Search Results (62)

Introduction: Human immunodeficiency virus (HIV)-associated neurocognitive impairment (NCI) remains a concern despite combination antiretroviral therapy (cART), with cognitive problems often persisting even after viral suppression. The mechanisms underlying neurocognitive deterioration in people living with HIV (PLWH) and the role of plasma biomarkers remain unclear. This study aims to evaluate neurocognitive trajectories and biomarker changes in a real-world cohort of newly diagnosed PLWH initiating cART in Greece. Methods: This prospective, single-center study assessed neuropsychological performance and plasma biomarkers in treatment-naïve PLWH at baseline and 18 months after cART initiation. HIV-associated neurocognitive disorder (HAND) was classified using the Frascati criteria, and plasma biomarkers of inflammation and monocyte activation were measured. Correlations between biomarkers and cognitive performance were analyzed. Results: A total of 39 treatment-naïve PLWH were enrolled in this study. At baseline, 45.7% of participants met criteria for HAND, predominantly, asymptomatic neurocognitive impairment (ANI). Over 18 months, neurocognitive function improved, particularly in speed of information processing, executive function, and visuospatial ability, while verbal fluency, fine motor dexterity, and attention/working memory remained unchanged. Biomarkers of inflammation and monocyte activation decreased following cART, except for neopterin, which increased (10.6 vs. 13 ng/mL, p = 0.002), and plasma NFL (7.5 vs. 7.2 pg/mL, p = 0.54), which remained stable. A negative correlation between monocyte activation markers and cognitive performance was observed only at follow-up, suggesting that systemic inflammation may mask these associations in untreated PLWH. Conclusions: Early cART initiation supports neurocognitive recovery and reduces immune activation in PLWH. The observed correlation between cognitive performance and monocyte activation markers after viral suppression highlights the potential utility of plasma biomarkers in predicting cognitive impairment. Full article

Background/Objectives: The goal of educators is to leave no learner behind. Ultrasounds require dexterity and 3D image interpretation. They are technologically complex, and current medical residency programs lack a reliable means of assessing this ability among their trainees. This prompts consideration as to whether background characteristics or certain pre-existing skills can serve as indicators of learning aptitude for ultrasounds. The objective of this study was to determine whether these characteristics and skills are indicative of learning aptitude for ultrasounds. Methods: This prospective study was conducted with third-year medical students rotating in emergency medicine at the New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA. First, students were given a pre-test survey to assess their background characteristics. Subsequently, a psychomotor task (Purdue Pegboard) and visual–spatial task (Revised Purdue Spatial Visualization Tests) were administered to the students. Lastly, an ultrasound task was given to identify the subxiphoid cardiac view. A rubric assessed ability, and proficiency was determined as a 75% or higher score in the ultrasound task. Results: In total, 97 students were tested. An analysis of variance (ANOVA) was used to ascertain if any background characteristics from the pre-test survey was associated with the ultrasound task score. The student’s use of cadavers to learn anatomy had the most correlation (p-value of 0.02). Assessing the psychomotor and visual–spatial tasks, linear regressions were used against the ultrasound task scores. Correspondingly, the p-values were 0.007 and 0.008. Conclusions: Ultrasound ability is based on hand–eye coordination and spatial relationships. Increased aptitude in these abilities may forecast future success in this skill. Those who may need more assistance can have their training tailored to them and further support offered. Full article

The REAtouch^® Lite device was recently developed to support motor skill learning-based interventions, integrating both games/activities and assessment tools to enable home-based telerehabilitation. Given the importance of hand functions in rehabilitation of patients with brain lesions, this study aimed to validate a virtual version of the Box and Block Test (vBBT) implemented in the REAtouch^® device. A total of 205 healthy participants, 37 post-stroke adults, and 37 children with cerebral palsy (CP) performed the standard BBT, various versions of the newly designed vBBT (with/without a separation wall; with 6, 4, and free zones) and the Tower of London test assessing executive function/planning abilities. Friedman’s ANOVA revealed significant differences between the BBT and all versions of the vBBT scores in healthy participants (all p < 0.001). However, the vBBT-4 zones showed the largest intraclass correlation coefficient (ICC) with the BBT in healthy participants (0.58) and even higher correlations in participants with CP and stroke (>0.8). Only the vBBT-6 zones version showed a significant correlation with patients’ planning abilities (p < 0.01; r = −0.28). These findings highlight the vBBT-4 zones as the most relevant version to assess hand dexterity directly with the REAtouch^® device, potentially within telerehabilitation modalities. Further normative data must be established. Full article

