomen, and pelvis
disorders
• if there are disturbances such as tremors, insomnia, agitation, tachycardia,
polyuria
• if there is very recent weight loss or weight gain
• if there has been exposure to excessive heat
Example of complete medical history: MARTA

GENERAL DATA

• She is 57 years old

• female sex
• female gender
• she was born and has always lived in Rome
• religious orientation: secular
• AB Rh-group
• she doesn't take any medications
• she was vaccinated against HBV and gets regular flu vaccinations
FAMILY HISTORY

• Father died from NHL at the age of 65, suffering from type two
diabetes and hiatus hernia
• Mother died at the age of 95 from stroke complications, suffering
from arterial hypertension and ischemic heart disease, hiatal hernia,
and colonic diverticula
• Obese brother with hypercholesterolemia, diabetes, arterial
hypertension, COPD
• Maternal grandparents died from a stroke at senile age
• Paternal grandparents deceased from senectus
PERSONAL AND PHYSIOLOGICAL HISTORY

• Second of two brothers

• Born at term from eutopic birth, birth weight 3.2 kilos
• Breastfeeding for six months
• She walked and talked before twelve months old
• Normal psychophysical development from childhood
• She has been practicing swimming, tennis, skiing, gym, intermittently, since
she was a teenager
• Puberty at 11 years old with regular cycles until menopause at 47 years old
• She moved when she was 21 and had a son at 27 who is in good health
• Specialization and master's degree
• She has always been working as a freelancer
• She follows a vegetarian diet and drinks about two and a half liters of water
a day
• She drinks one coffee a day, she is abstemious, she has never smoked
• She has regular digestion, tending to constipation
• She has been getting up once a night to urinate for a few years
• She walks at least 10,000 steps every day and exercises at home every day
• She falls asleep easily but since menopause she has been waking up at
least twice a night, but falls asleep again immediately
• She has always been reading many historical novels and books, she loves to
write and draw, and she studied music and plays music when she has time
REMOTE PATHOLOGICAL HISTORY

• Since birth she has been suffering from food, contact, and inhalation allergies,
with dermatitis, asthma, and intestinal disorders; she had episodes of urticaria
(the first at six years old) and a drug-induced anaphylactic shock at thirty years
old; allergy tests have shown positivity for many substances; since then, she has
been avoiding taking drugs and foods with additives or nickel; by doing so,
dermatitis has improved a lot.
• She had a cesarean section due to the baby weighing more than 4 kg. She had
renal colic at about 40; since then, she has been checking her kidneys, but,
despite diet and plenty of water intake, kidney stones are numerous
REMOTE PATHOLOGICAL HISTORY

• Since she was 20 she has been feeling pain in her shoulders and hands which she
attributes to scooter riding and tennis

• When she was 45 she underwent a gastroscopy for epigastric pain, and a hiatal
hernia was found

• Since the onset of menopause she has been suffering from intermittent joint pain
in the hands, knees, and feet, related to more or less intense physical activity

• After menopause, she underwent an echocardiogram, and a mitral valve prolapse

was diagnosed, which sometimes causes tachycardia and extrasystole
CURRENT PATHOLOGICAL HISTORY

• Marta goes to the doctor because she has pain in her shoulders and cannot
move easily;
• The doctor asks questions and Marta reports that the pain is so bad at night that
she cannot sleep; it gets worse if she tries to move her arms away from the body
or if she tries to lift a small weight;
• then she reports that she also feels a little pain in her back and above all she feels
a little stiff; moreover, she feels discomfort in the soles of her feet when walking.
• The doctor asks if she has noticed anything else in the last few weeks and if she
feels tired or worried too…
• Marta replies that she has been going through a period of severe work stress for
months and that there are health problems in her family that cause her concern;

• she also reports that she noticed that her nails break easily, her skin is very dry
even if she drinks a lot of water and the dermatitis she has suffered from since
she was a child has returned in some parts of her body, especially in the umbilical
scar and behind the ears, with itching and dry and red skin in those areas.

