Search Results (70)

Inspired by the adaptive flexible motion coordination of biological systems, this study presents a bioinspired control strategy that enables robotic manipulators to achieve precise and compliant motion–force coordination for embodied intelligence and dexterous interaction in physically constrained environments. To this end, a learning-based motion–force hybrid control (LMFC) framework is proposed, which unifies learning and kinematic-level control to regulate both motion and interaction forces under incomplete or implicit kinematic information, thereby enhancing robustness and precision. The LMFC formulation recasts motion–force coordination as a time-varying quadratic programming (TVQP) problem, seamlessly incorporating multiple practical constraints—including joint limits, end-effector orientation maintenance, and obstacle avoidance—at the acceleration level, while determining control decisions at the velocity level. An RNN-based controller is further designed to integrate adaptive learning and control, enabling online estimation of uncertain kinematic parameters and mitigating joint drift. Simulation and experimental results demonstrate the effectiveness and practicality of the proposed framework, highlighting its potential for adaptive and compliant robotic control in constraint-rich environments. Full article

Background: Persistent upper limb hemiparesis in patients with stroke can result in significant long-term disability and reduced quality of life. Transcranial direct current (tDCS) stimulation and virtual reality (VR) as stand alone or in combination are currently used for the rehabilitation of upper limb function following stroke. Objectives: The aim of this study is to determine the effects of combining tDCS with VR on level of motor impairment, motor function, spasticity, ADL, quality of life, manual dexterity, sensation, muscle strength, handgrip strength, cognitive flexibility and speed of processing, motor performance, cognition, and executive function after stroke. Design: The study is a systematic review and meta-analysis. Data Sources and Methods: PubMED, Embase, Web of Science (WoS), PEDro, and Scopus were searched until June 2023 for randomized controlled trials (RCTs) on the subject matter using the following keywords: stroke, upper extremity, upper limb, virtual reality, virtual rehabilitation, noninvasive brain stimulation, transcranial direct current stimulation, transcortical direct current stimulation, and tDCS. Methodological quality and risks of bias of the included studies were assessed using the PEDro scale and Cochrane risks of bias assessment tool, respectively. Random effect model analysis was used to compute the effect size and standardized mean difference (SMD). Results: The results showed that the included studies reported that combining tDCS with VR may improve level of motor impairment, motor function, spasticity, ADL, quality of life, manual dexterity, sensation, muscle strength, handgrip strength, cognitive flexibility and speed of processing, motor performance, cognition, and executive function. However, the result of the meta-analysis showed that it is only superior to the control at improving motor function (SMD = 0.44, 95% CI = 0.09 to 0.79, p = 0.01). Conclusions: Use of a combination of tDCS with VR may help optimize upper limb function outcomes. However, standardization of the protocol of such an intervention is needed in order to make it applicable in the real world. Registration: The study was registered in PROSPERO (registration number, CRD42023435702). Full article

(1) Background: Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) is a high-dose evidence-based neurorehabilitation. This study aims to develop and validate a protocol using three inertial measurement units (IMUs) to objectively document upper and lower extremities’ (UE; LE) motor activity during a HABIT-ILE intervention in chronic stroke adults. (2) Method: Thirteen adults (57.1 y ± 11.3) who completed 65 h of HABIT-ILE (2 weeks, 6.5 h/d) were included. Daily motor activity was recorded with IMUs placed on both wrists and one thigh with nine IMU-derived variables extracted to evaluate motor activity and posture. Each variable was correlated with baseline abilities and day-to-day patterns were observed with subgroup analyses based on baseline dexterity and walking endurance. Day-to-day patterns were highlighted based on mean values and effect size analyses. (3) Results: Only the Magnitude and Use ratios showed high correlations with baseline abilities, with a day-to-day specific pattern highlighted for participants with moderate to good dexterity at baseline. (4) Conclusions: All participants reported a high level of engagement during HABIT-ILE independently of their baseline abilities. Although we could not detect a global trend to document the content of a HABIT-ILE intervention, these exploratory results suggest IMU monitoring to be relevant to characterize therapeutic content. Full article

