Search Results (751)

Background/Objectives: Chronic psychomotor and cognitive slowing after stroke can persist despite standard rehabilitation, especially in young adults with subcortical injuries. Innovative, integrated interventions are crucial for patients who have reached a plateau in their rehabilitation. We present a case of a 41-year-old male with chronic psychomotor and cognitive slowing following a left lenticulostriate infarction (NIHSS score = 5 at onset), who had plateaued after conventional rehabilitation. Methods: Over 4 weeks the patient underwent 20 sessions of a multimodal approach including high-frequency repetitive transcranial magnetic resonance stimulation over the supplementary motor area and bilateral temporo-parietal junctions and simultaneous computerized cognitive training targeting attention and executive function. Both motor and cognitive assessments, along with quantitative EEG (qEEG) evaluations, were conducted before and after the treatment. Results: At the end of treatment, the patient showed significant clinical improvement: speed and coordination in upper extremities (Finger Tapping Test) increased by 66% (dominant hand) and 74% (non-dominant hand), while finger dexterity (Nine-Hole Peg Test) increased by 25% (dominant hand) and 19% (non-dominant hand). Cognitive scores improved in alertness (58%), visual exploration (25%), and flexibility (24%), while divided attention remained stable. qEEG investigation showed increases in alpha (79%), gamma (33%), and beta (10%) power, with topographic shifts in the stimulated regions. Conclusions: These findings highlight the feasibility of combining targeted rTMS and cognitive training to enhance neuroplasticity in the chronic phase of stroke. Clinical recovery was accompanied by normalized cortical rhythms, suggesting qEEG biomarkers may be useful for tracking treatment response. Multimodal precision neurorehabilitation may offer a path forward for patients with persistent cognitive–motor deficits post-stroke. Full article

Hand exoskeletons are increasingly used to support post-stroke reach-to-grasp, yet most intention-detection strategies trigger assistance from local hand events without considering the synergy between proximal arm transport and distal hand shaping. We evaluated whether proximal arm kinematics, alone or fused with EMG, can predict flexor and extensor digitorum activity for synergy-aligned hand assistance. We trained nine models per participant: linear regression (LINEAR), feedforward neural network (NONLINEAR), and LSTM, each under EMG-only, kinematics-only (KIN), and EMG+KIN inputs. Performance was assessed by RMSE on test trials and by a synergy-retention analysis, comparing synergy weights from original EMG versus a hybrid EMG in which extensor and flexor digitorum measure signals were replaced by model predictions. Results have shown that kinematic information can predict muscle activity even with a simple linear model (average RMSE around 30% of signal amplitude peak during go-to-grasp contractions), and synergy analysis indicated high cosine similarity between original and hybrid synergy weights (on average 0.87 for the LINEAR model). Furthermore, the LINEAR model with kinematics input has been tested in a real-time go-to-grasp motion, developing a high-level control strategy for a hand exoskeleton, to better simulate post-stroke rehabilitation scenarios. These results suggest the intrinsic synergistic motion of go-to-grasp actions, offering a practical path, in hand rehabilitation contexts, for timing hand assistance in synergy with arm transport and with minimal setup burden. Full article

Bilateral morphological asymmetry of the upper limbs may influence grip strength even in semi-active young adults. Understanding this relationship is important for identifying early neuromuscular imbalances with implications for ergonomics and rehabilitation. This study aimed to examine associations between upper limb anthropometric characteristics and grip strength in non-athlete students, considering gender and manual dominance. The sample included 192 healthy university students (110 females, 82 males; mean age 19.92 ± 1.4 years) without prior sports training. Thirteen bilateral anthropometric parameters of the upper limbs were assessed, including hand and palm dimensions, segmental lengths, and arm and forearm circumferences, along with grip strength measured by dynamometry in two positions: arm extended and arm flexed at 90°. Statistical analysis revealed significant differences in forearm length, arm and forearm circumferences, and grip strength (p < 0.001). The dominant limb consistently demonstrated higher grip strength, with mean differences of approximately 2 kg. Male participants showed higher absolute values for all morphological and functional variables, whereas stronger correlations between distal upper-limb morphology and grip strength were observed in females. These findings indicate that, despite largely symmetric skeletal dimensions, moderate functional asymmetries exist and grip strength is influenced primarily by local muscular development rather than overall limb size. Full article

