Search Results (153)

Background/Objectives: Although upper extremity dexterity problems are frequently reported in people with Parkinson’s disease (PwPD), valid and reliable scales for assessing upper extremity function and dexterity are limited. The objective of this study was to investigate the reliability and validity of the Action Research Arm Test (ARAT) and the Jebsen–Taylor Hand Function Test (JTHFT) in PwPD. Methods: Seventy PwPD and thirty HC were recruited. The test–retest reliability was evaluated by determining the intraclass correlation coefficient (ICC). MDC₉₅ was calculated by using ICC results. The concurrent validities of JTHFT and ARAT were determined by investigating their relationship with the Nine-Hole Peg Test (9-HPT), Hoehn and Yahr scale (H & Y), Unified Parkinson’s Disease Rating Scale (UPDRS), and motor symptoms (UPDRS-III). The cut-off times that best discriminated between PwPD and HC were investigated by plotting receiver operating characteristic (ROC) curves. Results: The ARAT and JTHFT showed excellent test–retest reliability (ICC = 0.937 to 0.995). The MDC₉₅ values for the ARAT were 0.38 for the dominant hand and 0.58 for the non-dominant hand. MDC₉₅ values for the JTHFT subtests and total scores ranged from 0.38 to 4.71. The ARAT, JTHFT subtests, and total scores demonstrated a fair-to-strong correlation with other outcomes (p < 0.05). The cut-off times that best differentiated JTHFT subtests and total scores ranged from 3.56 to 64.23. Conclusions: The JTHFT is a reliable and valid measurement tool for the assessment of manual dexterity in PwPD, while the ARAT is a reliable assessment tool in PwPD but does not have discriminant validity. Full article

Precise intraoperative identification of the canine thoracic duct remains challenging due to anatomical variability and limited visualization. This exploratory cadaveric feasibility study aimed to describe the technical applicability of fluorescence-guided thoracic duct mapping using video-assisted thoracoscopy (VATS) and robot-assisted thoracoscopy (Versius™ system). Four adult Beagle cadavers underwent bilateral thoracoscopic exploration after intranodal injection of indocyanine green (ICG, Verdye^®, 0.05 mg/kg; 0.5 mL). Near-infrared (NIR) fluorescence imaging enabled real-time visualization of the thoracic duct and its branches. Fluorescence quality was quantitatively characterized using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and contrast resolution (CR) calculated from standardized image frames. Both approaches achieved successful duct identification in all cadavers. VATS provided brighter overall fluorescence, whereas the robotic-assisted approach offered stable imaging, enhanced instrument dexterity, and improved duct-to-background discrimination. These findings confirm the feasibility of fluorescence-guided thoracic duct identification using both minimally invasive modalities in canine cadavers. The standardized assessment of optical parameters proposed here may support future in vivo studies to optimize imaging protocols and evaluate the clinical impact of fluorescence-guided thoracic duct surgery in dogs. Full article

Background/Objectives: Robotic-assisted surgery (RAS) has emerged as a technological advancement in gastrointestinal (GI) procedures, addressing limitations of conventional laparoscopy through enhanced dexterity, three-dimensional visualization, and ergonomic improvements. While its clinical use is expanding, the comparative benefits and cost-effectiveness of RAS across different GI domains remain unclear. Methods: An umbrella review was conducted to evaluate RAS across six GI domains: esophageal, gastric, liver, biliary, pancreatic, and colorectal. A systematic literature search of PubMed was performed in April 2025, yielding 8961 articles. Reviews published in English since 2018 and comparing RAS with laparoscopic or open approaches in human GI surgery were eligible. A total of 250 articles met the inclusion criteria. Data on technical feasibility, clinical outcomes, and cost-effectiveness were extracted. Methodological quality was appraised using the AMSTAR 2 checklist. Results were synthesized narratively. The study was supported by the National Research Foundation of Korea grant, and the protocol was registered in PROSPERO (CRD420251042541). Results: RAS demonstrated domain-specific advantages. Esophageal and gastric surgeries benefited from enhanced precision and lymphadenectomy, while long-term outcomes were comparable to laparoscopy. Robotic liver and biliary surgeries offered technical advantages in complex cases, but evidence was limited. The most significant clinical benefits were observed in pancreatic and colorectal procedures, in which RAS reduced conversion rates and improved short-term outcomes in anatomically challenging scenarios. Cost-effectiveness was generally unfavorable but showed improvement in high-volume centers due to reduced complications and shorter hospital stays. Conclusions: Robotic assistance provides the most consistent clinical benefit in pancreatic and colorectal surgery, especially for complex, high-risk cases. While high procedural costs remain a barrier, selective use of RAS in appropriate settings may yield improved outcomes. These findings support the need for ongoing evaluation of cost-effectiveness and long-term results to guide evidence-based integration of robotics into GI surgery. Full article