• Marta is allergic to anti-inflammatories; she took some steroids she had at home
to treat the pain, which reduced the pain and also cured the skin…
CONCLUSIONS
• The personal and clinical history of a Person is the basis for formulating a
reliable diagnostic hypothesis, but it must be well structured

• Taking a good history means making a very probable good and early
diagnosis

• Making a correct diagnosis helps to identify the right treatment, without

wasting time and resources

• The medical history is the first step towards the best practice of the
doctor…
Data collection
and Artificial
Intelligence
Digital healthcare, a future that is already present

• Digital health, also called E-HEALTH: this term means "the

use of tools based on information and communication
technologies to support and promote the prevention,
diagnosis, treatment, and monitoring of diseases and the
management of health and lifestyle.”

Digital healthcare was therefore created to support and improve the

relationship and communication between Doctor and Patient and citizens'
accessibility to all available healthcare services.
Digital healthcare does not only mean robotics,
precision surgery, personalized medicine, and
artificial intelligence, but also a revolution in the
logistics of daily interventions with repercussions
on diagnosis, prognosis, and therapy.

The leap into the future is a complex process, made up of algorithms,

artificial intelligence and modern software platforms subjected
to certification of suitability.
Efforts will have to be concentrated on certain technological areas
which will increasingly accompany clinical treatment paths
Remote healthcare activities

• digital systems for telemedicine,

• digital therapies,

• telerehabilitation,

• personalized medicine;

• new methods of analyzing the complexity of biological systems;

• new digital systems for conducting clinical trials.

The digital medical record

• The digitization of medical records is one of the main needs

promoted by technological innovation in both the public and
private health sectors

• A digital medical record provides the doctor with

all the information necessary to accompany the
patient in his treatment path, in a facilitated way.
• It can be built through writing programs (for example Word) or
software, cloud, or installed.
WHY use computerized medical records?

• Digital medical records offer the possibility of accurate anamnesis with

easy and quick consultation, provided that the data collected is accurate and

detailed

• Diagnostic reports, prescriptions, and therapies can be entered,

and data can be exchanged among structures or operators within the health

system, as long as the management software interfaces

• They are used to send prescriptions via web

• By using data search applications, it is possible to carry out epidemiological

and clinical pharmacological research, even on large numbers

• By correctly entering accurate data, prescriptive appropriateness can be

verified and the best practice of the Doctor, or of the operator, can be
guaranteed
Example of computerized medical record
COMPLETE NEWS, RECIPES SENDING, MEF CONNECTION

DRUGS
PROBLEMS

ASSESSMENTS
CLINICAL EVENTS
FOLLOW UP
GUIDELINES
and SCORE
Visualization of main clinical news
Data entry: PROBLEM

anamnesis
objective exame
value
path
Data entry: ASSESSMENTS
Data entry: DRUGS
Are we really sure?

• The initiatives described are certainly very useful, but

they do not eliminate the risk: at the moment, there

is no safe and 100% guaranteed technological

protection solution.
The general perception of data security is still too low.
PCs and systems are little or completely not managed in terms of security and
control of accesses, of the unique identification about who acts and how
he/she acts, and of the

certain reunification of the digital identity with a personal effective identity.

Wireless connections and networks, increasingly widespread due to their cost

and convenience, are the least secure in the world of telecommunications, as
very often they are not configured correctly in terms of information security.
Artificial Intelligence and
human-machine
interaction: approach in
Medicine
Treccani Dictionary: INTELLIGENCE

•Complex of psychic and mental faculties that

allow man to think, understand or explain facts or actions,
develop abstract models of reality, understand and be
understood by others, judge, and at the same time make him
capable of adapting to new situations and modify the
situation itself when it presents obstacles to adaptation;
• characteristic of the human being in which it
develops gradually starting from childhood and in
which it is accompanied by awareness and self-
awareness, it is also recognized, within certain limits
(associative memory, ability to react to internal and
external stimuli, to communicate in even complex
way, etc.), to animals, spec. mammals
Treccani Dictionary: ARTIFICIAL INTELLIGENCE

•It is a COMPUTER DISCIPLINE that studies the theoretical

foundations, methodologies and techniques that allow the design of
hardware systems and software program systems capable of providing the
electronic computer with performances that, to a common observer, would
appear to be the exclusive concern of intelligence.