Osteoarthritis (OA) is a progressive musculoskeletal disorder that affects not only older adults but also younger populations, often leading to chronic pain, joint stiffness, functional impairment, and a decline in quality of life. Non-invasive physical rehabilitation plays a critical role in slowing disease progression, alleviating symptoms, and maintaining joint mobility. However, rehabilitation tools such as compression gloves and manual exercise aids are typically passive and provide minimal real-time feedback to patients or clinicians. Others, such as exoskeletons and soft-actuated devices, can be costly or complex to use. This study presents the design and development of an electrically actuated glove integrated with force and flex sensors, intended to assist individuals diagnosed with Stage 2 OA in performing guided finger exercises. The system integrates a digital front-end application that offers real-time feedback and data visualization, enabling more personalized and trackable therapy sessions for both patients and healthcare providers. Preliminary results from an initial human trial with healthy participants demonstrate that the glove enables naturalistic movement without imposing excessive restriction or augmentation of motion. These findings support the glove’s potential in preserving hand coordination and dexterity, key objectives in early-stage OA intervention, and suggest its suitability for integration into home-based or clinical rehabilitation protocols. Full article

Soft pneumatic glove actuators for hand rehabilitation require compact, accurate models that can be evaluated in real time. At the same time, high-fidelity finite element (FE) simulations are too slow for iterative design and control. We develop a finite element-based calibration pipeline that combines a dependency-constrained human finger kinematic model with a segmented pseudo-rigid-body (PRB) description of ribbed-bellow soft pneumatic actuators sized to individual fingers. FE models with symmetry and contact generate pressure–pose data for the MCP, PIP, and DIP spans, from which we extract per-segment bending angles and axial elongations, fit simple pressure–kinematics relations, and identify PRB parameters using basin-hopping global optimization. The calibrated PRB reproduces FE flexion–extension trajectories for index and little finger actuators with millimetric accuracy (mean segment positioning errors of approximately 2.3 mm and 0.7 mm), preserves finger-like bending localized in the bellows, and maintains negligible compression of inter-joint links (below 1.2%). The pressure–bend and pressure–elongation maps achieve near-unity adjusted $R^2$, and the PRB forward kinematics evaluates complete pressure trajectories in less than half a millisecond, compared with several hours for the corresponding FE simulations. This pipeline provides a practical route from detailed FE models to controller-ready reduced-order surrogates for design-space exploration and patient-specific control of soft rehabilitation actuators. Full article

Advances in robotic technology for hand rehabilitation, particularly soft robotic gloves, have significant potential to improve patient outcomes. While vision-based algorithms pave the way for fast and convenient hand pose estimation, most current models struggle to accurately track hand movements when soft robotic gloves are used, primarily due to severe occlusion. This limitation reduces the applicability of soft robotic gloves in digital and remote rehabilitation assessment. Furthermore, traditional clinical assessments like the Fugl-Meyer Assessment (FMA) rely on manual measurements and subjective scoring scales, lacking the efficiency and quantitative accuracy needed to monitor hand function recovery in data-driven personalised rehabilitation. Consequently, few integrated evaluation systems provide reliable quantitative assessments. In this work, we propose an RGB-based evaluation system for soft robotic glove applications, which is aimed at bridging these gaps in assessing hand function. By incorporating the Hand Mesh Reconstruction (HaMeR) model fine-tuned with motion capture data, our hand estimation framework overcomes occlusion and enables accurate continuous tracking of hand movements with reduced errors. The resulting functional metrics include conventional clinical benchmarks such as the mean per joint angle error (MPJAE) and range of motion (ROM), providing quantitative, consistent measures of rehabilitation progress and achieving tracking errors lower than 10°. In addition, we introduce adapted benchmarks such as the angle percentage of correct keypoints (APCK), mean per joint angular velocity error (MPJAVE) and angular spectral arc length (SPARC) error to characterise movement stability and smoothness. This extensible and adaptable solution demonstrates the potential of vision-based systems for future clinical and home-based rehabilitation assessment. Full article