Background: The maintenance of an aseptic barrier between the surgical team and patient aids in the prevention of exposure of the patient to pathogens. Variations in gloving practice may have safety implications due to glove failure. An important relationship exists between optimum glove fit and manual dexterity, tactile sensitivity, and fatigue. The aim of this systematic review was to assess the presence and quality of the available literature that investigates the critical association between glove fit and provider performance in the operating theatre and to ascertain whether there is an established standard to determine appropriate glove size. Methods: A systematic review of the literature was undertaken in accordance with the PRISMA statement using one distinct research question regarding glove fit (INPLASY2025100008). Searches on PubMed, Embase, Cochrane Collaboration of Systematic Reviews and Metanalyses and Google Scholar were performed between 1 May 2022 and 24 January 2023. Studies were assessed for eligibility against pre-defined inclusion and exclusion criteria. Risk of bias was determined using multiple assessment tools. Results: This systematic review included 18 studies, nine of which were high-quality Level I or II trials, and multiple observational analyses. Poor glove fit was consistently associated with reduced manual dexterity, impaired tactile sensitivity, and decreased comfort, while oversized or undersized gloves increased the risk of glove perforation and fatigue. These findings underscore the clinical importance of appropriate glove sizing to optimize surgical performance and safety. Conclusions: There is a scarcity of high-quality studies investigating the relationship of glove fit and performance. Furthermore, there does not appear to be a standard method to determine the optimal glove fit for members of the surgical team, nor are there practical examples of how glove size is determined. Further research in this area is required. Full article

Modern dental education increasingly calls for smarter tools that combine precision with meaningful feedback. In response, this study presents the Intelligent Dental Handpiece (IDH), a next-generation training tool designed to support dental students and professionals by providing real-time insights into their techniques. The IDH integrates motion sensors and a lightweight machine learning system to monitor and classify hand movements during practice sessions. The system classifies three motion states: Alert (10°–15° deviation), Lever Range (0°–10°), and Stop Range (>15°), based on IMU-derived features. A dataset collected from 61 practitioners was used to train and evaluate three machine learning models: Logistic Regression, Random Forest, Support Vector Machine (Linear RBF, Polynomial kernels), and a Neural Network. Performance across models ranged from 98.52% to 100% accuracy, with Random Forest and Logistic Regression achieving perfect classification and AUC scores of 1.00. Motion features such as Deviation, Take Time, and Device type were most influential in predicting skill levels. The IDH offers a practical and scalable solution for improving dexterity, safety, and confidence in dental training environments. Full article

Introduction: Multiple sclerosis (MS) is a chronic neurodegenerative disease that entails high costs, progressive disability, and reduced quality of life (QoL). Telerehabilitation (TR), supported by new technologies, is emerging as an alternative or complement to in-person rehabilitation, potentially lowering socioeconomic impact and improving QoL. Aim: The objective of this study was to evaluate the effect of TR on the QoL of people with MS compared with in-person rehabilitation or no intervention. Materials and methods: A systematic review of randomized clinical trials was conducted (March–May 2025) following PRISMA guidelines. Searches were run in the PubMed-Medline, EMBASE, PEDro, Web of Science, and Dialnet databases. Methodological quality was assessed with the CASP scale, risk of bias with the Risk of Bias 2 tool, and evidence level and grade of recommendation with the Oxford Classification. The protocol was registered in PROSPERO (CRD420251110353). Results: Of the 151 articles initially found, 12 RCTs (598 total patients) met the inclusion criteria. Interventions included (a) four studies employing video-controlled exercise (one involving Pilates to improve fitness, another involving exercise to improve fatigue and general health, and two using exercises focused on the pelvic floor muscles); (b) three studies using a monitoring app to improve manual dexterity, symptom control, and increased physical activity; (c) two studies implementing an augmented reality system to treat cognitive deficits and sexual disorders, respectively; (d) one platform with a virtual reality headset for motor and cognitive training; (e) one study focusing on video-controlled motor imagery, along with the use of a pain management app; (f) a final study addressing cognitive training and pain reduction. Studies used eight different scales to assess QoL, finding similar improvements between groups in eight of the trials and statistically significant improvements in favor of TR in four. The included trials were of good methodological quality, with a moderate-to-low risk of bias and good levels of evidence and grades of recommendation. Conclusions: TR was more effective in improving the QoL of people with MS than no intervention, was as effective as in-person treatment in patients with EDSS ≤ 6, and appeared to be more effective than in-person intervention in patients with EDSS between 5.5 and 7.5 in terms of QoL. It may also eliminate some common barriers to accessing such treatments. Full article