Background/Objective: Parkinson’s disease (PD) is characterized by motor and cognitive impairments that significantly affect quality of life. Robotic-assisted therapies, such as the AMADEO^® system, have shown potential in rehabilitating upper limb function but are underexplored in PD. This study aimed to assess the effects of Robotic-Assisted Therapy (RAT) compared to Conventional Physical Therapy (CPT) on cognitive, motor, and functional outcomes in PD patients. Methods: A single-blind, randomized controlled trial was conducted with PD patients allocated to RAT or CPT. Participants were assessed at baseline (T0) and post-intervention (T1) using measures including MoCA, FAB, UPDRS-III, 9-Hole Peg Test, FMA-UE, FIM, and PDQ-39. Statistical analyses included ANCOVA and regression models. Results: RAT led to significant improvements in global cognition (MoCA, p < 0.001) and executive functioning (FAB, p = 0.0002) compared to CPT. Motor function improved, particularly in wrist and hand control (FMA-UE), whereas changes in fine motor dexterity (9-Hole Peg Test) were less consistent and did not reach robust significance. No significant improvements were observed in broader quality of life domains, depressive symptoms, or memory-related cognitive measures. However, quality of life improved significantly in the stigma subdomain of the PDQ-39 (p = 0.0075). Regression analyses showed that baseline motor impairment predicted cognitive outcomes. Conclusions: RAT demonstrated superior cognitive and motor benefits in PD patients compared to CPT. These results support the integration of robotic rehabilitation into PD management. Further studies with larger sample sizes and long-term follow-up are needed to validate these findings and assess their sustainability. Full article

Background: Humans interacting with virtual objects is becoming common due to the popularity of the devices adopting the mixed reality (MR) techniques. Assessing hand functions using these devices for medical purposes provides alternatives in addition to the traditional hand function assessment techniques. Objectives: The objectives were to compare the movement time (MT) of handing a real and a virtual object between post-surgery wrist fracture patients and healthy adults and to determine the correlation between the MT and commonly adopted hand function indicators. Methods: An experiment was performed. A total of 29 participants, including 17 patients and 12 healthy adults, joined. All the participants moved a real or a virtual tube from an origin to a destination. A set of MR device was adopted to generate the virtual object. The MTs were analyzed to compare differences between the patients and the healthy adults. Regression models were developed to predict the MT under experimental conditions. Results: The MT of the surgical hand was significantly longer than that of the nonsurgical hand of the patients and was significantly longer than that of the left hand of the healthy adults. The MT was negatively correlated with the commonly adopted hand function indicators, including grip strength, range of motion, hand dexterity score, and Modified Mayo Wrist Score. Conclusions: The anticipation that the MT of interacting with virtual objects for patients may reveal hand function characteristics for post-surgery patients was supported. The regression models developed could reveal the progression of hand function recovery for these patients. Having patients interact with virtual objects could be a supplemental approach in assessing their hand functions. Full article

Background and Objectives: This cross-sectional study investigates the association between fatigue and upper limb (UL) function in people with Multiple Sclerosis (PwMS). Methods: Adult PwMS were recruited from five Italian MS centers. Fatigue was evaluated using the Modified Fatigue Impact Scale (MFIS), while UL function was assessed through the Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and Hand-Grip Strength (HGS). Data analysis included Spearman rank correlations and Mann–Whitney U tests. Results: A total of 261 participants were involved. Significant correlations were found between fatigue severity, UL function, and patient-reported manual ability. Physical and cognitive aspects of fatigue were independently related to functional impairments. Participants with clinically relevant fatigue demonstrated lower subjective UL function, poorer BBT and HGS performance, and greater HGS asymmetry. Discussion: The study underscores the complex relationship between fatigue and functional impairments in MS. The findings suggest both strength and dexterity contribute to the perception of clinically relevant fatigue in PwMS, highlighting the importance of incorporating both domains to complement neurological assessment. Conclusion: Fatigue in PwMS is linked to both subjective and objective measures of UL function. Assessing strength and dexterity alongside fatigue may enhance clinical understanding and inform targeted rehabilitation strategies. Full article

