Search Results (2,479)

Background/Objectives: Previous studies have measured a limited number of biomechanical parameters during medical rehabilitation of an anterior cruciate ligament (ACL) rupture. This study aimed to quantitatively assess changes in gait biomechanics, knee function, and lower-extremity muscle activity during after ACL reconstruction. Methods: The study included 32 patients after arthroscopic ACL reconstruction. The patients were divided into three groups based on postoperative time points: 0.5 year (12 men), 1 year (7), and over 1 year (9). Gait analysis at both self-selected and fast speeds was performed using an inertial system. Statistical analysis was performed using rank models and full-factorial orthogonal designs. Results: After 0.5 year, the timing of the gait cycle at self-selected speed was within the control group’s range and showed no significant asymmetry. With increasing speed, a decrease in knee joint range of motion was observed in the 0.5 year and 1-year groups, without achieving a full physiological increase in range of motion at long-term follow-up. Multivariate analysis revealed the greatest biomechanical imbalance during fast walking at one year and a phase-dependent effect of time after surgery, speed, and limb status on kinematics and EMG, particularly in the quadriceps. Conclusions: Basic temporal gait parameters during self-selected walking were within the control range by 0.5 year, but load-dependent knee kinematic and EMG abnormalities persisted. The knee joint’s response to increased loads remained impaired for at least one year. The persistence of phase-specific compensatory changes in kinematics and muscle activity at later stages can be assessed using exercise testing. Full article

Background and Objectives: Bell’s palsy (BP) is the most common cause of acute unilateral peripheral facial nerve paralysis. The aim of this study was to evaluate the time to complete clinical recovery in patients with BP treated with acupuncture and to identify baseline clinical and electrophysiological predictors of recovery outcomes. In addition, electrophysiological characteristics at the time of complete clinical recovery were examined. Materials and Methods: This prospective, observational, uncontrolled cohort study included 1050 patients with clinically confirmed BP who received acupuncture as the only therapeutic intervention between January 2017 and August 2025. Clinical severity was assessed using the House–Brackmann (HB) and Sunnybrook (SB) grading systems. Electrophysiological evaluation included compound muscle action potential (CMAP) analysis and needle electromyography (EMG). Time-to-event analysis was performed using the Kaplan–Meier method and Cox proportional hazards regression analysis. Results: Complete clinical recovery was achieved in 843 patients (80.3%). The median time to recovery was 40 days (IQR 30–60). Patients with milder baseline deficits (HB II–IV) demonstrated significantly faster recovery than those with severe paralysis (HB V–VI) (log-rank p < 0.001). In multivariable Cox regression analysis, higher baseline HB grade, older age, and more severe EMG denervation were independently associated with slower recovery. Residual electrophysiological abnormalities persisted in most patients despite complete clinical recovery. Conclusions: Recovery from BP is a dynamic and heterogeneous process, significantly influenced by initial clinical severity and the degree of electrophysiological impairment. Combined clinical and electrophysiological assessment may contribute to more precise prognostic stratification and follow-up of patients with BP. Persistent electrophysiological abnormalities despite complete clinical recovery suggest that complete clinical recovery may precede complete neurophysiological regeneration of the facial nerve. Full article