The control of tendon-driven robotic fingers presents significant challenges due to their inherent underactuation, coupled with complex non-linear dynamics arising from tendon elasticity, friction, and external disturbances. Therefore, achieving precise control of finger motion and contact interactions necessitates advanced modeling, estimation, and control strategies capable of addressing uncertainties in tendon tension, routing, and elasticity. This paper presents a comprehensive comparative study of three distinct control paradigms: feedback linearization with Proportional-Derivative (FBL-PD) control, feedback linearization with super-twisting sliding-mode algorithm (FBL-STA), and deep-deterministic reinforcement learning (DDPG-RL), for the precise trajectory tracking of a three-link tendon-driven robotic finger. Through extensive simulations, the performance of each controller is rigorously evaluated based on trajectory-tracking accuracy and robustness to varying disturbances. The results indicate that under disturbance-free conditions, the FBL-PD and FBL-STA controllers, when properly tuned, achieve precise tracking of the reference trajectory; however, they produce noticeably noisy control signals. When subjected to external disturbances, these controllers exhibit increased sensitivity, producing even noisier responses. In contrast, the DDPG-RL maintains smooth control dynamics and achieves sufficiently accurate tracking in both scenarios. This comparative analysis elucidates the strengths and weaknesses of each control strategy, offering critical insights and practical guidelines for the design and implementation of advanced control systems for dexterous tendon-driven robotic fingers. 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

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

Emerging virtual reality (VR) technologies provide objective and immersive methods for assessing cognitive–motor function, particularly in elite sport. This study evaluated the reliability and validity of VR-based cognitive–motor assessments in a large sample of elite male athletes (n = 829). Ten cognitive–motor tests, delivered via Oculus Quest 2 headsets, were used, covering four domains: Balance and Gait (BG), Decision-Making (DM), Manual Dexterity (MD), and Memory (ME). A Confirmatory Factor Analysis (CFA) was conducted to establish a four-factor model and generate data-driven weights for domain-specific composite scores. The results demonstrated that the composite scores for BG, MD, ME, and a Global Cognitive–Motor (CM) score were all normally distributed. However, the DM score significantly deviated from normality, exhibiting a pronounced ceiling effect. Test–retest reliability was high across all cognitive–motor domains. In summary, VR assessments offer ecologically valid and precise measurements of cognitive–motor abilities by capitalising on high-fidelity motion tracking and standardised test delivery. In particular, the Global CM Score offers a robust metric for parametric analyses. While future work should address the DM ceiling effect and validate these tools in diverse populations, this approach holds significant potential for enhancing the precision and sensitivity of psychological and clinical assessment. Full article

This study investigates the use of multi-field electrostimulation with the Fesia Grasp device for hand rehabilitation in patients with Multiple Sclerosis (MS). This research aims to evaluate the effectiveness of this novel approach in improving hand function and dexterity in MS patients. A cohort of MS patients with varying degrees of hand impairment underwent a structured rehabilitation program using the Fesia Grasp device, which delivers targeted electrical stimulation to specific muscle groups. Outcome measures assessed multiple aspects of hand function, including gross and fine motor skills, strength, and functional independence, at baseline, post-intervention, and 1-month follow-up. The main finding was a sustained between-group improvement in gross manual dexterity, measured by the Box and Block Test, at 1-month follow-up (p = 0.008, η²ₚ = 0.429). Secondary analyses showed task-specific gains in the experimental group, with significant intragroup improvements in Jebsen–Taylor Hand Function Test items related to simulated feeding (p = 0.012) and lifting light objects (p = 0.036), and a trend toward better performance in stacking checkers (p = 0.069) and faster page-turning (p = 0.046) after the intervention. Other outcomes showed non-significant changes favoring the experimental group. This research contributes to the growing body of evidence supporting the use of advanced electrostimulation techniques in neurological rehabilitation and offers promising implications for enhancing the quality of life for individuals with MS-related hand dysfunction. 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

