Search Results (111)

Kinesthetic motor imagery (KMI), the mental rehearsal of a motor task without its actual performance, constitutes one of the most common techniques used for brain–computer interface (BCI) control for movement-related tasks. The effect of neural injury on motor cortical activity during execution and imagery remains under investigation in terms of activations, processing of motor onset, and BCI control. The current work aims to conduct a post hoc investigation of the event-related potential (ERP)-based processing of KMI during BCI control of anthropomorphic robotic arms by spinal cord injury (SCI) patients and healthy control participants in a completed clinical trial. For this purpose, we analyzed 14-channel electroencephalography (EEG) data from 10 patients with cervical SCI and 8 healthy individuals, recorded through Emotiv EPOC BCI, as the participants attempted to move anthropomorphic robotic arms using KMI. EEG data were pre-processed by band-pass filtering (8–30 Hz) and independent component analysis (ICA). ERPs were calculated at the sensor space, and analysis of variance (ANOVA) was used to determine potential differences between groups. Our results showed no statistically significant differences between SCI patients and healthy control groups regarding mean amplitude and latency (p < 0.05) across the recorded channels at various time points during stimulus presentation. Notably, no significant differences were observed in ERP components, except for the P200 component at the T8 channel. These findings suggest that brain circuits associated with motor planning and sensorimotor processes are not disrupted due to anatomical damage following SCI. The temporal dynamics of motor-related areas—particularly in channels like F3, FC5, and F7—indicate that essential motor imagery (MI) circuits remain functional. Limitations include the relatively small sample size that may hamper the generalization of our findings, the sensor-space analysis that restricts anatomical specificity and neurophysiological interpretations, and the use of a low-density EEG headset, lacking coverage over key motor regions. Non-invasive EEG-based BCI systems for motor rehabilitation in SCI patients could effectively leverage intact neural circuits to promote neuroplasticity and facilitate motor recovery. Future work should include validation against larger, longitudinal, high-density, source-space EEG datasets. Full article

Background/Objectives: Spinal cord injuries (SCIs) are among the most debilitating conditions and are a leading cause of disability in young people. This study aimed to analyze the causes of SCIs, assess injury severity using the AIS scale, and evaluate complications during rehabilitation in a hospital setting. Methods: The study involved 176 individuals with SCI, including 142 with a traumatic SCI (TSCI) and 34 with a non-traumatic SCI (NTSCI), rehabilitated at various times post-injury. The data on injury causes, paresis type, complications, wheelchair use, gender, age, and treatment methods were collected. The injury severity was assessed using the AIS. Results: A significant gender difference was found between the TSCI and NTSCI groups (85.2% male vs. 61.8% male). TSCI individuals were also younger. The causes of TSCI were traffic accidents, falls from height, and diving, while the causes for NTSCI included spinal ischemia, tumors, degenerative disc disease, and inflammation. TSCI individuals had more AIS A lesions (52.8% vs. 26.5%) and more cervical injuries (53.5% vs. 14.7%), whereas NTSCI individuals had more AIS C lesions (38.2% vs. 18.3%) and thoracic damage (58.8% vs. 35.2%). TSCI patients were more often treated surgically (95.7% vs. 61.8%) and used wheelchairs (88% vs. 55.9%). No significant differences were found in terms of complications between the groups, though TSCI individuals underwent more chronic rehabilitation. Conclusions: Our research shows that there are significant differences between TSCI and NTSCI both in terms of the level of damage and the severity of damage to neural structures (AIS scales), and thus significant differences in the patients’ functioning in later life for both groups of individuals. Full article