Background: Muscle cramps are sudden, painful, and recurrent contractions that may interfere with physical activity and daily life. Although stretching is commonly used to relieve cramps, the effectiveness of neuromuscular electrical stimulation (NMES) has not been fully established. Objective: This study aimed to investigate the effects of NMES on cramp threshold frequency (CTF) and pain intensity in individuals with a history of nocturnal leg cramps without identifiable underlying disorders. Methods: Twenty healthy adults with a history of leg cramps were randomly assigned to either an experimental group (n = 10) or a control group (n = 10). The experimental group received electrical stimulation to both calves using an NMES device, whereas the control group performed lower-extremity static stretching exercises. Both groups participated in an intervention program conducted three times per week for 20 min per session over 4 weeks. CTF was measured using surface electromyography, and muscle cramps were induced using an electrical stimulation device starting at 4 Hz, with the frequency increased by 2 Hz after each stimulation set until cramp onset. Pain intensity was assessed using the Visual Analog Scale (VAS). Within-group and between-group comparisons before and after the intervention were analyzed using paired-samples t-tests and independent-samples t-tests, respectively, with the level of statistical significance set at p < 0.05. Results: Both groups showed significant improvements in CTF and pain intensity after the intervention. However, the NMES group demonstrated significantly greater improvement than the stretching group. The increase in CTF was significantly greater in the experimental group than in the control group (9.20 ± 6.75 vs. 1.80 ± 1.75; t = 3.357, p = 0.007). Likewise, the reduction in VAS score was significantly greater in the experimental group than in the control group (−5.20 ± 0.92 vs. −1.60 ± 0.84; t = 9.128, p < 0.001). Conclusions: NMES may be an effective intervention for increasing cramp threshold frequency and reducing pain in individuals with leg cramps, with greater benefits than lower extremity stretching. Full article

Background and Objectives: Foot wedges are widely used to modulate ankle alignment in clinical and athletic settings, yet the effects of mediolateral wedge placement on multi-planar lower limb biomechanics during functional unilateral exercises remain poorly characterized. This study aimed to quantify the effects of medial and lateral foot wedge placement on lower limb joint kinematics, muscle activation, and ground reaction forces (GRFs) during the split squat. Materials and Methods: Thirty healthy young adults (12 males, 18 females; 24.5 ± 2.7 years) performed split squats under three randomized conditions using a rigid inclined platform rather than a custom foot orthosis: no wedge (NW), medial wedge (MW), and lateral wedge (LW). Three-dimensional kinematics (Qualisys, 100 Hz), bilateral GRFs (Bertec, 1000 Hz), and surface electromyography (sEMG, 1000 Hz) of the peroneus longus (PL), tibialis anterior (TA), vastus medialis (VM), and vastus lateralis (VL) were recorded synchronously. Repeated-measures ANOVA with Bonferroni post hoc tests and partial eta-squared (η²_p) were used (α = 0.05). Results: LW significantly increased PL and VM activation, sagittal-plane range of motion (ROM) at the ankle, knee, and pelvis, and vertical GRF, compared with MW and NW (p < 0.05). MW significantly increased TA and VL activation and reduced sagittal hip ROM (p < 0.05). No significant differences were observed for mediolateral or anteroposterior GRF. Conclusions: Mediolateral foot wedge placement acutely reorganizes lower limb neuromuscular recruitment, joint kinematics, and vertical ground reaction force during the split squat in healthy young adults. These preliminary findings indicate that wedge orientation, applied via a rigid inclined platform, can acutely and selectively modulate muscle activation patterns; any therapeutic or performance applications, however, were not evaluated here and should not be generalized to conventional clinical orthoses without further investigation. Full article

The educational pathway for expertise in intraoperative neurophysiological monitoring (IONM) is complex and lengthy, requiring a solid foundation in neuroscience, neurophysiology, and neuroanatomy. It also demands direct familiarity with a broad range of neurosurgical scenarios, including supratentorial, infratentorial, and spinal procedures, gained through exposure to at least ten distinct surgical approaches. Intraoperative neurophysiology must be tailored to each patient’s preoperative assessments. It relies on a variety of methods to collect, analyze, and report neurophysiological signals that are relevant to the surgical procedure. Despite its importance, there remains a substantial shortage of training tools designed to support realistic practice and skill development. To address this gap, we developed a comprehensive framework (ION-Sim) that integrates all laboratory testing modalities and adapts them to the operating room environment. ION_sim supports the simulation and analysis of spontaneous EEG and EMG activity, a wide range of evoked potentials, and intraoperative stimulus–response testing protocols. The framework provides a unified environment for practicing, testing, and validating the core neurophysiological procedures employed during neurosurgical interventions. In addition, it incorporates a robust data-management architecture, maintaining a database with system setups, user profiles, educational performance metrics, and automatically generating reports. This structure enables the longitudinal tracking of objective skill acquisition and facilitates standardized assessments of trainee progress. ION_Sim is distributed both as a ready-to-use application, suitable for direct integration into teaching and training programs, and as a modular scientific library. Through its dedicated APIs, users can design customized configurations, create novel simulation scenarios, and extend the platform to support additional research or educational objectives. It is available upon request for educational purposes and is open-source and released under the GNU General Public License, ensuring transparency, reproducibility, and long-term accessibility for the scientific and clinical communities. Full article