Trigger finger (TF) is a common debilitating hand disorder that often results in pain and functional limitations. Currently accepted conservative treatments include splinting, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. Recently, transfer energy capacitive and resistive (TECAR) therapy is emerging as a promising intervention for its potential to enhance microcirculation, reduce pain and inflammation, and stimulate tissue regeneration in various musculoskeletal conditions. However, its effectiveness for TF remains unclear. This study aims to compare the outcomes between TF conservative management with splinting alone, TECAR therapy alone, and the combined approach. Twenty-one fingers from 16 patients were included, with outcomes measured in terms of pain intensity, Green’s TF classification, frequency, severity and functional impact of triggering, and Quick-Disabilities of the Arm, Shoulder, and Hand. Assessments were conducted at baseline, at the fourth and eighth weeks after the initial treatment, and at one-month follow-up. Although all groups showed beneficial effects in all outcomes from baseline to the follow-up, the combined therapy group demonstrated statistically significant, quicker, and higher magnitude improvements in all clinical parameters compared to the single-treatment groups. By combining TECAR therapy with conventional splinting, TF patients may experience faster pain relief and functional recovery. Thus, integrating TECAR therapy into rehabilitation programs may represent a valuable opportunity for enhancing pain management and recovery in TF patients. Full article

Frailty assessment and monitoring are essential for supporting independent living and preventing adverse outcomes among older adults. This study aimed to develop and evaluate the concurrent validity of a high-accuracy home-monitoring system for assessing and tracking frailty in older adults. The system integrated off-the-shelf, zero-effort technologies, including ultra-wideband (UWB) indoor positioning, a smart scale, a connected hand dynamometer, and a Bluetooth speakerphone, to measure the five components of Fried’s Frailty Phenotype criteria. Twenty-one participants (aged 21–90 years) completed frailty assessments using both traditional clinical measures and the sensor-based system within a simulated home environment within a major rehabilitation hospital. The developed system demonstrated very strong and statistically significant correlations between the sensor-based system and the Fried’s Frailty Phenotype criteria, strong correlations with the Clinical Frailty Scale, and moderate-to-strong correlations with the Edmonton Frailty Scale, confirming the system’s strong concurrent validity. These findings indicate that high-accuracy, home-based monitoring technologies can provide reliable, objective, and non-invasive assessment of frailty in older adults, supporting early detection and continuous monitoring. This approach shows promise for future integration into smart home environments to enhance proactive frailty management and aging-in-place strategies. Full article

Background: Despite advances in myoelectric control of hand prostheses, their dropout rate remains high. Methods: We analyzed 37 features extracted from surface electromyography (sEMG) recordings from 15 participants, distributed into three groups: non-impaired individuals, impaired individuals with limb loss due to trauma, and impaired individuals with limb loss due to electrical burn. Feature relationships were examined with correlation heatmaps and two feature-selection methods (ReliefF and Minimal Redundancy Maximum Relevance), and classification performance was evaluated using machine-learning models to characterize sEMG behavior across groups. Results: Individuals with electrical-burn injury exhibited increased forearm co-contraction on the affected side across normalized isometric contractions, indicating altered motor coordination and likely higher energetic cost for prosthetic control. Feature selection and model results revealed etiology-dependent differences in the most informative sEMG features, underscoring the need for personalized, etiology-aware myoelectric control strategies. Conclusions: These findings inform the design of adaptive prosthetic controllers and targeted rehabilitation protocols that account for injury-specific motor control adaptations. Full article