Background/Objectives: Platelet-rich plasma (PRP) is emerging as a safe and effective treatment for facet-mediated pain. Studies have demonstrated reductions in pain and improvements in function, both in the short (3 months) and longer term (6 and 12 months). The mechanisms underlying clinical improvements are largely unknown. It is also unclear whether reported outcomes are due to the PRP administered or concurrently applied rehabilitation. Methods: A prospective case series was conducted in a single, multidisciplinary chronic pain centre. Forty-two participants with chronic WAD and cervical facet-mediated pain who received PRP (64% female; mean age (SD) 42.8 (11.6) years; median WAD duration [IQR] 23 [18,29] mths), attended rehabilitation, and reported successful outcomes 3 months post-PRP fulfilled the inclusion criteria. Measures of pain, cervical isometric strength, and range of motion were collected at baseline and 3 months post-PRP. Mediation analyses were performed to determine how these factors influenced disability. Results: Participants demonstrated clinically significant and relevant improvements in pain, disability, and isometric strength measures (all p < 0.01). Causative mediation analyses demonstrated independent direct, but not indirect, effects of both pain and strength on disability (both p < 0.001), with no direct or indirect effects of cervical ROM on disability. Full article

Objectives: The objective of this study was to evaluate changes in anatomical point position, cranio-cervical posture, and respiratory dimensions following conventional bimaxillary total prosthetic rehabilitation. Methods: A prospective, longitudinal, observational, analytical study was conducted on 12 patients, aged 55 to 75 years, at the Department of Dental Prosthetics at the University of Medicine and Pharmacy in Cluj-Napoca. All patients had complete bimaxillary edentulism and received removable dentures as treatment. Clinical and cephalometric analyses were performed before and after prosthetic treatment to compare changes. The cephalometric analysis was based on the guidelines of Tweed and Rocabado for evaluation. Quantitative data were described using the mean and standard deviation for normal distribution and represented by bar graphs with error bars. A paired samples t-test was used to determine differences between groups, with a significance threshold of 0.05 for the bilateral p-value. Results: When analyzing changes in cranial base inclination, the corresponding angles exhibited an increase, indicating cephalic extension. A statistically significant difference in the anteroposterior diameter of the oropharyngeal lumen with and without bimaxillary complete dentures was identified (p < 0.05). For hyperdivergent patients, modifications in the position of anatomical features on cephalometry slightly reduced the VDO and had a slight compensatory effect on skeletal typology. In contrast, for hypodivergent patients, modifications to the position of anatomical landmarks also had a compensatory effect on skeletal typology, increasing the VDO. Conclusion: Changes in the position of anatomical features on cephalometry generally have a compensatory effect on skeletal typology after complete denture placement. Complete prosthetic treatment with removable dentures can significantly influence respiratory function by reducing the oropharyngeal lumen and body posture by cephalic extension and attenuation of the lordotic curvature of the cervical spine. Full article

Objective: Although Global Postural Re-education (GPR) is widely used for musculoskeletal conditions, its specific benefits for this population remain unclear due to inconsistent findings across studies. This systematic review aims to analyze the effects of GPR on pain intensity, functionality, and range of motion (ROM) in individuals with chronic non-specific neck pain. Methods: Computerized search was performed in the Cochrane CENTRAL, Lilacs, EBSCO, PEDro, Pubmed, RCAAP and Scielo databases using the keyword combination (“Global Postural Rehabilitation” OR “Global Postural Reeducation” OR “Global Posture Reeducation” OR “Global Postural Re-education” OR “GPR”) AND (“Neck Pain” OR “Cervicalgia”). Methodological quality was assessed using the Physiotherapy Evidence Database Scale. Results: Six studies with a total of 393 participants (322 women, aged 18–80) were included. The methodological quality was moderate (average PEDro score: 6.7/10), with frequent limitations related to lack of blinding and allocation concealment. Risk of bias was rated as “some concerns” in four studies and “high” in two. GPR was associated with improvements in pain intensity, functionality, and cervical ROM (flexion/extension). While three studies found no significant differences between GPR and static stretching or specific cervical exercises, the remaining three studies reported greater improvements with GPR compared to manual therapy or traditional neck education and exercise therapy. No adverse effects were reported in any of the included trials. Conclusions: GPR appears to be a safe and potentially effective intervention for individuals with chronic non-specific neck pain, particularly in improving pain, function, and cervical ROM. Nonetheless, further high-quality randomized controlled trials are needed to confirm its superiority over other physiotherapeutic interventions and to determine the optimal treatment parameters. PROSPERO registration: CRD420251068974. Full article