During coal mine fracturing operations, real-time monitoring of the vibration frequency of the drilling assembly is crucial for assessing crack development, optimizing fracturing parameters, and ensuring the safety of downhole equipment. However, traditional active vibration sensors are limited by their reliance on external power supplies in the complex environment of underground mining, reducing their operational efficiency and effectiveness. Accordingly, a self-powered Z-shaped vibration sensor based on hybrid triboelectric and electromagnetic mechanisms was developed for monitoring coal mine fracturing drilling. This sensor utilizes the vibrations of the drilling tool to induce frictional electric pulse signals that correspond to the vibration frequency, enabling simultaneous vibration monitoring and energy generation. Experimental results demonstrate the stable performance of the proposed sensor under thermal conditions up to 150 °C and moisture levels reaching 90% relative humidity. The proposed sensor exhibits an operating frequency range of 0 to 11 Hz, with the measurement deviation constrained within a 5% threshold. Under optimal impedance matching, the triboelectric and electromagnetic units deliver peak power outputs of 0.04 mW and 110.5 mW when connected to external loads of 10⁸ Ω and 3.3 × 10² Ω respectively. The proposed hybrid self-powered sensor uses the high-amplitude pulsed voltage signals generated by the TENG unit for vibration frequency identification, while the EMG unit harvests mechanical energy from low-frequency vibrations, thereby enhancing the self-powered capability of the sensor for underground vibration monitoring in coal-mine hydraulic fracturing drilling. Full article

Background/Objectives: The aim of this study was to precisely characterize neurological deficits in patients with idiophatic scoliosis (IS) by comparing preoperative clinical and neurophysiological examination results in patients with Lenke 1 and 3 spinal curvatures. Bracing alone (NTP) is commonly applied preoperatively in subjects with IS, but incorporating the concept of prerehabilitation with additional physiotherapy (TP) may further slow the progression of scoliosis. Methods: An interview regarding the development and conservative treatment of IS, clinical neurological assessment, and bilateral neurophysiological tests involving electromyography (sEMG) of motor unit activity in the paraspinal and lower extremity muscles, electroneurography (ENG) of neural impulse transmission in the peroneal nerve motor fibers and entire efferent conduction involving recordings of motor evoked potentials (MEPs) induced with transcranial magnetic field stimulation (TMS) were performed in patients with Lenke 1 (N = 33) and Lenke 3 (N = 27) spine curvatures in two groups (N = 30 each) that were treated (TP) or not treated (NTP) with physiotherapy. Results: Back pain, assessed on the VAS by all Lenke 3 patients, was 3.3 on average. Limited spine mobility (p < 0.001) was not associated with better results following physiotherapeutic treatment in either Lenke patient group. Sensory perception studies within the L3–S1 dermatomes and vibration sensation tests were found to be slightly decreased in Lenke 3 patients (p < 0.001), predominantly on the concave IS side, but less so in the TP group. Achilles tendon and patellar reflexes were detected as pathological (p < 0.001) only in Lenke 3 patients, and less frequently in the TP group. Asymmetry on the concave side of scoliosis in manual muscle testing scores was found (p < 0.001) in Lenke 3 patients, showing moderate muscle weakness in the distal lower extremities, mainly in the NTP group. sEMG recordings from the paraspinal muscles revealed moderate neurogenic abnormality that was more intense on the concave side of scoliosis curvature, both main and second; the pattern of muscle motor unit activity in the proximal and distal muscles of the lower extremities was consistent with the muscle strength deficits observed in manual muscle testing, though less so in the TP group. Deficits in MEP amplitudes recorded from lower extremity muscles and the peroneal nerve were found to be more commonly expressed on the concave side of the main scoliosis curvature and on the concave side of the second scoliosis curvature, particularly in Lenke 3 patients, but the significance of changes was lower in the TP group (p = 0.03–0.009). ENG studies showed moderate abnormalities in peripheral neural conduction of peroneal nerve motor fibers originating at the L5 ventral root, especially in Lenke 3 patients from the NTP group. Conclusions: Neurological diagnostic tests, supported by selected clinical neurophysiological studies, reveal greater motor and sensory abnormalities in IS patients with Lenke 3 than with Lenke 1 curvatures. The study indicates that patients in both groups who received only bracing had poorer outcomes than those who received additional physiotherapy. In the context of prerehabilitation, a combined conservative treatment approach including physiotherapy can provide functional benefits for the IS patient before the necessary surgical treatment. In this study, differences were observed between the groups treated with physiotherapy and those not treated; however, a causal link cannot be established. The results are consistent with a possible benefit of the physiotherapy, but they require further prospective studies to be proven. Full article