The operational performance of robotic arms for multi-rotor flying robots (MFRs) has attracted growing attention in recent years. To explore new possibilities for aerial manipulation, this study investigates a novel parallel mechanism, the TriVariant, comprising one UP limb and two identical UPS limbs (2-UPS&UP). To evaluate its potential, we analyze its dimensional and kinematic characteristics and benchmark them against the widely adopted Delta robot, which is commonly integrated with unmanned aerial vehicles (UAVs). A prototype of the TriVariant is fabricated for experimental validation. Both analytical and experimental results reveal that, within a cylindrical task workspace characterized by a large diameter and moderate height, the TriVariant offers a more compact structure than the Delta robot, despite its slightly reduced dexterity. These findings highlight that the TriVariant is especially suitable for aerial manipulation in space-constrained environments where all limbs must be mounted beneath the UAV. Full article

Introduction: 3D-printing is an emerging technology in the field of prosthetics, offering advantages such as cost-effectiveness, ease of customization, and improved accessibility. While previous reviews have focused on limited aspects, the aim of this systematic review is to provide a comprehensive evaluation of the clinical outcomes of 3D-printed prostheses for both upper and lower limbs. Methods: A search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across six databases (PubMed, Web of Science, EBSCO, Scopus, Cochrane Library, and Sage). Studies on 3D-printed prostheses in human rehabilitation that focused on the clinical outcomes of the device were included, while studies lacking clinical data, 3D printing details, or focusing on traditional manufacturing methods were excluded. Finally, the risk of bias was assessed using the modified Downs & Black Checklist. Results: A total of 1420 studies were identified, with 11 meeting the inclusion criteria. The included studies assessed different 3D-printed prosthetic types and upper and lower limb prostheses. The main clinical outcomes analyzed were functional performance, design and material integrity, and overall effectiveness of 3D-printed prostheses. Studies on upper limb prostheses reported improved dexterity, range of motion (ROM), and user satisfaction, despite some durability limitations. Lower limb prostheses showed enhancements in comfort, gait parameters, and customization, particularly in amphibious and partial foot designs. Conclusions: 3D-printed prostheses show potential to improve functional performance, patient satisfaction, fit, and implementation feasibility compared to conventional methods. However, limitations such as small sample sizes, variability in assessment tools, and limited high-quality evidence highlight the need for further research to support broader clinical adoption. Full article

This study presents the design and evaluation of a dexterous prosthetic hand featuring five fingers, ten independently actuated joints, and four passively driven joints. The hand’s dexterity is enabled by a novel rigid–flexible coupled finger mechanism that incorporates a 1-active–1-passive joint configuration, which can enhance the dexterity of traditional rigid actuators while achieving a human-like workspace. Each finger is designed with a specific degree of rotational freedom to mimic natural opening and closing motions. This study also elaborates on the mapping of eight-channel electromyography to finger grasping force through improved TCN, as well as the control algorithm for grasping flexible objects. A functional prototype of the prosthetic hand was fabricated, and a series of experiments involving adaptive grasping and handheld manipulation tasks were conducted to validate the effectiveness of the proposed mechanical structure and control strategy. The results demonstrate that the hand can stably grasp flexible objects of various shapes and sizes. This work provides a practical solution for prosthetic hand design, offering promising potential for developing lightweight, dexterous, and highly anthropomorphic robotic hands suitable for real-world applications. Full article