Integrating bioinspired design and additive manufacturing into engineering education fosters innovation to meet the growing demand for accessible, personalized assistive technologies. This paper presents the outcomes of an international course, “3D Prosthetics and Orthotics”, offered to undergraduate students in the Biomimetic program at Westfälische Hochschule (Germany), in collaboration with the 3D Orthotics and Prosthetics Laboratory at the Federal University of São Paulo—UNIFESP (Brazil). The course combined theoretical and hands-on modules covering digital modeling (CAD), simulation (CAE), and fabrication (CAM), enabling students to develop bioinspired assistive devices through a Project-based learning approach. Working in interdisciplinary teams, students addressed real-world rehabilitation challenges by translating biological mechanisms into engineered solutions using additive manufacturing. Resulting prototypes included a hand prosthesis based on the Fin Ray effect, a modular finger prosthesis inspired by tendon–muscle antagonism, and a cervical orthosis designed based on stingray morphology. Each device was digitally modeled, mechanically analyzed, and physically fabricated using open-source and low-cost methods. This initiative illustrates how biomimetic mechanisms and design can be integrated into education to generate functional outcomes and socially impactful health technologies. Grounded in the Mao3D open-source methodology, this experience demonstrates the value of combining nature-inspired principles, digital fabrication, Design Thinking, and international collaboration to advance inclusive, low-cost innovations in assistive technology. Full article

Background: Cervical degenerative disease is a common condition associated with significant morbidity, often presenting as neck pain, radiculopathy, or myelopathy. Its growing incidence, particularly in the aging population, has led to an increased demand for surgical interventions aimed at relieving neural compression and restoring spinal stability. Objective: This study aims to evaluate surgical outcomes in patients with degenerative cervical conditions, with a particular focus on the role of intraoperative neurophysiological monitoring (IONM) in preventing adverse neurological events both immediately postoperatively and at long-term follow-up. Methods: A retrospective analysis was performed on patients who underwent cervical spine surgery for degenerative conditions between January 2021 and June 2024. Data collected included demographics, comorbidities, surgical details, and intraoperative neurophysiological monitoring. Surgical outcomes were assessed using the modified Rankin Scale (mRS), Odom’s Criteria, and the modified Japanese Association (mJOA) score. Results: Key findings demonstrated that advanced age and the presence of preoperative myelopathy were significantly associated with poorer postoperative outcomes across all evaluated measures. Conversely, factors such as gender, surgical approach, and the number of treated levels did not significantly influence recovery. Although intraoperative neurophysiological monitoring (IONM) did not show an immediate effect on postoperative outcomes, it was linked to prognostic value for long-term neurological status, suggesting a potential protective role in preserving neurological function. Conclusions: This study identifies age, preoperative functional status, and myelopathy as crucial predictors of postoperative recovery in cervical spine surgery for degenerative disease. These findings underscore the importance of early intervention in patients with myelopathy and highlight the complex role of IONM in improving long-term neurological outcomes. IONM changes may help identify patients at higher risk of poor recovery who could benefit from intensive postoperative rehabilitation. Further prospective studies are warranted to elucidate the complex interactions between patient characteristics and surgical factors in optimizing postoperative recovery. Full article

This paper presents a wearable, open-source system that combines electromyography (EMG) and functional electrical stimulation (FES) to restore hand function in individuals with disabilities caused by cervical spinal cord injuries or stroke. The device captures electrical signals produced during volitional muscle contractions and analyzes them to interpret the user’s intent to move. This information is then used to stimulate impaired muscles, promoting improved hand function and rehabilitation. We detail the design, prototyping, and testing of the system, emphasizing its modularity, affordability, and accessibility. Hardware and software, along with 3D-printable components, are shared via GitHub to enable replication and customization by professionals and makers. The system serves as both an orthotic device for enhancing grasping ability and a therapeutic tool for rehabilitating hemiparetic hands, with potential for broader applications. By addressing cost, customization, and accessibility barriers, this initiative promotes collaboration and further innovation in rehabilitation technologies, advancing the development of affordable, user-centered solutions for individuals with disabilities. Full article