Background: Postural disability develops in almost all patients with diabetic polyneuropathy (DPN). While transcutaneous electrical nerve stimulation (TENS) has proven effective in regressing sensory and motor impairments, its efficacy in improving postural control remains insufficiently studied. Purpose: To evaluate and compare the efficacy of direct peroneal and tibial high-frequency low-amplitude (HFLA) TENS and low-frequency high-amplitude (LFHA) TENS in correcting DPN-related postural disability, among European female patients without a documented history of falls, motor deficits, or pronounced electromyographic impairments, using computerized static posturography and the tandem walk test. Materials and methods: In this single-center, three-arm, randomized controlled trial (registration number: ISRCTN47534508, 3 December 2024), we conducted a longitudinal prospective analysis of European women with DPN-related postural disability. All enrolled patients were non-fallers with no motor deficits and baseline compound muscle action potential (CMAP) amplitudes of the peroneal and tibial nerves of at least 1.5 mV. The intervention groups received HFLA TENS (n = 24) or LFHA TENS (n = 25), while the control group underwent sham TENS (n = 24). Primary endpoints were assessed via static posturography and the tandem walk test (TWT); secondary endpoints were evaluated using hypoesthesia and pain evaluation, the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), and electromyography. Assessments were performed before treatment, immediately post-treatment, and at the conclusion of a 2-month follow-up period. Results: Comparative analysis incorporating the Bonferroni adjustment demonstrated that LFHA TENS is significantly superior to HFLA TENS. Post-treatment, LFHA TENS induced a reduction in envelope area by 20.7% under the eyes-open (EO) condition (p < α_adj; α_adj = 0.0028) and 32.9% under the eyes-closed (EC) condition (p < α_adj; α_adj = 0.0028), alongside a 16.6% decrease in the Romberg uotient (RQ) (p < α_adj; α_adj = 0.0056). Furthermore, LFHA TENS elicited a significant 39.0% reduction in velocity of CoP sway (VCS) under the EO condition (p < α_adj; α_adj = 0.0042), and decreased total CoP sway excursion by an average of 35.8% (EO) (p < α_adj; α_adj = 0.0042) and 43.8% (EC) (p < α_adj; α_adj = 0.0042) compared to baseline. In contrast, no statistically significant changes in these parameters were observed after HFLA TENS. Ultimately, LFHA TENS outperformed HFLA TENS in improving postural stability by 7.04% under the EO condition (p < α_adj; α_adj = 0.0042) and by 25.5% under the EC condition (p < α_adj; α_adj = 0.0042) in both the tandem walk test (TWT) and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB). Notably, a statistically significant increase in the CMAP amplitude of the affected peroneal nerves by 22.2% was observed exclusively following LFHA TENS treatment (p < α_adj; α_adj = 0.0056). Conclusions: The clinical efficacy of direct peroneal and tibial TENS compared to sham stimulation in reducing postural disability during both static and dynamic conditions was established in European female patients with moderate-to-severe DPN and unremarkable EMG impairments. Comparative analysis reveals a clear therapeutic superiority of LFHA TENS over HFLA TENS, as evidenced by significantly greater improvements in both posturographic parameters (envelope area, total CoP excursion under EO and EC conditions, and VCS under the EO condition) and functional clinical tests (TWT and mCTSIB), demonstrating long-term stability for up to 2 months post-intervention. Full article