Background and Objectives: Brain-computer interface (BCI) technology is revolutionizing stroke rehabilitation by offering innovative neuroengineering solutions to address neurological deficits. By bypassing peripheral nerves and muscles, BCIs enable individuals with severe motor impairments to communicate their intentions directly through control signals derived from brain activity, opening new pathways for recovery and improving the quality of life. The aim of this study was to explore the beneficial effects of BCI system-based interventions on upper limb motor function and performance of activities of daily living (ADL) in stroke patients. We hypothesized that integrating BCI into occupational therapy would result in measurable improvements in hand strength, dexterity, independence in daily activities, and cognitive function compared to baseline. Materials and Methods: An observational study was conducted on 56 patients with subacute stroke. All patients received standard medical care and rehabilitation for 54 days, as part of the comprehensive treatment protocol. Patients underwent BCI training 2–3 times a week instead of some occupational therapy sessions, with each patient completing 15 sessions of BCI-based recoveriX treatment during rehabilitation. The occupational therapy program included bilateral exercises, grip-strengthening activities, fine motor/coordination tasks, tactile discrimination exercises, proprioceptive training, and mirror therapy to enhance motor recovery through visual feedback. Participants received ADL-related training aimed at improving their functional independence in everyday activities. Routine occupational therapy was provided five times a week for 50 min per session. Upper extremity function was evaluated using the Box and Block Test (BBT), Nine-Hole Peg Test (9HPT), and dynamometry to assess gross manual dexterity, fine motor skills, and grip strength. Independence in daily living was assessed using the Functional Independence Measure (FIM). Results: Statistically significant improvements were observed across all the outcome measures (p < 0.001). The strength of the stroke-affected hand improved from 5.0 kg to 6.7 kg, and that of the unaffected hand improved from 29.7 kg to 40.0 kg. Functional independence increased notably, with the FIM scores rising from 43.0 to 83.5. Cognitive function also improved, with MMSE scores increasing from 22.0 to 26.0. The effect sizes ranged from moderate to large, indicating clinically meaningful benefits. Conclusions: This study suggests that BCI-based occupational therapy interventions effectively improve upper extremity motor function and daily functions and have a positive impact on the cognition of patients with subacute stroke. 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

Background and Objectives: Although virtual reality (VR) has been shown to be effective in rehabilitation through motor learning principles, its impact on upper extremity function, particularly in the context of console use, remains unclear. Materials and Methods: This study aimed to investigate the effects of VR-based task-oriented movement on the upper extremity of healthy individuals. A total of 26 healthy individuals performed task-oriented movements in both real and virtual environments in a randomized order. All participants completed a single session of task-oriented movements using a VR Goggle system in a virtual setting. Physiotherapists designed immersive VR-based experiences and 3D screen-based exergames for this study. Upper extremity function was assessed using several measures: joint position sense (JPS) of the wrist and shoulder was evaluated using a universal goniometer, reaction time was measured via a mobile application, and gross manual dexterity was assessed using the box-and-block test (BBT). Evaluations were conducted before and after the interventions. Results: The results showed that JPS remained similar between conditions, while BBT performance improved in both groups. However, the reaction time increased significantly only after VR intervention (p < 0.05). No significant period or carryover effects were observed across the parameters. These findings suggest that VR-based task-oriented training positively influences reaction time and supports hand function. Moreover, VR systems that simulate joint position sense similar to real-world conditions may be beneficial for individuals with musculoskeletal motor deficits. Conclusions: These results highlight the potential for integrating VR technology into rehabilitation programs for patients with neurological or orthopedic impairments, providing a novel tool for enhancing upper extremity function and injury prevention strategies. Full article

Background/Objectives: This study evaluated the effects of a tactile-discrimination compensatory real-time feedback device on hand sensorimotor function in cervical spinal cord injury patients. The study assessed changes in hand numbness, dexterity, and electroencephalogram (EEG) activity, particularly γ-wave power in the sensorimotor area during skilled finger movements. Methods: Three patients with cervical spinal cord injury who presented with hand sensorimotor dysfunction underwent treatment with this device. All cases underwent the intervention using an AB design; A is the exercise task without the system device, and B is the exercise task under the system device. To confirm the reproducibility and minimize the influence of confounding factors, a multiple-baseline design, in which the intervention period was staggered for each subject, was applied. To determine efficacy, the hand numbness numerical rating scale, peg test, and EEG were measured daily, and Tau-U calculations were performed. Results: In two of three cases, moderate or very large changes were observed in numbness in B. In all cases, there was a large or very large change in the peg test results in the B. Regarding EEG activity, the non-skilled participants showed amplification of γ-wave power in the sensorimotor area during the B. Conversely, in the skilled participants, the γ-wave power of the sensorimotor area was attenuated during skillful movements. Conclusions: These findings indicate that the ability of the brain to compare and align predictive control with sensory feedback might be compromised in patients with damage to the afferent pathways of the central nervous system. Moreover, the use of this device appears to have played a role in supporting functional recovery. Full article