• Its purpose is not to replicate this intelligence, but to reproduce or

emulate some of its functions.
Intelligent performances are obtained using the machine's

mechanisms, to provide performances that are qualitatively

equivalent and quantitatively superior to human

ones.
Computers are incredibly accurate, fast, and
stupid; humans are extremely inaccurate, slow,
and intelligent.

The two together constitute an incalculable force.

AI and Medicine
Types of artificial intelligence
NARROW ARTIFICIAL INTELLIGENCE (ANI)
• Focuses on a specific task, such as voice or facial recognition. It has no
general capabilities.

• It is weak artificial intelligence, it refers to AIs designed to perform

specific, well-defined tasks. These AIs are “weak” in the sense that they are
limited in their scope of application and do not possess general cognitive
abilities comparable to those of humans.
• Within their specific domain, they can often surpass human performance
in speed, accuracy, and efficiency.
Examples of ANI

• Virtual assistants, such as Apple's Siri or Amazon's Alexa

• Recommendation systems, widely used by streaming platforms such

as Netflix or e-commerce sites such as Amazon. These algorithms
analyze data about user preferences and behaviors to suggest
personalized content or products

• Chatbots like ChatGPT, AI-based conversational systems, can

understand natural language and generate coherent and relevant
responses based on large training datasets.
GENERAL ARTIFICIAL INTELLIGENCE OR ARTIFICIAL GENERAL
INTELLIGENCE (AGI)

• It has human-like cognitive abilities and can learn from different

experiences to perform any intellectual activity, like Sonny, the robot

from I-Robot with Will Smith. Currently, it does not yet exist.

• Defined as STRONG, it refers to AI with cognitive abilities comparable

to those of humans. An AGI would be able to learn, reason and apply
knowledge flexibly across a wide range of fields, just like a human does.
• One of the most promising approaches is to create cognitive
architectures that mimic the structure and functioning of the human
brain, such as artificial neural networks, reinforcement learning and
deep learning systems

• their development also raises important ethical and safety

issues that must be carefully considered.

HIGHER ARTIFICIAL INTELLIGENCE OR ARTIFICIAL SUPER
INTELLIGENCE (ASI)

• It has abilities superior to human intelligence. At the

moment it is only hypothetical.

• Artificial superintelligence refers to AIs that far surpass human
cognitive abilities in all domains. ASIs would be able to learn, reason,
and innovate at an unprecedented pace and scale, solving problems
beyond current human capabilities
• They could accelerate scientific and technological progress
at an unprecedented rate, opening new frontiers in
understanding the universe and our place within it.

• On the other hand, they raise important existential

concerns. If not properly designed and aligned with human
values ​and goals, ASIs could pose a significant threat to
humanity…
AI in Medicine: SWOT

Strenghts Opportunities

Weaknesses Threats
Strengths of AI

• Monitoring of large-scale populations by associating health problems

with the socio-economic-geographical context

• Strengthening of clinical trials

• Diagnostic improvement (particularly radiology)

• Optimization of personalized care (pharmacological treatment and

assistance)

• Application of advanced interventional techniques even remotely

EXAMPLES

• Algorithms in the medical field allow us to interpret enormous

quantities of data and identify possible cause-effect relationships
between the data and the pathologies from which a patient suffers,