Neurolymphomatosis (NL), a rare manifestation of non-Hodgkin’s lymphoma affecting the peripheral nervous system, remains a diagnostic challenge. This study aimed to define an optimal diagnostic approach for timely and effective identification of NL. We analyzed 559 NL cases from 231 articles published from 1951 to 2022, examining how patient outcomes correlated with various diagnostic modalities, including magnetic resonance imaging (MRI), computed tomography (CT), [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET), electromyography-nerve conduction studies (EMG-NCS), ultrasound, and tissue biopsy when used individually or in combination. Separate analyses were performed in a mutually exclusive fashion to minimize confounding effects from multiple modalities. The results of this investigation revealed that patients with biopsies had a longer time interval from first treatment to progression (Kruskal–Wallis p < 0.0001), survival from diagnosis (overall survival) (p < 0.0001), and survival from symptom onset (p < 0.0001), but not symptom onset to diagnosis (p = 0.2134). Pairwise comparisons of biopsy plus 2, 3, or 4 diagnostic modalities revealed a positive trend for the combination of biopsy + PET + MRI + EMG-NCS. A majority of patients without biopsy had secondary NL. In this non-biopsied population, no diagnostic modality had a significant correlation with outcome. The data collectively indicate that histological confirmation of NL from biopsy was associated with a positive patient outcome. Management of NL patients requires timely testing using PET, MRI, and EMG-NCS to quickly identify a site for image-guided nerve biopsy. Full article

As global populations grow and technology advances, daily life is increasingly shaped by digital systems such as computers and smart devices. However, prolonged device use has contributed to increasing physical and mental health concerns, particularly those associated with poor sitting posture. Posture-related strain is frequently overlooked and contributes to musculoskeletal discomfort, including back, neck, shoulder, and wrist pain, and may also be associated with sleep disturbances and elevated stress levels. To the best of our knowledge and based on the existing literature, this is the first study to introduce a machine learning-based framework for advanced muscle strain severity classification using Internet of Things (IoT) devices that integrates posture monitoring and muscle strain detection into a unified low-cost framework ($23 hardware cost). The primary objective of this work is accurate classification of muscle strain severity, while real-time alerts serve as a secondary ergonomic feedback mechanism. Specifically, this study makes four major contributions. First, we created a novel dataset through real-time acquisition of electromyography (EMG) and posture signals from participants in hospital and industrial environments, capturing diverse muscle strain patterns validated against clinical assessment procedures. Second, we designed a two-part hardware architecture consisting of posture detection (PD) and strain detection (SD) modules using a NodeMCU ESP8266, HC-SR04 ultrasonic sensor, EMG sensor, and buzzer for real-time physiological monitoring, incorporating EMG-specific preprocessing including band-pass filtering, rectification, and RMS smoothing. Third, we proposed and evaluated a hybrid machine learning framework integrating Vision Transformer (ViT) and XGBoost to classify strain severity into three study-specific categories: baseline (EMG RMS < 40 µV), compensatory strain (40–59 µV), and overload (≥60 µV). These categories were used as reproducible severity proxies for machine learning annotation and should not be interpreted as universal biomarkers of structural tissue damage. Finally, the proposed framework achieved a classification accuracy of 99.0% (95% CI: 98.5–99.5%) with an inference latency of 15.2 ms. Full article