The ability to walk is often lost after neural injury, leading to multiple secondary complications that reduce quality of life and increase healthcare costs. The current rehabilitation interventions primarily focus on restoring leg movements through intensive training on a treadmill or using robotic devices, but ignore engaging the arms. Several groups have recently shown that simultaneous arm and leg (A&L) cycling improves walking function and interlimb connectivity. These findings highlight the importance of neuronal pathways between the arm (cervical) and leg (lumbar) control regions in the spinal cord during locomotion, and emphasize the need for activating these pathways to improve walking after neural injury or disease. While the findings to date provide important evidence about actively including the arms in walking rehabilitation, these strategies have yet to be optimized. Moreover, improvements beyond A&L cycling alone may be possible with conjunctive targeted strategies to enhance spinal interlimb connectivity. The aim of this review is to highlight the current evidence for improvements in walking function and neural interlimb connectivity after neural injury or disease with cycling-based rehabilitation paradigms. Furthermore, strategies to enhance the outcomes of A&L cycling as a rehabilitation strategy are explored. These include the use of functional electrical stimulation-assisted cycling in acute care settings, utilizing non-invasive transcutaneous spinal cord stimulation to activate previously inaccessible circuitry in the spinal cord, and the use of paired arm and leg rehabilitation robotics. This review aims to consolidate the effects of exercise interventions that incorporate the arms on improved outcomes for walking, functional mobility, and neurological integrity, underscoring the importance of integrating the arms into the rehabilitation of walking after neurological conditions affecting sensorimotor function. Full article

Postoperative infection following anterior cervical spine surgery, particularly when complicated by esophageal injury, is a rare but serious condition associated with significant morbidity and mortality. This review elucidates the complex interplay between postoperative infection and esophageal injury. We systematically analyzed studies from 2000 to 2025 using PubMed, Scopus, and Web of Science, focusing on infection, esophageal injury, surgical outcomes, and management strategies, with emphasis on recent advances in diagnostics, surgical techniques, and postoperative care. Our findings highlight the multifactorial nature of these complications and the critical role of early recognition, accurate diagnosis, and timely management. Imaging modalities such as CT, MRI, and contrast esophagography, along with flexible esophagoscopy, are indispensable in assessing injury and infection extent. Effective management requires a multidisciplinary approach integrating broad-spectrum antibiotics, surgical debridement, vascularized flap reinforcement, negative pressure wound therapy, and antibiotic-loaded cement beads. Meticulous postoperative care with prolonged antibiotics, nutritional support, and imaging follow-up is vital for optimizing outcomes. Innovative approaches, including vascularized muscle flaps and hyperbaric oxygen therapy, show promise in enhancing healing and reducing infections. Our review underscores the need for future meta-analyses to strengthen evidence and refine protocols. As surgical techniques evolve, so too must our diagnostic, surgical, and postoperative strategies to minimize complications and improve patient outcomes. Full article