Objectives: The primary objective of this study was to determine whether motor disorders are significantly more prevalent in children with Autism Spectrum Disorder (ASD) without co-occurring genetic or neurological conditions compared to neurotypical children. Another aim was to explore the applicability of the MABC-2 test for assessing motor skills in a Polish cohort of children with ASD. Additionally, this study sought to develop a basic framework for motor skill assessment in children with autism. Methods: This study included 166 Caucasian children, both sexes, aged 5–12 years, without intellectual disability (IQ ≥ 70), without concomitant genetic or neurological disorders, particularly epilepsy or cerebral palsy. The study group consisted of children with ASD (n = 71), and the control group consisted of neurotypical children (n = 95). The participants were assessed with the Movement Assessment Battery for Children–second edition (MABC-2), MABC-2 checklist and the Developmental Coordination Disorder Questionnaire (DCDQ), used as a reference point. Results: The children with ASD obtained significantly lower MABC-2 test results in all subtests in comparison with the control group. The children with suspected or diagnosed coordination disorders were characterized by a significantly greater number of co-occurring non-motor factors than the other participants of this study. MABC-2 test showed greater consistency with DCDQ than with the MABC-2 questionnaire. Conclusions: Children with ASD present a lower level of manual dexterity and balance and greater difficulties in performing tasks, including throwing and catching, in comparison with neurotypical children. The MABC-2 test with the MABC-2 checklist and DCDQ questionnaire constitute a complementary diagnostic tool. Full article

Background: Mirror therapy (MT) creates a cerebral illusion of a normal movement in a paretic limb. Although mirror therapy has been studied as a suitable intervention for children with Unilateral Cerebral Palsy (UCP), a comprehensive understanding of its full range of benefits is still lacking. Thus, the aim of this systematic review and meta-analysis was to determine all motor and sensory effects of MT in children and adolescents with UCP. Methods: Clinical trials focused on the application of MT in the upper limb (UL) of children and adolescents with UCP were included. A search was performed in PubMed, Cochrane Library, Web of Science, and LILACS databases. Eleven studies were included in this systematic review. The PEDro scale and the MINORS scale were applied to evaluate the methodological quality of randomized and non-randomized controlled trials, respectively. The Risk of Bias tool was also employed to evaluate the potential bias. In addition, the TIDieR checklist was used to assess the quality of intervention reporting. A random-effects model was used for the meta-analysis. Results: The studies included children with UCP from three to eighteen years, classified in Manual Ability Classification System levels I–IV. Motor effects of MT were found in nine studies. Also, two studies reported sensory effects on registration, perception, and proprioception abilities. Qualitative and quantitative analysis showed that MT improved manual dexterity and tactile registration in children and adolescents with UCP. Conclusions: MT is a therapy capable of inducing motor and sensory improvements in the affected UL of children with UCP. Full article