Hands-free command interfaces are essential for users who cannot reliably operate joysticks or upper-limb myoelectric control. Neck–shoulder surface electromyography (sEMG) is a promising alternative; however, performance is often reported using window-level validation which can overestimate accuracy due to overlap and trial leakage, and false-trigger behavior is not always quantified when an idle REST state is included. This pilot study presents a motion-capture (MoCap)-referenced decoding framework that uses four bilateral upper trapezius (UT) and sternocleidomastoid (SCM) sEMG channels with integrated inertial measurement units (IMUs). Optical MoCap was used as an external kinematic reference to support baseline-posture assessment and movement-execution quality control. Seven commands were decoded (shrug L/R, double shrug, rotation L/R, rotation + shrug L/R). To enable an eight-class formulation, a REST class was defined using low-activity segments extracted from baseline recordings and included in the evaluation. Computationally efficient time-domain sEMG features, pattern/symmetry descriptors, and baseline-referenced IMU kinematics (including an SCM yaw-range indicator) were classified using linear discriminant analysis (LDA), k-nearest neighbors (kNN), and linear support vector machine (SVM), evaluated using within-subject testing, trial-wise grouped cross-validation, and leave-one-subject-out (LOSO) testing. Across six participants, within-subject mean best-per-subject accuracy was 96.02% (seven-class) and 96.35% (eight-class); and pooled trial-wise accuracy reached 92.1% and 90.5%, respectively. Under LOSO, best-configuration accuracy decreased to 60.4% and 63.8% for the seven-class and eight-class formulations, respectively. Across the top LOSO configurations, REST FAR ranged from approximately 9.8% to 25.6%. These findings demonstrate controlled offline pilot feasibility and quantify key generalization and REST false-activation trade-offs, providing a foundation for future validation in larger, more diverse, and clinically relevant populations. Full article

Approximately 30% of patients with tremor-dominant Parkinson’s disease (PD) have rest tremor that persists despite optimal dopaminergic therapy. When deep brain stimulation and focused ultrasound are unavailable or declined, the therapeutic options narrow. Botulinum toxin (BoNT) offers a targeted, titratable, reversible approach, but whether a peripheral neuromuscular blocking agent makes sense for a centrally generated tremor is a legitimate question that deserves a direct answer. This narrative critical review appraises what is currently known across PD and non-PD tremor conditions, defines the technical requirements for safe and effective injection, and provides a practical framework for patient selection and clinical management. The PD-specific literature rests on a single positive double-blind randomized controlled trial of 30 patients; all remaining data are open-label or extrapolated from other tremor conditions, and this narrative synthesis combines heterogeneous conditions, outcome scales, and toxin protocols. A recurring technical observation is that, in the available trials, individualized, EMG-guided injection has been associated with substantially lower rates of hand weakness than fixed-dose injection (reported reductions from roughly 30–70% to below 15%) while maintaining tremor reduction, although the degree of benefit and weakness risk vary with the tremor syndrome, injected muscles, baseline impairment, dose, and guidance method. The careful patient selection this approach requires helps the individual clinician and patient achieve tremor relief, but it departs from the unselected real-world PD population and introduces selection bias that makes a large, statistically representative cohort difficult to assemble. In well-selected patients at centers with the appropriate expertise, BoNT may be a clinically useful option, but routine adoption is not yet supported. Full article

