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The progressive aging of the population in developed countries is becoming a problem for healthcare systems, which must invest ever higher sums in caring for their older citizens. One of the most important issues in this area involves the physical and cognitive problems associated with growing old. In order to reduce the effect of these problems, gerontechnology has emerged as one of the most promising alternatives, especially in the field of the telerehabilitation systems developed to date. However, most of these systems do not offer therapists the facilities to design therapies adapted to individual patients. This paper proposes a novel system that supplies this need and enables therapists to create bespoke motor therapies as state diagrams and manage them efficiently in a collaborative setting. The proposed system is equipped with a fuzzy-based decision-making component that therapists can use to control transitioning between states according to variables such as fatigue and performance. Therefore, the system makes it feasible to provide older patients with the treatment they need in their own homes while its effectiveness is controlled by a Fuzzy Inference System.

Software evolution is an increasingly challenging and compelling concern for every developed software system because of the changes in the requirements, the technology, etc. When software evolution is carried out, software architecture emerges as one of the cornerstones that should be considered from two different points of view: as an artifact for the evolution, as it helps the architect plan and restructure the system, and as an artifact of the evolution, because it has to be modified as well. This paper focuses on the second point of view-that is, on the evolution of the software architecture, but taking into account architectural knowledge as a key driver of the process. Given that architecture rationale and design intent are critical in evolving software systems, it is imperative that they be captured in some useful form to aid that evolution process. We present a new approach for evolution styles that extends them by considering in their description the architectural knowledge as a valuable asset of the evolution process.

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Spasticity can be a very disabling problem in some amyotrophic lateral sclerosis (ALS) phenotypes, such as upper motor neuron-dominant ALS (UMN-D ALS) and primary lateral sclerosis (PLS). Our aim is to describe the safety and efficacy of botulinum toxin A (BoTox-A) for improving gait in those ALS phenotypes. UMN-D ALS and PLS outpatients experiencing gait disturbances, secondary to moderate-to-severe spasticity despite optimized oral medication, were offered BoTox-A treatment. Stretching exercises were indicated to complement BoTox-A effect, and ankle-foot orthotics were prescribed when appropriate. Tolerance (muscle strength, disease progression rate) and efficacy (10-m walk test) were measured at baseline and after treatment. Eight out of 122 ALS outpatients were offered BoTox-A treatment. One declined and the other seven were administered BoTox-A in the lower limbs, every 5-8 months. All of them experienced improvement in the clinical outcome and all but one referred subjective improvement. Moreover, after a median follow-up of 16 months and three injections, BoTox-A effect was maintained with no adverse events. This study provides class IV evidence that BoTox-A is safe , and could be beneficial in the short term and long term in a subset of ALS patients with moderate-to-severe spasticity.