as well as to strengthen prediction systems, capable of identifying

possible pathologies even before they occur; artificial intelligence
could, in a short time, also come into use to predict who is at risk of
sudden cardiac arrest (PREVENT algorithm)
AI, which is still young, is already being used in the
radiology value chain, from image reconstruction to
report generation. Eventually, AI will allow radiologists
to perform at the top of their license.
• PIGMENTED SKIN LESIONS: A study published by The Lancet Digital
Health compared the accuracy in diagnosis and therapy
recommendation of two different algorithms in smartphone
applications with that of doctors. The results show that the
application of AI generally achieved good results in diagnosis.
However, doctors were clearly superior when it came to making
treatment decisions.
• CHANCE OF CANCER: The OncoSeek algorithm calculates
the probability of cancer based on blood test results and
general information such as age and gender. The instrument
also indicates in which tissue the disease originates. The
specificity of tumor markers has been increased to over
90% thanks to artificial intelligence. Overall, the algorithm
showed an accuracy of approximately 84%.
Human brain mapped by Google AI
• Thanks to its Large Language Models and the collaboration of a group of
neuroscientists from Harvard University, Google has created a highly
detailed brain map of a part of the brain, which will provide a valuable
study tool for neuroscientists.
• Encoding this dataset required 1.4 petabytes of memory
• The map, accessible to the public, offers an extraordinary insight into the
intricate neural connections within the analyzed sample. It allows us to
observe the complex network of neurons and synapses, with some neurons
measuring just 15 micrometers...
AI opportunities
• Sharing of huge databases, for example for pharmacovigilance
• Facilitation of knowledge, skills and competences of healthcare
professionals (training)
• Telemedicine (Televisit, Telediagnosis, Teleconsultation,
Teleassistance, Telerehabilitation)
• Robotic surgery
• Remote control: e.g. sleep apnea, pacemakers, continuous
monitoring of glucose levels, humanoid robots
EXAMPLES
Robots in the ward and Doctor on video
link…
The most advanced humanoid robots in 2025

• Designed to resemble humans in appearance and behavior, they are

equipped with advanced technologies such as artificial intelligence,
computer vision, and natural language processing, which allow them
to interact effectively with humans and the environment
surrounding.

• They are now able to walk, run, and even climb stairs with amazing
agility and stability.
• With the integration of advanced sensors they can sense the
environment, recognize objects, and make real-time changes
to their movements.

• The ability to manipulate things with dexterity has

improved greatly, allowing them to perform complex tasks
such as picking up objects, pouring liquids, and assembling
components.
• Produced by a subsidiary of Stardust Intelligence
based in Shenzhen, China.
The humanoid S1
• It can perform movements with a maximum
speed of 10 meters per second and handle a
payload of 10kg per arm – enough to pull a
tablecloth from under a stack of wine glasses
without them falling to the floor.
• The bot isn't just fast: it's also incredibly precise:
from opening and pouring wine to delicately
cutting a cucumber, from flipping a sandwich in a
pan to writing a bit of calligraphy, and it's very
good at imitating movements humans…
Tele
rehabilitation
Innovation in rehabilitation…
Virtual/Augmented reality

• Virtual reality (VR) has the potential to meet all rehabilitation

requirements.

• It allows the Patient to interact with the environment and receive

feedback continuously and immediately. VR does not require the use of
complicated hardware or exceptional graphics (in the rehabilitation field)
therefore it is a good candidate for creating an interesting and low-cost
treatment program.
• The great advantage of the spread of devices such as
smartphones and tablets is the possibility of creating a
personalized therapy path to be carried out directly at home
with interactive communication between the patient and the
person who follows him.

• Collaboration between the two is more frequent through

telerehabilitation programs, and leads to a reduction in costs
and travel difficulties
• the BMI approach is not of the "one size fits all" type and
therefore algorithms are needed that adapts to the patient
and continuously evolve depending on the subject's neural
activity; in this way, each therapeutic process will be
different from the other.
Biomedical robots and rehabilitation

• Intelligent machines and interactive environments

can express their full rehabilitation potential by

integrating into innovations that allow the user to be

involved both physically and mentally in tasks aimed

at functional recovery.
• Robotic systems such as exoskeletons can assist
physical rehabilitation procedures adapted to patient
motor and physiological data collected by wearable,
mobile, and environmental sensors even during
activities of daily living.
Robotics for Rehabilitation

• These systems aim to help the patient in rehabilitation procedures so that

the actions performed, however repetitive, are accurate and personalized
based on the data collected about the person.

• In particular, robots for neurorehabilitation are also part of the class of

neurotechnologies, given that they assist exercises that affect the patient's
nervous system to restore its functions interactively, according to the real-
time processing of the motor and physiological data collected, always by
training protocols based on neural principles (such as that of plasticity).
Exoskeletons, wearable robots