Arthrogenic muscle inhibition (AMI), neurophysiological suppression of voluntary quadriceps activation triggered by joint effusion and inflammation, is consistently initiated within hours of any form of knee surgery. If not actively counteracted during the first two postoperative weeks, AMI may drive a cascade of neuromuscular, morphological, and biomechanical deficits that can persist for years, substantially increasing the risk of post-traumatic osteoarthritis, reinjury, and long-term functional disability. Emerging evidence indicates that preoperative patient-related factors, including baseline quadriceps strength, age, body mass index, and physical fitness, further modulate the rehabilitation response and should be considered in planning early postoperative protocols. This narrative review, which was not designed as a systematic review or meta-analysis and therefore does not include formal quality assessment or pooled statistical analysis, evaluates evidence for seven early-phase (0–2 weeks postoperative) knee muscle activation interventions: neuromuscular electrical stimulation (NMES), isometric quadriceps exercise, blood flow restriction (BFR) training, electromyographic (EMG) biofeedback, open and closed kinetic chain (OKC/CKC) exercise, cryotherapy, and continuous passive motion (CPM). Findings are synthesized against six clinically relevant dimensions, safety in the 0–2 week window, home-based usability, capacity to overcome AMI, requirement for volitional effort, objective monitoring capability, and progressive resistance, to characterize a consistent pattern: no single existing modality simultaneously meets all combined requirements for home deployment, volitional engagement, objective monitoring, and progressive resistance from postoperative day one. This collective unmet need provides direction for future device development and clinical research. Full article

This study investigated the feasibility and biomechanical effects of volitional electromyography (EMG)-based control of a powered transtibial ankle prosthesis. Four male participants completed static and dynamic EMG assessments and gait analysis while using both their prescribed passive prosthesis and an EMG-controlled powered prototype during level walking at self-selected and fast speeds, as well as ramp ascent and descent. Selective activation of residual tibialis anterior and gastrocnemius muscles was quantified using a co-contraction index, and lower-limb kinematics and kinetics were compared between prosthetic conditions. Participants were able to generate task-dependent residual muscle activity, supporting the feasibility of EMG-based volitional control. However, muscle selectivity was reduced during dynamic tasks, with higher co-contraction during gait than during seated static contractions, and substantial inter-subject variability was observed. Compared to the prescribed passive prosthesis, the EMG-controlled prototype generally produced lower prosthetic-side ankle range of motion and ankle power, although ankle moments were sometimes slightly greater. These findings suggest that EMG control is feasible, but that future controller design must remain flexible to individual users’ neuromuscular abilities and dynamic control limitations. The results provide important guidance for the development and testing of more adaptive, personalized, and functionally effective EMG-controlled prosthetic ankle systems. Full article

Background/Objectives: Wearable technology is increasingly used to provide biofeedback in physical rehabilitation; however, there is no consensus on which biofeedback parameter is most appropriate for clinical use, as most studies evaluate only one arbitrarily selected parameter. This study presents a wearable multimodal biofeedback system integrating multiple parameters selected based on the prior literature and evaluates its feasibility, usability, and implementation within a rehabilitation context through a longitudinal post-stroke case study. Methods: The system integrates inertial and electromyographic sensors to monitor centre of mass (CoM-B), joint angle (ANG-B), and muscle activity (EMG-B), delivering real-time sensory cues based on the monitored parameters. Feasibility was assessed in a post-stroke participant (male, 32 years, 29 months post-stroke, left hemiparesis, Fugl-Meyer Lower Extremity Score = 27) across 15 sessions involving stand-to-sit, split-stance weight shifting, and walking tasks. Each task was practiced with all three biofeedback parameters, with five sessions per parameter. Results: The motor performance varied across biofeedback parameters and tasks. CoM-B was associated with favourable trends in motor performance during stand-to-sit, showing improvements in medio-lateral displacement (0.03/session); ANG-B during walking, showing increased ankle dorsiflexion (1 deg/session); and EMG-B during split-stance weight shifting, showing increased tibialis anterior activation (5 µV/session). Conclusions: The findings generate the hypothesis that the ability of biofeedback to elicit favourable motor performance is task-dependent, suggesting that the choice of biofeedback parameters may need to be adapted to task demands. The system demonstrated high usability and feasibility, supporting its potential for post-stroke rehabilitation. Further studies are needed to test the generated hypothesis and evaluate the system efficacy. Full article