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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Neurol.</journal-id>
<journal-title>Frontiers in Neurology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Neurol.</abbrev-journal-title>
<issn pub-type="epub">1664-2295</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fneur.2024.1371430</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Neurology</subject>
<subj-group>
<subject>Editorial</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Editorial: Job integration/reintegration of people with neuromuscular disorders in the epoch of &#x0201C;industry 4.0&#x0201D;</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Ranavolo</surname> <given-names>Alberto</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/585094/overview"/>
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<contrib contrib-type="author">
<name><surname>Ajoudani</surname> <given-names>Arash</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/76170/overview"/>
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</contrib>
<contrib contrib-type="author">
<name><surname>Bonnet</surname> <given-names>Vincent</given-names></name>
<xref ref-type="aff" rid="aff3"><sup>3</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/684104/overview"/>
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<contrib contrib-type="author">
<name><surname>De Nunzio</surname> <given-names>Alessandro Marco</given-names></name>
<xref ref-type="aff" rid="aff4"><sup>4</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/918182/overview"/>
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</contrib>
<contrib contrib-type="author">
<name><surname>Draicchio</surname> <given-names>Francesco</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
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</contrib>
<contrib contrib-type="author">
<name><surname>Sartori</surname> <given-names>Massimo</given-names></name>
<xref ref-type="aff" rid="aff5"><sup>5</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/58825/overview"/>
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<contrib contrib-type="author">
<name><surname>Serrao</surname> <given-names>Mariano</given-names></name>
<xref ref-type="aff" rid="aff6"><sup>6</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/573283/overview"/>
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<aff id="aff1"><sup>1</sup><institution>Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL - National Institute for Insurance Against Accidents at Work</institution>, <addr-line>Rome</addr-line>, <country>Italy</country></aff>
<aff id="aff2"><sup>2</sup><institution>HRI2 Laboratory, Italian Institute of Technology (IIT)</institution>, <addr-line>Genova</addr-line>, <country>Italy</country></aff>
<aff id="aff3"><sup>3</sup><institution>LAAS-CNRS, Universit&#x000E9; Paul Sabatier, CNRS</institution>, <addr-line>Toulouse</addr-line>, <country>France</country></aff>
<aff id="aff4"><sup>4</sup><institution>Research and Development Department, Lunex University</institution>, <addr-line>Differdange</addr-line>, <country>Luxembourg</country></aff>
<aff id="aff5"><sup>5</sup><institution>Department of Biomechanical Engineering, University of Twente</institution>, <addr-line>Enschede</addr-line>, <country>Netherlands</country></aff>
<aff id="aff6"><sup>6</sup><institution>Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome</institution>, <addr-line>Latina</addr-line>, <country>Italy</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited and reviewed by: Giorgio Sandrini, Fondazione Cirna Onlus, Italy</p></fn>
<corresp id="c001">&#x0002A;Correspondence: Alberto Ranavolo <email>a.ranavolo&#x00040;inail.it</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>21</day>
<month>02</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>15</volume>
<elocation-id>1371430</elocation-id>
<history>
<date date-type="received">
<day>16</day>
<month>01</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>26</day>
<month>01</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2024 Ranavolo, Ajoudani, Bonnet, De Nunzio, Draicchio, Sartori and Serrao.</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Ranavolo, Ajoudani, Bonnet, De Nunzio, Draicchio, Sartori and Serrao</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license>
</permissions>
<related-article id="RA1" related-article-type="commentary-article" xlink:href="https://www.frontiersin.org/research-topics/19956/job-integrationreintegration-of-people-with-neuromuscular-disorders-in-the-epoch-of-industry-40" ext-link-type="uri">Editorial on the Research Topic <article-title>Job integration/reintegration of people with neuromuscular disorders in the epoch of &#x0201C;industry 4.0&#x0201D;</article-title></related-article>
<kwd-group>
<kwd>job reintegration</kwd>
<kwd>industry 4.0</kwd>
<kwd>biomechanic analysis</kwd>
<kwd>neurological disorders</kwd>
<kwd>return to work</kwd>
</kwd-group>
<counts>
<fig-count count="0"/>
<table-count count="0"/>
<equation-count count="0"/>
<ref-count count="26"/>
<page-count count="4"/>
<word-count count="2481"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Neurorehabilitation</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="s1">
<title>Introduction</title>