• As wearable robots, exoskeletons (and exosuits) are designed

to associate and align their joints with the patient's body (at
the level of the upper or lower limbs as well as the trunk) to
influence posture and movements through the control of
the position and orientation of each joint.
• The systems are designed to also provide feedback on the
patient's health status, monitoring the main physiological
parameters, producing specific reports on the therapeutic
outcome (according to a logic similar to the Digital Health
and Digital Therapeutics approaches) to adapt their
functioning-based on the indications from clinicians (also in
terms of ergonomics and safety).
The advantages of Virtuality for Rehabilitation
• Virtual reality systems (in which the environment experienced by the patient is
entirely modeled by the computer), augmented reality (in which virtual objects
are superimposed on real environments), augmented virtuality (in which views
of real objects are added to a virtual environment) and mixed reality (a term
that originally referred to all cases in which real and virtual objects coexist in the
scene perceived by the user, while current trends add requirements such as the
possibility of interacting with digital elements as if they were physical objects),
are considered cases of extended reality (a term that defines all how real and
virtual can combine and integrate).
• The versatility of these technologies (supported by visualization
systems based on viewers or projectors, as well as on simple screens
in case of non-immersive conditions) in providing multimodal
feedback and scenarios with engaging tasks in rehabilitation contexts
allows for the creation of real high-performance environments.
ecological validity (similarity to real contexts), to give meaning and
depth to the actions that the patient must carry out repeatedly.
Video game scenarios inspired by
everyday life

• The use of exergames (serious games designed to stimulate exercise)

that are inspired by culturally specific activities of the patients'
context is extremely interesting, especially in the case of elderly
people, citing, for example, systems designed to promote the
performance of exercises motor and cardiovascular training inspired
by specific activities
• The interactive rehabilitation environments developed aim at both

cognitive and motor recovery: in fact, it should not be forgotten that

the versatility of virtual/augmented/mixed reality systems is also expressed

in making the person exercise certain cognitive functions (such as

visuospatial attention) thanks to a design informed by the latest

discoveries in psychology and cognitive neuroscience.

Biosensors

• Smart wearable systems have multiple applications designed

following physiognomic and biological criteria, to make them more
usable and at the same time less cumbersome.

• Wearable devices have allowed the development of new operational

methodologies in the healthcare sector, becoming part of the
systems used in telemedicine.
• Designing wearable devices is complex due to the
peculiarities of the human body: physiological and dynamic
aspects must be considered to design devices that are
resistant, flexible, adaptable, washable or even integrable
with clothing.
Wearable medical device

• The use of new flexible polymers, advances in sensors, and the

miniaturization of electronics have allowed the improvement of wearable
devices, diversifying their use in many fields, including healthcare.

• Wearable technology exploits the potential of the IoT world to

revolutionize clinical diagnosis and healthcare methodologies, giving life
to the Internet of Medical Things and making a significant contribution to
emerging telemedicine.
• The introduction of wearable, implantable, and ingestible
biosensors revolutionizes the operational methodologies for
the control and monitoring of biochemical and physical
parameters, for the diagnosis and administration of certain
types of pharmacological treatments.
• Thanks to new wearable devices, it is possible to constantly monitor
a patient's vital parameters, obtaining accurate information in real-
time and therefore improving the diagnostic phases and the methods
of administering care and therapy.

• Thanks to IoMT, it is possible to monitor patients remotely (Remote

Patient Monitoring) and this allows to guarantee greater health
protection to users, reducing the need for hospitalization.
• Smartwatches, smart glasses, fitness trackers, wearables, smart rings,
smart bands, etc. are just a few examples of wearable devices and the
features are just as numerous: web access, video calls, photos, music, AR
applications, and much more, including monitoring vital parameters for
sports or health purposes.

• Among the fundamental components of a wearable device, Sensors are

essential for detecting data relating to physiological parameters, motor
activity, etc. Various types of sensors can be integrated into wearable
devices, including force, pressure, temperature, position sensors, etc.
IoT technology in the medical field is used for:

• Monitoring the patient's health status (a smart bed for example

provides information regarding the patient's position, heart rate,
blood pressure, sleep patterns, etc.)

• Management of patient admissions/discharges/movements;

• Monitoring of occupied/free beds in the facility, optimization of the

operations of the various departments.
• Remote monitoring, or monitoring of a patient's vital
parameters remotely, without the need for hospitalization.
• It is particularly useful in the case of chronic diseases, long-
term pathologies, following surgery or for the constant
monitoring of parameters during the cycle of a new drug
therapy.
IoMT and telemedicine include different types
of useful tools that can be divided:

• Home device: usable at home

• Body device: wearable systems for data collection or infusing

medicines

• Hospital device: including the instruments used in hospital facilities

• Wearable technology allows the acquisition and transmission of
patient health data to other technological components belonging to
the telemonitoring system, including mobile technology, computers,
clinical decision support platforms, etc.