Introduction: Hypoglossal nerve stimulation (HNS) “Inspire_© therapy” has garnered popularity among obstructive sleep apnea (OSA) patients seeking an alternative to continuous positive airway pressure (CPAP) therapy. The growth in HNS has been particularly high in older adults living with OSA. Consistent and proper use of HNS in the geriatric population faces unique age-associated barriers: a high rate of multiple chronic conditions (MCC) and polypharmacy (being on five or more drugs). Early recognition and patient-centered management of these barriers will allow older patients to obtain maximum benefits from HNS. HNS has distinct advantages in the geriatric population because it overcomes many concerns related to CPAP therapy adherence, such as mechanical limitations due to manual dexterity, maxillofacial anatomy, dental issues such as usage of dentures, allergy/otolaryngology-related disorders, and pre-existing post-traumatic stress disorder-related claustrophobia. This paper describes how we worked with older patients with OSA and their care partners to overcome these barriers so patients can continue to derive cardiovascular, neurologic, and quality of life benefits resulting from optimal OSA management. These benefits are especially important in the older population because of higher rates of comorbidities (dementia, coronary artery disease, and atrial fibrillation) exacerbated by sub-optimally treated OSA. In this article, we describe our clinical experience with elderly patients on Inspire_© therapy, with a focus on the everyday difficulties faced by these patients and the measures implemented to address and mitigate these barriers. Methods: A retrospective chart review was conducted to identify patients aged 65 and above who underwent hypoglossal nerve stimulator insertion. Experiences of older patients during and after the insertion procedure were documented and compared to a younger population of patients on HNS therapy. We specifically collected information on difficulties encountered during activation or follow-up visits and compared them between the different age groups. Using this information, we identified areas to improve treatment adherence from the patients’ perspectives. Results: We identified 43 geriatric (65 to 86 years old) patients who received the Inspire implant at a tertiary academic medical center and compared them to a younger population of 23 patients. Most common challenges noted—with a potential to impact adherence—included orofacial and lingual neuropraxia (ischemic or demyelination-induced neuropathy) at activation, cognitive dysfunction (memory problems), preexisting anxiety, and insomnia. Other difficulties that are less commonly reported but equally important to consistent and proper use of HNS included headaches, concerns of device malfunction, change in comfort levels after cardiac procedures, and general intolerance of the device. The older patient population had a statistically significant higher incidence of cognitive difficulties (30.2% vs. 4.4%) and a smaller social support system (62.8% vs. 91.3%) affecting device usage compared to the younger population. There were no statistically significant differences in the rates of other more commonly reported adverse effects such as headaches, dry mouth, and anxiety between the two age groups. Conclusion: Despite several challenges faced by geriatric patients, Inspire_© hypoglossal nerve stimulation remains a viable, alternative treatment option for OSA with improved tolerance and adherence compared to CPAP. After identifying less commonly reported barriers such as cognitive decline, sensory deficits, and decreased social support systems, minor adjustments and appropriate education on use allows older patients to correctly use and benefit from Inspire_© device therapy, with subsequent improvement in sleep and overall quality of life. Full article

Background/Objectives: Action observation therapy (AOT) has gained attention as a rehabilitation method for motor function recovery following nerve injury. Although the total observation time and daily session duration have been studied, the effective observation duration per trial remains unclear. This study examined the effect of different observation durations on manual dexterity, mirror neuron system activity, and subjective psychomotor effort in healthy adults. Methods: Twenty-four healthy right-handed adults participated in this crossover study under four conditions: observing ball rotations with the dominant hand for one, two, or three minutes, or geometric patterns (control) for two minutes. The outcomes included maximum rotations and errors by both hands during a ball rotation task and interpersonal motor resonance (IMR), indicating mirror neuron system activity. These measures were compared before and after intervention. Subjective ratings of concentration, physical fatigue, and mental fatigue were assessed post-intervention. Results: Rotation performance significantly increased for the intervention hand after a 2 min observation and showed a notable effect (p = 0.113, r = 0.48) for the non-intervention hand after a 3 min observation compared to the control. The IMR was significantly greater during the 2 min observation than in the control. Compared to the 1 min observation, the 2 min and 3 min observations resulted in higher mental fatigue, and the 3 min observation showed lower concentration levels. Conclusions: These findings indicate that the observation duration has varying effects on manual dexterity and mirror neuron system activity, with optimal effects observed at specific time intervals while also highlighting the relationship between observational learning and psychomotor effort. Full article

Within the framework of Dexter’s theory, we calculate the energies of the Stark levels of Yb³⁺-Yb³⁺ paired centers in lithium niobate doped with Yb³⁺ ions (LiNbO₃:Yb³⁺) crystal, considering the interaction of optical electrons of ytterbium ions forming the paired center. The calculated Stark level energies are shown to correspond well with the observed cooperative luminescence wavelengths. Full article