Background/Objective: Diagnostic trial restorations play a crucial role in restorative dentistry by allowing clinicians to evaluate aesthetics, function, and phonetics before finalizing definitive restorations. These restorations facilitate communication between patients, clinicians, and dental technicians, ensuring treatment alignment and predictable outcomes. The accuracy of transferring diagnostic trial restorations to the oral cavity is essential to maintain the integrity of the planned design. Various fabrication techniques, including conventional silicone matrices and computer-aided design/computer-aided manufacturing (CAD-CAM)-based methods, have been developed to improve transfer precision. However, there is limited evidence directly comparing their dimensional accuracy. This randomized in vivo study aimed to evaluate and compare the accuracy of four commonly used techniques—condensation silicone, addition PVS silicone, transparent PVS silicone, and CAD-CAM combination matrices—by assessing their linear and volumetric discrepancies. Methods: Twenty patients requiring aesthetic rehabilitation of their anterior maxillary teeth participated. The sequence of matrix usage was determined through randomization. Four techniques for transferring diagnostic trial restorations were evaluated: (1) condensation silicone matrix, (2) addition polyvinyl siloxane (PVS) silicone matrix, (3) transparent PVS silicone matrix, and (4) CAD-CAM combination matrix. Dimensional accuracy was assessed by comparing intraoral scans (IOSs) of the transferred restorations to the original diagnostic wax-up. Linear discrepancies were measured at four buccal landmarks (cervical, medial, lower medial, and incisal), and volumetric deviation was evaluated using reverse engineering alignment software. Results: Significant differences were observed among the groups in both linear and volumetric discrepancies (p < 0.05). The CAD-CAM combination matrix showed superior volumetric accuracy, with minimal deviations from the diagnostic wax-up. The addition PVS silicone matrix demonstrated consistent linear accuracy, particularly at the cervical and medial landmarks. The condensation silicone matrix exhibited moderate performance across both linear and volumetric accuracy. The transparent PVS silicone matrix showed the highest variability, with greater volumetric deviations. Conclusions: The study highlights that the choice of matrix material and technique significantly impacts the dimensional accuracy of diagnostic trial restoration transfers. The CAD-CAM combination matrix and the addition PVS silicone matrix demonstrated superior advantages compared to the other techniques. Clinicians should consider the specific requirements of each case, including accuracy and ease of use, when selecting a transfer technique for aesthetic rehabilitations. Full article

Introduction: Hemangioblastomas (HBs) are benign, highly vascular tumors that can be found intracranially or in the spinal region, representing around 2–15% of primary intramedullary tumors. They can occur sporadically or in association with Von Hipple–Lindau (VHL) disease. Despite recent of advancement of nonsurgical treatments, complete surgical resection remains the gold standard of care for the spinal HBs. Materials and Methods: We conducted an international multicenter retrospective analysis of adult patients surgically treated for spinal HBs in four European referral centers between January 2000 and September 2024, with a minimum post-operative follow-up duration of 6 months. Patients’ sex and age at surgical intervention, clinical presentation, and duration symptoms prior to clinical diagnosis were identified. The pre- and post-operative neurological status at 1 and 6 months and at the last visit was assessed using the modified McCormick score (MCS). The extent of surgical resection was divided into gross total resection (GTR) and subtotal resection (STR). Finally, post-operative complications were inspected as well, namely cerebrospinal fluid leaks, infections, hemorrhages and post-operative spinal stability. Results: A total of 35 patients were included in the cohort, with an age median of 52 years (34.5–60) and a slight male predominance (21/35, i.e., 60%). The median follow-up period was 37.5 months (12–75). More than half were located in the cervical region, making it the most common (54.3%). Syrinxes were observed in 23 cases (72%), and HBs were more commonly intramedullary (80%). GTR was achievable in around 88% of cases. Post-operative complications were observed in nine patients (25.7%). Nearly half of patients were discharged into rehabilitations centers (48.5%). Tumor recurrence was seen in 10.3% only. At the last follow-up, an excellent overall post-operative neurological status (positive ∆ McCormick) was observed in most of patients (88%) and was found to be associated with a relatively younger age group. Tumor location and presence of syrinxes did not show any statistical significance regarding clinical outcome. In patients having benefited from intra-operative monitoring, only D-wave changes showed statistical significance regarding post-operative outcome (p < 0.05). Conclusions: A large majority of patients operated for a spinal HB demonstrated favorable outcome after surgery, with unchanged or improved neurological status. Advanced age could have an impact on the post-operative neurological outcome. Other factors such as tumor size, location, and the presence of syrinx did not seem to significantly impact the neurological outcome. Finally, the surgery of these vascular lesions with no possibility of debulking or piece-meal removal and requiring “en bloc” resection is technically demanding and should be performed by experienced teams in spine and spinal cord surgery only. Full article