<p>Individuals with neuromuscular disorders may have impairment in a number of motor functions, including reaching, grasping, balancing, and locomotion, during the working years (<xref ref-type="bibr" rid="B1">1</xref>&#x02013;<xref ref-type="bibr" rid="B3">3</xref>). Rehabilitation, medical and surgical treatments, as well as ergonomic interventions, are all necessary to enable these people reintegrate into the workforce. It has been demonstrated that looking for a suitable job and avoiding premature exit from it improves the overall quality of life of these workers (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B4">4</xref>&#x02013;<xref ref-type="bibr" rid="B6">6</xref>). This is because these individuals were able to fully benefit from the positive effects of vocational rehabilitation and overcome barriers to finding, staying, or going back to employment (<xref ref-type="bibr" rid="B7">7</xref>&#x02013;<xref ref-type="bibr" rid="B13">13</xref>). The ability of these people to maintain an effective motor behavior by adopting diverse compensatory strategies throughout the course of the disease, despite a possible illness progression and movement decline, supports this idea (<xref ref-type="bibr" rid="B14">14</xref>).</p>
<p>The European Union (EU) Equality Strategy for the Rights of Persons with Disabilities 2021&#x02013;2030 states that the digital transformation is providing new opportunities to build on-site, and remote services suited to the requirements of people with disabilities using, among the others, artificial intelligence (AI) and human-robot collaboration (HRC) technologies. Therefore, extra ergonomic options afforded by technologies of the fourth industrial revolution should be considered when designing and developing reasonable and efficient job integration/reintegration programs for people with neuromuscular disability. Miniaturized wearable monitoring sensors (WS), feedback devices (FD), exoskeletons and collaborative robots (cobots) can be employed for movement-related elements. MS should be able to continuously decode and classify residual motor function in workers, monitor pre-post job integration programs and optimize HRC technologies controlling (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>). FD should be used for alerting purposes (<xref ref-type="bibr" rid="B17">17</xref>&#x02013;<xref ref-type="bibr" rid="B20">20</xref>). HRC technologies should dynamically adapt to the workplace to aid disabled persons with a wide range of lower and upper limbs and trunk motor functions (<xref ref-type="bibr" rid="B21">21</xref>, <xref ref-type="bibr" rid="B22">22</xref>).</p>
</sec>
<sec id="s2">
<title>Return-to-work rehabilitation</title>
<p>Job integration of people with neuromuscular disorders is represented by any action taken to change or modify the job requirements, motor executions and work environment while taking into account training initiatives and technological advancements, such as HRC technologies, WS, FD, and AI), and the worker&#x00027;s clinical treatment outside the work context.</p>
<p>In this regard, a mini systematic review (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fneur.2021.696276">Agostini et al.</ext-link>) has been published emphasizing the significance of including rehabilitation data when formulating return-to-work approaches. Particular focus should be made on the most practical ways for a better and quicker &#x0201C;restitutio ad integrum&#x0201D; of the worker. Motor imagery is considered a promising rehabilitation technique to reduce fatigue symptoms.</p>
<p>Findings of another study demonstrate that embodied rehabilitation improves body image perception, interoceptive awareness, balance, and quality of life (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fneur.2022.1095180">Paolucci et al.</ext-link>) which also reflects positively on the employment sphere.</p>
<p>To achieve effective job placement, it is essential to explore all therapeutic opportunities, including the proven Chinese massage as a feasible treatment for Peripheral neuropathy (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fneur.2023.1148150">Ge et al.</ext-link>).</p>
</sec>
<sec id="s3">
<title>The European regulatory framework for job accommodation as a reference</title>
<p>In WHO European Region Member States approximately 6 to 10 individuals out of every 100 persons live with a disability. Persons with disabilities are affected by a low employment rate of around 50% and leave labor markets earlier. Article 1 of Council Directive 2000/78/EC of 27 November 2000 has the general provision to lay down a general framework for combating, among the others, discrimination on the grounds of disability. Article 7 states that &#x0201C;the principle of equal treatment shall be without prejudice to the right of Member States to maintain or adopt provisions on the protection of health and safety at work or to measures aimed at creating or maintaining provisions or facilities for safeguarding or promoting their integration into the working environment.&#x0201D; Article 26 of the Charter of Fundamental Rights of the EU states that &#x0201C;the EU recognizes and respects the right of persons with disabilities to benefit from measures designed to ensure their independence, social and occupational integration and participation in the life of the community.&#x0201D; The EU is engaged in improving the social and economic status of persons with disabilities based on the &#x0201C;Treaty on the Functioning of the EU.&#x0201D; The EU are party to the &#x0201C;United Nations Convention on the Rights of Persons with Disabilities (UNCRPD),&#x0201D; a treaty which has guided the contents of the &#x0201C;European disability strategy 2010&#x02013;2020,&#x0201D; a renewed commitment to a barrier-free Europe. In the present decade, quality employment services are essential for all people with disabilities to live a dignified life (Equality Strategy for the Rights of Persons with Disabilities 2021&#x02013;2030).</p>