Background/Objectives: Manual dexterity and hand strength are common challenges in children with unilateral cerebral palsy (UCP), limiting the use of their affected upper limb and impacting daily activities. The efficacy of a long-duration Mirror Visual Feedback (MVF) program compared to Modified Constraint-Induced Movement Therapy (mCIMT) in addressing these issues remains unreported. This study was conducted to compare the efficacy of mCIMT and MVF in improving manual dexterity and hand strength in children with UCP. Methods: Fifty children with UCP (aged 5–9 years) were randomly assigned to either the MVF or mCIMT group. Children in both groups received their respective interventions for 30 min, five times per week, over 12 weeks. Additionally, all participants underwent traditional physical therapy for 12 weeks, three times per week, with each session lasting 45 to 60 min. Manual dexterity was assessed using the Box and Block Test (BBT), and maximum isometric hand strength was measured with a hydraulic handheld dynamometer. Evaluations were conducted before the intervention and 12 weeks later. Results: Repeated measures of MANOVA revealed significant enhancements in manual dexterity and hand strength in both groups after the intervention. However, the mCIMT group demonstrated significantly greater gains in BBT scores (p = 0.014) and maximum isometric hand strength (p = 0.017) compared to the MVF group, with effect sizes of 0.75 and 0.79, respectively. Conclusions: Incorporating either mCIMT or MVF into rehabilitation significantly enhances manual dexterity and hand strength in children with UCP, with mCIMT yielding superior outcomes. 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

Background: With technological advancements, virtual versions of the Box and Block Test (BBT) employing the Leap Motion Controller have been developed for evaluating hand dexterity. Currently, there are no studies about the usefulness of this system in children with unilateral cerebral palsy (UCP). Thus, our main objective is to apply a virtual BBT based on the Leap Motion Controller in children with UCP compared with the real BTT for assessing upper limb function within a pilot study. Methods: Seven children between the ages of 4 and 8 years who were diagnosed with UCP were assessed three times using the real and virtual BBT. Results: For all the participants, performance was greater in the real BBT than in the virtual BBT. During the last assessment, the participants reached 28.17 (SD:6.31) blocks in the real test and 9.00 (SD:5.90) in the virtual test. The correlation index between the two modalities of the BBT was moderate (r = 0.708). Conclusions: The results obtained in this study suggest that the application of the virtual BBT in children with UCP is feasible. Future studies are needed to validate the application of the virtual BBT in children with UCP. Full article

Background/Objectives: Huntington’s disease (HD) is a neurodegenerative movement disorder associated with significant disability and impairment of Activities of Daily Living (ADLs). The impact of upper limb disability on quality of life (QoL) and its influence on ADLs is not well known yet. The aim of this study was to describe the manipulative dexterity, strength, and manual eye coordination of patients with manifest and premanifest-HD compared to healthy individuals and to analyze its influence on ADLs and QoL. Methods: We performed an observational, cross-sectional study including 71 ambulatory participants (27 manifest-HD patients, 15 premanifest-HD, and 29 controls). We gathered sociodemographic data, as well as clinical data, including cognition (MMSE), HD motor severity (Unified HD rating scale, UHDRS-TMS), QoL (Neuro-QoL), and ADLs (HD-ADL). Hand dexterity and strength in the dominant and non-dominant hand were assessed with the Nine Hole Peg Test, Ten Neurotest, Nut and Bolt Test, dynamometry, and Late-Life FDI. Analysis of covariance (ANCOVA) models were performed to investigate differences in hand function between manifest-HD, premanifest-HD, and controls. Results: Manifest-HD patients had significantly worse performance in manual and finger dexterity, fine-motor coordination, and poorer handgrip strength than premanifest-HD and controls. Premanifest-HD required more time to complete the test than controls. Significant correlations were found between hand variables and Late-Life FDI, Neuro-QoL, HD-ADL, and UHDRS-TMS. Conclusions: HD affects manipulative dexterity and hand function in premanifest and manifest patients. Therefore, to prevent disability and decreased QoL, evaluating the progression of upper limb dysfunction in HD is important to offer the best possible therapeutic interventions. 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