Primary cervical dystonia (PCD), or spasmodic torticollis, is a focal dystonia characterized by involuntary and often painful muscle contractions, leading to abnormal cervical movements and postures. While botulinum toxin injections are the first-line treatment, additional therapies, such as segmental muscle vibration (SMV), remain underexplored. SMV, a non-invasive neuromodulation technique, may enhance motor cortex excitability and promote neuroplasticity, offering potential benefits in PCD management. This single-center triple-blinded randomized controlled trial evaluates SMV’s efficacy in reducing dystonic pain and improving quality of life in PCD patients undergoing standardized rehabilitation after botulinum toxin treatment. Participants with a pain level of ≥3 on the Numerical Rating Scale will be randomized into two groups. The experimental group will receive 80 Hz SMV during a 10-session rehabilitation program, while the control group will undergo sham SMV. Both groups will follow identical physiotherapy and occupational therapy protocols. The primary outcomes include changes in pain intensity and function, assessed at baseline, mid-treatment, and post-treatment using validated scales. The secondary outcomes will evaluate quality of life and patient satisfaction. This study hypothesizes that SMV will significantly reduce dystonic pain and enhance quality of life, supporting its integration into multidisciplinary rehabilitation for dystonic disorders. Trial registration number: NCT06748846. Full article

Whiplash-Associated Disorders (WADs) often result from traffic accidents, leading to persistent symptoms, including neck pain, disability, dizziness, and central sensitization (CS). A key concern is cervical range of motion (cROM) impairment and sensorimotor dysfunction, which contribute to prolonged disability. This study assessed functional performance in individuals with subacute (>1, <3 months) WADs (n = 122) compared to healthy controls (n = 45). Clinical measures included cROM, movement control (Butterfly test), and position sense (Head–Neck Relocation Test, HNRT). Patient-reported outcomes included neck disability, pain intensity, central sensitization, and dizziness. Mixed and linear models evaluated group differences and the influence of demographic and symptom-related factors. WAD patients had significantly reduced cROM and impaired movement control (p < 0.001). Neck disability (p < 0.001) and pain intensity (p = 0.015) affected cROM within the WAD group. Interaction effects revealed greater amplitude accuracy (AA) impairments at greater difficulty levels (p = 0.043), while time on target (TOT) differences decreased (p < 0.001). Dizziness was associated with increased undershoot (p < 0.001), while pain negatively impacted both AA (p = 0.003) and TOT (p = 0.037). Position sense did not differentiate WAD patients from controls. Findings suggest task-dependent sensorimotor deficits, highlighting the need for multimodal assessment. Early CS screening may optimize rehabilitation and prevent chronic disability. Full article

Virtual reality (VR), among other technologies, is establishing the direction of development in the rehabilitation field. Diagnostic tools in cervical spine movement assessments have been described in many studies. The aim of this study was to present the potential of using VR for diagnosing movement quality disorders in the cervical spine. Additional objectives of the research include determining whether Virtual Reality conditions are reliable and objective for measuring the range of motion of the cervical spine when using the proprietary VR Head Tracking application, as well as assessing the level of satisfaction and tolerance of this type of diagnostic method among the subjects. We reached the following conclusions: the measurements of the cervical spine range of motion conducted using the proprietary VR Head Tracking application are reliable and objective, the level of satisfaction with the diagnostic method, as well as the tolerance of the VR examination, is consistently favorable in adults, the results obtained from the VR application allow for a deeper analysis of the data, beyond just the angles of the range of motion. The use of diagnostic methods in a Virtual Reality environment for assessing the biomechanics of the musculoskeletal system in the cervical spine is valid and can be efficiently and non-invasively carried out. Full article