• The data is collected by increasingly sensitive and accurate sensors,

and transmitted quickly (or in real-time) to data analysis software to
direct technical personnel towards the best decisions regarding care
and therapy.
• The healthcare professional can obtain more accurate data, relating
to longer and more constant periods, which allows for a refinement of
clinical understanding and the subsequent choice of the most
suitable therapy without the need for hospitalization, reducing the
use of invasive, bulky, and difficult-to-use machinery.
Wearable medical device, examples

THEY ARE MANY AND CREATED FOR DIFFERENT PURPOSES:

• monitoring of patients with diabetes,

• treatment of diabetic ulcers,

• bioelectronic masks for the detection of airborne respiratory infections

• ingestible sensors such as smart pills,

• wearable robots to facilitate the motor skills of patients with ALS,

• subcutaneous devices, patches and smart tattoos for monitoring parameters and for the

controlled infusion of medicines

• smart headbands to process brain signals and detect
electroencephalograms (EFGs),

• smart theranostic contact lenses (i.e., they integrate therapeutic and

diagnostic purposes), capable of measuring eye pressure and administering
drugs (in the case of glaucoma, but also useful in other contexts),

• airpods to improve hearing,

• smart clothing, heart rate monitors for monitoring the heart and
performance, remote control systems for implantable cardiac devices,

• smart systems in dentistry, etc.

Weaknesses of AI

• AI makes PROBABILISTIC predictions through percentages, NOT

deterministic predictions…

• Collection of sensitive data…

• Technologies implemented too quickly, sometimes without a full

understanding of how they work, and therefore possibly creation of
bubbles of excellence that become bubbles of privilege!

• Technology is a human extension, but…

• Artificial intelligence systems are also characterized by the
ability to manage, process, and exchange knowledge through
mechanisms typical of human intelligence, such as (but not
limited to): inference, deduction, reasoning with
uncertainty, analogical reasoning, generalization,
particularization, generation and evaluation of hypotheses,
learning…
• Artificial intelligence can also be defined as the
science that addresses the problem of how to
represent, manipulate, and construct knowledge
about facts, actions, and laws of causality.
ChatGPT answers
patients' questions...

• The research highlights that ChatGPT messages responded with nuanced and accurate information that often
addressed more aspects of patients' questions than doctors' responses.

• ChatGPT's responses were rated significantly higher quality than those from physicians: good or very good
quality responses were 3.6 times higher for ChatGPT than from physicians (doctors 22.1% vs. ChatGPT 78.5%).

• Responses were also more empathetic: empathetic or very empathetic responses were 9.8 times higher for
ChatGPT than for doctors (doctors 4.6% vs. ChatGPT 45.1%).
WHO: “Artificial intelligence represents great

AI threats promise for health, but also brings serious

challenges, including the collection of unethical data,
cybersecurity threats and amplification of prejudice
or misinformation"

• computer security : TCP Attacks (Man-in-the-Middle). Theft or

tampering of cloud data

• amplification of prejudice or misinformation

• Use of information for illicit healthcare objectives: General Data

Protection Regulation (GDPR). Health Insurance Portability and
Accountability Act (HIPAA)
OBSERVATIONS

• AI is transnational, so it is difficult to regulate it…

• The Guidelines that each State proposes are certainly useful for
sharing a vision intended for regulation at a global level…
• We need AI to address complex, systemic problems that no single
stakeholder, or group of stakeholders, can solve alone. But the
opportunities they present also come with profound risks: social,
political, and economic disruptions that we must carefully manage.

• It is critical to Recognizing that these technologies are at the heart of

global transformation is critical. They have the potential to benefit or
disrupt us all.
The Intelligent Age, then, is not
just about developing
intelligent technologies. It is
also about ensuring that
humanity remains intelligent in
using these tools.
Along with innovation, we
must cultivate wisdom…