Search Results (149)

Background/objective: Despite the fact that almost 87% of children with Autism Spectrum Disorder (ASD) have physical coordination issues, motor skills are not the primary concern when ASD is diagnosed. An aquatic environment can provide multisensory stimuli that might assist these children; however, studies related to hydrotherapy with children with ASD have not yet examined whether this environment has an effect on balance and coordination. Methods: A control vs. research group examined the effect of a weekly, three-month hydrotherapy program on the balance and coordination abilities of male children and adolescents diagnosed with high-functioning ASD. Children (N = 22) between the ages of 6 and 17 years (mean: 8.4 ± 2.4), participated in this study. Each participant’s coordination and balance abilities were evaluated using the Movement Assessment Battery for Children-Second Edition (M-ABC-II). The initial evaluation (test one) was repeated (test two) after two months to establish improvement prior to intervention. The final evaluation (test three) was conducted at intervention termination. Individual functional goals were set for each patient using the Goal Attainment Scale (GAS). Results: No improvement was noted within the pre-intervention period (between tests one and two), yet there was a statistically significant improvement in the M-ABC-II Total Test score (p = 0.0133), in Manual Dexterity (p = 0.0181), and balance (p = 0.0053) post-intervention, between tests two and three. The mean GAS score for this study was 52.1, suggesting the achievement of prespecified functional goals. Conclusions: This study demonstrated a positive impact of a 12-week hydrotherapy program on balance and coordination and manual dexterity among children with ASD. A positive impact was also noted in patients’ individual functional abilities. 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

Understanding the forces imparted onto an object during manipulation can shed light on the quality of daily manual behaviors. We have developed an objective measure of the quality of hand function in children, the Bead Maze Hand Function Test, which quantifies how well the individual performs the activity by integrating measures of time and force control. Our main objectives were to examine associations between performance (total force output) on the Bead Maze Hand Function Test (BMHFT) and (1) performance on a sensitive measure of force scaling obtained on a laboratory-based dexterous manipulation task, and (2) general sensory and motor parameters important for fine motor skills. A total of 39 typically developing participants ranging in age from 5 to 10 years old (n = 28) and 15 to 17 years (n = 11). We found that the anticipatory coordination of digit forces was the best predictor of performance on the Bead Maze Hand Function test. We also found that factors such as age, gender, and pinch strength were associated with the BMHFT performance. These findings support the integration of more sensitive sensorimotor metrics, such as the total applied force, into clinical assessments. Linking the development of sensorimotor capabilities to functional task performance may facilitate more targeted and effective intervention strategies, ultimately improving a child’s participation in daily activities. Full article

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

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

Background and Clinical Significance: Uveal melanoma (UM) is an ocular malignancy with high mortality for which supportive therapies to mitigate disease and treatment-related side effects are lacking. Exercise therapy is one of the most versatile symptom-management strategies in oncology. We investigated the effects of a 4-month combined exercise intervention to restore and stabilize disease and treatment-related side effects. Case Presentation: A moderately active 61-year-old woman, diagnosed with metastatic UM in the right eye and treated with Cyberknife radiation, presented with diminished visual motor capacity due to disease-related loss of stereopsis and visual field reduction, without systemic comorbidities. The main outcome measures were visuomotor and functional tests (VFT) and cardio-pulmonary exercise testing (CEPT). All functional and most visuomotor tests demonstrated meaningful improvements between baseline and post-intervention by 7–128% and 8–24%, respectively. The CPET-derived parameters (% for ${\mathrm{V}}_{\dot{\mathrm{E}}}$, $\mathrm{V}{\dot{\mathrm{O}}}_2$, PPO, CEPT duration) showed improvements between 10 and 30% throughout the 4-month period. Conclusions: Data from this case report indicate that the 4-month exercise intervention yielded a consistent pattern of improvement in most VFT dimensions and cardio-pulmonary capacity. Interestingly, our data imply that post-radiation declines in visuomotor capacity recovered and expanded with enhanced manual dexterity. Future investigations need to extend our findings to a larger cohort of UM patients. Full article