This work introduces a low-cost, wearable assistive mouse designed to support digital interaction for individuals with motor impairments. The system combines inertial sensing for head-movement tracking and a pressure-based interface for simulating mouse clicks via “sip-and-puff” actions. The device enables full mouse control (pointer movement, clicks, and double-clicks) without relying on hand mobility. Preliminary evaluations, conducted with input from occupational therapy professionals, demonstrated promising usability and functionality comparable to commercial devices. The proposed solution offers a cost-effective, open-source alternative to existing adaptive technologies, with future development aimed at broader testing and integration in rehabilitation settings. Future work will include usability testing with individuals presenting real motor impairments to validate clinical applicability. Full article

Objectives: The recovery of arm function after macroreplantation is influenced by various factors. The aim of this study was to present the results of functional rehabilitation outcome after replantation of an upper extremity. Moreover, we assessed nerve conduction validity in the process of monitoring the return of manual functions. Methods: The study was performed in a group of seven patients after upper extremity macroreplantation and rehabilitation. Assessments included measuring hand/arm function loss using Swanson’s method, range of motion, muscle strength, sensation, and manipulation dexterity through the NHPT (Nine-Hole Peg Test). The nerve conduction study measured response amplitude, conduction speed, and distal latency. Results: The average loss of function of the hand diminished from 63.6% to 49.18%. Significant improvement in global pressure was achieved. In the functional capacity test (NHPT), the average time of the test was improved. The final nerve conduction study demonstrated improvements in motor and sensory conduction parameters. A correlation between improvement in conduction parameters in sensory fibers and sensation in the two-point discrimination test was found. Increased potential amplitude in motor fibers of the examined nerves correlated with a decrease in loss of function of the arm. Conclusions: Functional assessment and tailored rehabilitation strategies would maximize recovery potential after macroreplantation. Nerve conduction remains a crucial tool in monitoring the progress of manual skills after months of rehabilitation. Our findings highlight the importance of long-term follow-up of these patients. Full article

Stroke-induced motor impairment necessitates objective and quantitative assessment tools for rehabilitation planning. In this study, a gesture-specific framework based on high-density surface electromyography (HD-sEMG) was developed to characterize neuromuscular dysfunction using eight macroscopic features and two microscopic motor unit decomposition features. HD-sEMG recordings were collected from stroke patients (n = 11; affected and unaffected sides) and healthy controls (n = 8; dominant side) during seven standardized hand gestures. Feature-level comparisons revealed hierarchical abnormalities, with the affected side showing significantly reduced activation/coordination relative to healthy controls, while the unaffected side exhibited intermediate deviations. For each gesture, dedicated K-nearest neighbors (KNN) models were constructed for clinical validation. For Brunnstrom stage classification, wrist extension yielded the best performance, achieving 92.08% accuracy and effectively discriminating severe (Stage 4), moderate (Stage 5), and mild (Stage 6) impairment as well as healthy controls. For fine motor recovery prediction, the thumb–index–middle finger pinch provided the optimal regression performance, predicting Upper Extremity Fugl–Meyer Assessment (UE-FMA) scores with R = 0.86 and RMSE = 3.24. These results indicate that gesture selection should be aligned with the clinical endpoint: wrist extension is most informative for gross recovery staging, whereas pinch gestures better capture fine motor control. Overall, the proposed HD-sEMG framework provides an objective approach for monitoring post-stroke recovery and supporting personalized rehabilitation assessment. Full article

