Heterotopic ossification (HO) occurs in 4-49% of patients with spinal cord injury, but the cause of the complication has not been established. The aim of this study was to investigate clinical factors related to the occurrence of HO. The incidence of HO was determined in 91 consecutive patients with traumatic lesions of the spinal cord who had been admitted to the National Spinal Injuries Centre for management and rehabilitation. Clinical data were analysed. Clinically apparent HO occurred only in 10 of 56 patients in whom the start of passive movements to their paralysed limbs was delayed until 7 days or more from time of injury. The findings of this study are consistent with the view that HO occurs as a result of trauma induced by passive movements carried out on joints where contractures have started to develop.

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The use of haptic devices in rehabilitation is becoming rather popular, given the proven effectiveness of such devices in stimulating the proprioceptive and tactile sensing of the users. In a standard framework, such devices are used in a local scenario, where the patient interacts with virtual manipulation experiments, presented on a computer screen. In this paper, we propose an extension of this standard approach by allowing the therapist to remotely interact with the patient, in order to remotely assess the degree of progress (or recovery) and, in turn, properly design new rehabilitation exercises. We apply the proposed concept on single d.o.f., bilateral system, based on two hand orthosis, one used as a master device by the therapist and the other applied to the patient's hand. By using the master device (which incorporates a hand prosthesis, to make the manipulation more realistic), the therapist can remotely move the patient's hand and, at the same time, thanks to the bilateral force feedback, he/she can perceive the patient's resistance to the motion, allowing the remote motor and functional evaluation of the hand