</sec>
<sec id="s4">
<title>Identifying the most appropriate technologies for movement monitoring and alerting to help people with neuromuscular disorders return to work</title>
<p>To analyze workers residual abilities, workstations, work environments, rehabilitation interventions and work gestures, kinematic, kinetic, and low- and high-density surface electromyographic data need to be collected.</p>
<p>Currently, workers are assessed using wearable, wireless, and miniaturized technology while doing manual material handling tasks (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B23">23</xref>, <xref ref-type="bibr" rid="B24">24</xref>). Bipolar and high-density surface electromyography are used to estimate muscle behavior, insoles and sensorized shoes are used to measure reaction forces (kinetics), and inertial measurement units (IMUs) and 3D depth cameras are utilized for whole-body 3D reconstructions (kinematics) (<xref ref-type="bibr" rid="B15">15</xref>, <xref ref-type="bibr" rid="B16">16</xref>, <xref ref-type="bibr" rid="B23">23</xref>).</p>
<p>These wearables represent an effective way to control worker centered occupational HRC technology. It has also been shown that these sensors can deliver auditory, visual, and haptic-vibrotactile stimuli (<xref ref-type="bibr" rid="B25">25</xref>) representing promising solutions to lower biomechanical effort and injuries related to the workplace.</p>
<p>Industry 4.0 has made innovative HRC technologies more broadly available, and they are successfully supporting people in the workplace in real time. Miniaturized WS are essential in this context for the classification of residual motor functions and optimization of human-robot interfaces.</p>
</sec>
<sec id="s5">
<title>Determining the most relevant indices for motor/muscle performance monitoring</title>
<p>In a systematic review (<ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3389/fneur.2022.968818">Chini et al.</ext-link>) that was published in this article collection, efficient indicators for workers monitoring in the occupational integration/reintegration period has been very thoroughly covered. The authors draw attention to the numerous quantitative physiological and biomechanical indices proposed in the literature. Compared to those produced from kinetic and sEMG measurements, those obtained from kinematic measurements are more commonly used (<xref ref-type="bibr" rid="B15">15</xref>). These indices make it possible to effectively evaluate ergonomic interventions for workplace and work task rehabilitation effectively, enabling accurate motor monitoring in work integration/reintegration programs. Many of these indices also have modest processing costs, making them ideal for real-time HRC technology monitoring applications.</p>
<p>Assessing the new human-robot interfaces (HRI) paradigm to promote re-integration of individuals who have suffered from neuromuscular injuries, such as stroke, muscle-tendon ripping, and musculoskeletal discomfort.</p>
<p>A potential alternative to the traditional assistive system to promote the re-integration of individuals who have suffered from neuromuscular injuries would involve an independent robotic system that acts as a supernumerary body capable of applying external forces to the patient, emulating the assistance that therapist would provide. According to the preliminary work presented by Ruiz-Ruiz and colleagues (<xref ref-type="bibr" rid="B26">26</xref>), collaborative mobile manipulators seem to be a workable and promising solution. The authors proposed the usage of a mobile collaborative robot with an interaction-assistive whole-body interface to help people unable to maintain balance.</p>
</sec>
<sec sec-type="author-contributions" id="s6">
<title>Author contributions</title>
<p>AR: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. AA: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. VB: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. AD: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. FD: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. MSa: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing. MSe: Writing&#x02014;original draft, Writing&#x02014;review &#x00026; editing.</p>
</sec>
</body>
<back>
<sec sec-type="funding-information" id="s7">
<title>Funding</title>
<p>The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This editorial was carried out as part of the SOPHIA Project, which has received funding from the European Union&#x00027;s Horizon 2020 Research and Innovation Program under grant agreement no. 871237 and as part of &#x0201C;Bando Ricerche in Collaborazione&#x0201D; 2022 ID 57 funded by INAIL.</p>
</sec>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
<p>The handling editor declared a past co-authorship with the authors, AR, FD, and MSe.</p>
</sec>
<sec sec-type="disclaimer" id="s8">
<title>Publisher&#x00027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
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