Background/Objectives: Cognitive impairment is frequent in multiple sclerosis, yet routine screening is inconsistently implemented. We aimed to characterize cognitive impairment using CogEval in a Mexican cohort and to identify clinical and functional correlates. Methods: We conducted a cross-sectional study at UMAE No. 71 (Torreón, Mexico). Adults with MS (n = 81) underwent CogEval screening (classified as normal, mild, or severe). Disability, upper-limb dexterity (9-Hole Peg Test, mean of both hands), and gait speed (Timed 25-Foot Walk) were assessed. Bivariate tests and multivariable logistic regression examined associations with cognitive impairment. Results: Participants were 61.7% women; mean age was 35.7 ± 9.9 years. Median EDSS was 2.0 (IQR 1.0–4.0); 28.4% had EDSS ≥ 4. CogEval identified impairment in 49.4% (40/81), with 62.5% severe and 37.5% mild. In bivariate analyses, impairment was associated with higher EDSS (p < 0.001), slower 9-HPT (p < 0.001), and slower T25FW (p = 0.0058), but not with age, sex, or disease duration. In adjusted models, EDSS (OR 1.86, 95% CI 1.14–3.03; p = 0.012) and 9-HPT per second (OR 1.31, 95% CI 1.09–1.58; p = 0.005) independently predicted impairment, whereas T25FW and age were not significant. Discrimination was good (AUC = 0.863). Conclusions: About half of this Mexican MS cohort screened positive for cognitive impairment, particularly those with greater disability and reduced manual dexterity. CogEval appears feasible for routine screening and may help prioritize comprehensive neuropsychological assessment and rehabilitation. 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

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

Deaf-blindness, particularly in progressive conditions such as Usher syndrome, presents profound challenges to communication, independence, and access to information. Existing tactile communication technologies for individuals with Usher syndrome are often limited by the need for close physical proximity to trained interpreters, typically requiring hand-to-hand contact. In this study, we introduce a novel, cloud-based, AI-assisted gesture recognition and haptic communication system designed for long-term use by individuals with Usher syndrome, whose auditory and visual abilities deteriorate with age. Central to our approach is a wearable haptic interface that relocates tactile input and output from the hands to an arm-mounted sleeve, thereby preserving manual dexterity and enabling continuous, bidirectional tactile interaction. The system uses surface electromyography (sEMG) to capture user-specific muscle activations in the hand and forearm and employs lightweight, personalized convolutional neural networks (CNNs), hosted on a centralized server, to perform real-time gesture classification. A key innovation of the system is its ability to adapt over time to each user’s evolving physiological condition, including the progressive loss of vision and hearing. Experimental validation using a public dataset, along with real-time testing involving seven participants, demonstrates that personalized models consistently outperform cross-user models in terms of accuracy, adaptability, and usability. This platform offers a scalable, longitudinally adaptable solution for non-visual communication and holds significant promise for advancing assistive technologies for the deaf-blind community. 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

Traditionally, the determination of the Denavit–Hartenberg (DH) parameters for serial robotic manipulators is a manual process that depends on manufacturer documentation or user-defined conventions, often leading to inefficiency and ambiguity in DH frame placement and parameters. This study introduces a universal and systematic methodology for automatically deriving DH parameters directly from a robot’s zero configuration, using only the geometric relationships between consecutive joint axes. The approach was implemented in a MATLAB-based kinematics toolbox capable of computing both the classical and modified DH parameters. In addition to parameter extraction, the toolbox integrates workspace visualization, manipulability and dexterity analysis, and a slicing and alpha-shape algorithm for accurate workspace volume computation. Validation was conducted on multiple industrial robots by comparing the extracted parameters with the manufacturer data and the RoboDK models. Benchmark studies confirmed the accuracy of the volume estimation, yielding an absolute percentage error of less than 4%. While the current implementation relies on RoboDK models for verification and requires the manual tuning of the alpha-shape parameter, the toolbox provides a reproducible and extensible framework for research, education, and robot design. 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

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