Background: Hand function is critical for daily living, occupational performance, and sports. Optimal training approaches for healthy adults remain unclear. Objective: To evaluate the effects of hand-focused strength and proprioceptive training on grip strength, pinch strength, manual dexterity, maximum voluntary contraction, joint position sense, and force sense in healthy younger and older adults. Methods: PubMed, Google Scholar, Semantic Scholar, Web of Science, Cochrane CENTRAL and registers were searched until July 2025 for randomized controlled trials (RCTs) involving adults (≥18 years) without upper limb dysfunction. Studies with clinical populations, single-session interventions, or lacking pre–post outcome data were excluded. Risk of bias was assessed using the Cochrane RoB 2 tool. Random-effects meta-analyses (Hedges’ g) pooled pre–post change score differences for each outcome; subgroup analyses examined age, training type, and comparator. Results: Twenty-two RCTs (n = 1017 participants; 19–78 years) met the inclusion criteria. Strength and proprioceptive training produced a small-to-moderate improvement in grip strength (g = 0.44, 95% CI [0.23–0.64], 95%PI [–0.09, 0.96]) and a large improvement in manual dexterity (g = 1.11, 95% CI [0.52–1.71], 95%PI [–0.01, 2.23]). Effects on pinch strength were positive but non-significant (g = 0.63, 95% CI [–0.09–1.35], 95%PI [–1.38, 2.63]) and showed substantial heterogeneity. Moderator analyses indicated greater effects in older adults (g = 0.97) compared to younger adults (g = 0.18). Strength-only protocols showed significant effects, while combined protocols yielded smaller, non-significant effects; however, the difference between them was not statistically significant. Effects were also larger when compared with passive controls than with untrained hands. Limitations: Evidence quality was limited by high risk of bias, measurement variability, and small study numbers for some outcomes. Conclusions: Strength-focused hand training, particularly in older adults, yields meaningful improvements in grip strength and dexterity. Further high-quality RCTs are needed for under-studied outcomes. Full article

Digital Entrepreneurial Capability (DEC) is the integrated and learnable capacity that equips individuals, or founding teams, to sense, evaluate, and exploit entrepreneurial opportunities within digitally intermediated, platform-centric markets. The construct synthesises four interlocking elements. First, it requires technical dexterity: mastery of data engineering, AI-driven analytics, low-code development, cloud orchestration, and cybersecurity safeguards. Second, it draws on accumulated human capital—formal education, sector experience, and tacit managerial know-how that ground vision in operational reality. Third, DEC hinges on an opportunity-seeking mindset characterised by cognitive alertness, creative problem framing, a high need for achievement, and autonomous motivation. Finally, it depends on calculated risk tolerance, encompassing the ability to price and mitigate economic, technical, algorithmic, and competitive uncertainties endemic to platform economies. When these pillars operate synergistically, entrepreneurs translate digital affordances into scalable, resilient business models; when one pillar is weak, capability bottlenecks arise and ventures falter. Because each pillar can be intentionally developed through education, deliberate practice, and ecosystem support, DEC serves as a practical roadmap for stakeholders. It now informs scholarship across entrepreneurship, information systems, innovation management, and public-policy disciplines, and guides interventions ranging from curriculum design and accelerator programming to due-diligence heuristics and national digital literacy initiatives. Full article

Objectives: The primary objective was to compare the usage of Hazardous Materials (HazMat) Protective Personal Equipment (PPE) and ordinary PPE when performing basic and advanced health care support maneuvers in a prehospital setting, evaluating the effectiveness of several procedures, defined as the mean success rate of each. The secondary objective was to evaluate the presence of a learning effect, with improvements in the success rate and/or procedure timing. Methods: This was a prospective within-subjects (repeated-measures) study conducted on Emergency Medical Services (EMS) responders within their Chemical-Biological-Radiological-Nuclear-Explosive (CBRNe) training institutional programme. Volunteers performed a trial sequence of eight lifesaving procedures four times. During the first trial sequence, they wore standard clothing; during the three successive trials, they wore full HazMat PPE equipment. The primary outcomes were changes in success rate and time interval across the four trials. Results: A total of 146 EMS responders volunteered for the experiment. Procedure success rates remained high overall, with the most notable initial drop observed for video-assisted intubation (≈−10%). The only statistically significant delay in the first HazMat trial compared with baseline was for intravenous access (median +30 s; p < 0.001). In the two successive HazMat trials, success rates and timings improved, with median values coming close to baseline. However, only 61% of participants completed the entire drill due to tolerance limits of the equipment. Conclusions: HazMat PPE, while physically and ergonomically demanding, has minimal impact on most lifesaving procedures, though it may reduce intubation success and delay intravenous access. Tolerance to prolonged use is a key limitation, but dexterity improves rapidly with brief practice. EMS responders can benefit from continuous training practice, while manufacturers could explore ergonomic and tolerance improvements in their PPE equipment. Full article