Aim: Preoperative planning and in-office patient education are essential elements of clinical management in patients afflicted with hand injuries. Three-dimensional (3D) printing aims to tackle these challenges by converting feedstock material into solid replicas. The purpose of this study was to review the clinical uses for 3D printing in hand surgery to identify approaches for delivering more personalized treatment strategies. Method: A systematic review was completed following PRISMA guidelines using Medline, Embase, and CINAHL databases, identifying studies published between 2013 and January 2025. A two-stage screening process, involving title, abstract, and full text reviews, was performed independently by two reviewers. Eligible studies included those involving patients with hand or wrist injuries (up to the distal radius) where 3D printing was utilized for diagnosis, surgical intervention, or rehabilitation. Results: The review included 751 patients (mean age: 38 years, range: 5–81 years) across 58 studies. The distal radius was the most commonly studied anatomical region (47%, N = 27), followed by the scaphoid (19%, N = 11). Key applications of 3D printing included preoperative planning (19%, N = 11), patient education (5%, N = 3), medical training (7%, N = 4), intra-operative assistance (38%, N = 22), splinting and casting (19%, N = 11), and prothesis and functional reconstruction (12%, N = 7). Conclusions: Despite its early stage of adoption in hand surgery, 3D printing has shown advantages, especially in enabling more personalized treatment strategies by improving intra-operative assistance, preoperative planning, and patient education. Further research is required to determine whether it positively affects postoperative outcomes, to calculate the cost–benefit ratio, and to compare its usage against standards of care. Full article

A 15-year-old female developed refractory Complex Regional Pain Syndrome (CRPS) Type I of the left hand following metacarpal fixation. Conservative therapy and hand rehabilitation failed, resulting in persistent allodynia and functional loss. She was admitted for multimodal analgesia combining subanesthetic ketamine infusion, gabapentin, and a tunneled supraclavicular continuous nerve catheter delivering ropivacaine. Pain decreased from 7/10 at rest to 0/10 within 48 h. Allodynia has resolved, and motor function has fully recovered. The catheter was removed nine days later without complication, and pain remission persisted. This case demonstrates a safe and effective multimodal strategy for adolescent CRPS integrating central and peripheral desensitization mechanisms. Full article

Background: Group-based dance interventions (GBDIs) have emerged as a promising approach to rehabilitation for neurological disorders. This pilot study evaluated the feasibility and preliminary effects of a GBDI on motor function, cognition, fatigue, and quality of life in individuals with Relapsing–Remitting Multiple Sclerosis (RRMS). Methods: The intervention consisted of two 60-min ballet sessions per week over 10 weeks, structured as 10 min of warm-up, 40 min of ballet exercises, and 10 min of stretching. Assessments were conducted at baseline (T0) and post-intervention (T1). Concerning motor measures, balance was assessed using the Mini-BESTest; gait performance was evaluated through the 6-min walk test (6MWT), four square step test (FSST), and figure-of-8 walk test (F8WT); upper limb motor functions were assessed using the box and block test (BBT) and 9-hole peg test (9HPT). Regarding cognitive functions, the Rey auditory verbal learning test (RAVLT), symbol digit modalities test (SDMT), and trail making test A and B (TMT-A/B) were administered, while fatigue and quality of life were assessed using the modified fatigue impact scale (MFIS) and the Short Form survey-36 (SF-36), respectively. Results: At T1, participants improved in Mini-BESTest (+17.5%), 6MWT (+7.3%), and BBT dominant hand (+6.9%). Performance also improved on the following cognitive tests: RAVLT Immediate Recall (+5.9%), RAVLT Delayed Recall (+20.3%), SDMT (+47.4%), TMT-A (−21.2%), and (TMT-B −24.5%). Conclusions: The very small sample size (n = 4) and the lack of a control group probably restrict the generalizability of the findings. Consequently, the results obtained by this pilot study should be considered exploratory and hypothesis-generating rather than definitive evidence of a robust benefit. Future studies should confirm these findings by enlarging the intervention cohorts and adopting a randomized controlled design. In this sense, a 10-week GBDI may provide a solid base for a safe and promising dance-based rehabilitation program that could lead to improvements in motor, cognition, and psychosocial spheres in people with RRMS. Full article