Degenerative cervical myelopathy (DCM) is characterized by progressive neurological dysfunction, yet the contribution of intramedullary stress and strain during neck motion remains unclear. This study used patient-specific finite element models (FEMs) of the cervical spine and spinal cord to examine the relationship between spinal cord biomechanics and neurological dysfunction. Twenty DCM patients (mean age 62.7 ± 11.6 years; thirteen females) underwent pre-surgical MRI-based modeling to quantify von Mises stress and maximum principal strains at the level of maximum spinal cord compression during simulated neck flexion and extension. Pre-surgical functional assessments included hand sensation, dexterity, and balance. During flexion, the mean intramedullary stress and strain at the level of maximum compression were 7.6 ± 3.7 kPa and 4.3 ± 2.0%, respectively. Increased intramedullary strain during flexion correlated with decreased right-hand sensation (r = −0.58, p = 0.014), impaired right-hand dexterity (r = −0.50, p = 0.048), and prolonged dexterity time (r = 0.52, p = 0.039). Similar correlations were observed with intramedullary stress. Patients with severe DCM exhibited significantly greater stress during flexion than those with mild/moderate disease (p = 0.03). These findings underscore the impact of dynamic spinal cord biomechanics on neurological dysfunction and support their potential utility in improving DCM diagnosis and management. Full article

Trunk-like robots have attracted a lot of attention in the community of researchers interested in the general field of bio-inspired soft robotics, because trunk-like soft arms may offer high dexterity and adaptability very similar to elephants and potentially quite superior to traditional articulated manipulators. In view of the practical applications, the integration of a soft hydrostatic segment with a hard-articulated segment, i.e., a hybrid kinematic structure similar to the elephant’s body, is probably the best design framework. It is proposed that this integration should occur at the conceptual/cognitive level before being implemented in specific soft technologies, including the related control paradigms. The proposed modeling approach is based on the passive motion paradigm (PMP), originally conceived for addressing the degrees of freedom problem of highly redundant, articulated structures. It is shown that this approach can be naturally extended from highly redundant to hyper-redundant structures, including hybrid structures that include a hard and a soft component. The PMP model is force-based, not motion-based, and it is characterized by two main computational modules: the Jacobian matrix of the hybrid kinematic chain and a compliance matrix that maps generalized force fields into coordinated gestures of the whole-body model. It is shown how the modulation of the compliance matrix can be used for the synergy formation process, which coordinates the hyper-redundant nature of the hybrid body model and, at the same time, for the preparation of the trunk tip in view of a stable physical interaction of the body with the environment, in agreement with the general impedance–control concept. Full article

Soft grippers perform various handling tasks using passive conformability. This article reviews the improvements in their capabilities of dexterous manipulations, including how they achieve dexterity and how their performance could be evaluated. This article particularly points out the correlations between potential and real dexterity, and the relationship between the space of degrees of freedom and the corresponding dexterity level. Our main contribution is the proposition of a uniform framework for the characterization of soft grippers and their performance. We first present an introduction to soft grippers and those capable of in-hand manipulation. We emphasize their hybridization by combining soft and rigid materials or using several active materials. Next, we define and discuss the manipulation tasks and how to achieve dexterity, making a distinction between stable grasping and stable in-hand manipulation. We finally discuss the means to achieve assessment and how the performance can be evaluated, and we develop a general exploitable approach for characterizing soft grippers and their dexterous performance based on their architecture, DOF space, and physical performance. Full article

Aim: The aim of this study was to evaluate the relationship between oral hygiene (OH) efficiency and manual dexterity skills in Spanish five-year-old children using two fine motor tests. Methods: A cross-sectional study with a pre–post evaluation was designed. The children’s OH was measured according to the Silness and Löe plaque index (PI) before toothbrushing upon arrival at school (pre) and after supervised toothbrushing (post). Motor skills (children’s dexterity) were determined with the Visual Motor Skills and Resistance to Fatigue test (VMSRF test) and the scale for the Behavioural Assessment of Preschool Skills (BAPS scale). Data were analysed with the SPSS^® statistics software with a 95% confidence interval and bilateral significance. Results: One hundred and twenty-nine children were evaluated. The mean PI was 2.5, indicating generally poor OH in the sample. No difference in OH was observed between genders or in the brushing frequency categories. No significant differences in OH or the PI were found between right- and left-handed children either (p > 0.05). Significant differences were found between the OH category pre and post toothbrushing in the total sample, as well as in the various sextants and surfaces evaluated. The results of the VMSRF and BAPS tests indicate moderate visuomotor skills and fatigue resistance and a poor average skill level. A statistically significant improvement in the PI was found in children with higher scores in the VMSRF and BAPS tests. Conclusions: A significantly higher OH efficacy was found in children with better motor skills, although five-year-old children showed moderate visuomotor skills and fatigue resistance and a poor average preschool skill level. Full article