Search Results (1,983)

Repeated sit-to-stand practice is an important rehabilitation strategy for individuals with trunk and lower limb impairments; however, its implementation is often limited by fall risk, patient fatigue, and the physical burden on assisting staff. This prospective single-center feasibility study evaluated the safety and feasibility of sit-to-stand training using Qolo, a motor-free, gas-spring-assisted sit-to-stand training device, in 40 clinically selected individuals with trunk and lower limb impairments. All sessions were performed under physiatrist supervision. The primary feasibility endpoint was completion of at least three intervention sessions using Qolo. A total of 181 sessions were conducted, and in this clinically selected, supervised cohort, 36 participants achieved the primary endpoint, yielding a feasibility rate of 90.0% (95% confidence interval, 76.9–96.0%). The median number of sessions was 4 per participant, with 48 sit-to-stand repetitions per session and 134 repetitions per participant. Participant-reported fatigue was descriptively higher after training, whereas perceived fatigue among primary assisting staff remained low. No intervention-related adverse events, falls, or skin injuries were observed in this supervised feasibility study. Thirteen device-related problems were recorded, most of which involved the Qolo–tablet connection rather than the assistive mechanism, indicating important usability and reliability issues for further refinement. These findings support the early feasibility of Qolo-assisted sit-to-stand training in this small, clinically selected, supervised, heterogeneous cohort. Further controlled studies are warranted to evaluate clinical effectiveness, sustained adherence, staff workload, device reliability, and safety under routine clinical use. Full article

EEG-based motor imagery (MI) decoding is commonly evaluated in open loop, but strong offline performance does not necessarily translate into stable real-time control once decoder outputs drive a physical device. This issue is especially relevant for lower-limb exoskeletons, where initiating movement, sustaining movement, stopping movement, and maintaining rest can impose different controller-level demands. This study presents a proof-of-concept controller-level validation of an EEG-driven ankle exoskeleton framework, using a staged design that links open-loop decoder development to real-time closed-loop controller testing. Open-loop EEG data were collected from nine able-bodied participants during static and dynamic ankle MI using an eight-channel g.tec Unicorn Hybrid Black system, with matched PA-SEMI outputs available for eight participants in the primary open-loop comparison. We used a hybrid feature representation combining spectral, spatial covariance, and temporal complexity descriptors to compare a supervised Passive–Aggressive (PA) classifier with a Semi-supervised latent learning network (SEMI). Performance was assessed using epoch-level and persistence-based event metrics intended to reflect controller triggering. Under the evaluated model-specific protocols, SEMI produced higher open-loop accuracy and lower false-trigger rates than PA. The reported SEMI analysis was transductive: feature windows from the target-participant evaluation runs were available without labels during consistency training, and their labels were withheld until final evaluation. However, we selected PA for the primary matched closed-loop validation because it could be retrained, checked, and deployed within the same-day workflow. Since SEMI was not evaluated in a balanced matched closed-loop comparison, this study does not determine whether PA or SEMI provides superior real-time controller performance. Deployment-oriented PA updates were audited using limited same-day calibration data and evaluated in matched PA-based closed-loop trials with three participants, based on online controller logs. The closed-loop experiments were conducted on RehAnkle, a pre-commercial robotic ankle rehabilitation device operated here as a single-active-DoF ankle platform for dorsiflexion-oriented EEG control. In closed-loop trials, start and stop commands were generally reliable, whereas sustained movement and sustained rest were less stable. These proof-of-concept results indicate that command generation and state maintenance should be evaluated as separate controller-level problems, and that open-loop accuracy alone is insufficient to characterize real-time exoskeleton control. Full article

Upper-limb motor dysfunction resulting from neurological disorders severely limits patients’ activities of daily living and social participation. Pneumatic upper-limb rehabilitation robots have emerged as a promising intervention owing to their inherent compliance, lightweight design, and high power-to-weight ratio, which facilitate safe, repetitive, and home-based training. Despite these advantages, extensive clinical translation remains hindered by challenges including actuator hysteresis, nonlinear dynamics, limited accuracy in intention recognition, and inconsistent clinical evaluation metrics. This review systematically examines recent advancements in pneumatic upper-limb rehabilitation robots across four critical dimensions: structural design, human–robot interaction, control strategies, and clinical translation. We comparatively analyze rigid exoskeletons, soft wearable devices, and rigid–soft hybrid configurations based on output capability, motion accuracy, comfort, and clinical applicability. The findings suggest that while rigid systems offer high precision and soft systems maximize safety, rigid–soft hybrid architectures represent a critical developmental trend for balancing motion accuracy with interaction compliance. Furthermore, the review evaluates multimodal sensing techniques (e.g., EMG, EEG, and IMUs) for motion intention decoding and training state monitoring, alongside conventional, adaptive, and artificial intelligence-driven control methods aimed at compensating for pneumatic nonlinearity and improving real-time response. Current clinical evidence indicates that these systems effectively enhance upper-limb function and muscle strength, particularly in post-stroke rehabilitation; however, existing trials are frequently constrained by small sample sizes, short interventions, and heterogeneous protocols. Future research must prioritize rigid–soft hybrid architectures, robust multimodal sensor fusion, digital twin-assisted assessment, adaptive intelligent control, and standardized home-based rehabilitation platforms. Ultimately, this comprehensive review provides a concise reference for the design optimization and clinical deployment of next-generation pneumatic rehabilitation systems. Full article

Background: Spasticity is one of the most disabling manifestations of multiple sclerosis (MS), contributing to limitations in walking and transfers, pain, progressive functional limitation, and reduced quality of life. Despite advances in rehabilitation, pharmacological therapies, botulinum toxin injections, and intrathecal baclofen, many patients continue to experience refractory focal or multifocal spasticity requiring alternative therapeutic approaches. Percutaneous cryoneurolysis has recently emerged as a minimally invasive peripheral neuromodulation technique capable of selectively reducing pathological muscle overactivity through reversible axonotmesis while preserving the structural framework necessary for nerve regeneration. Growing clinical experience has expanded its application across several neurological disorders; however, its role in MS has not yet been comprehensively defined. Methods: A structured narrative review was conducted through comprehensive searches of PubMed/MEDLINE, Scopus, and Web of Science. Original clinical studies evaluating percutaneous cryoneurolysis for neurological spasticity were identified and critically synthesized. Because disease-specific evidence in MS remains limited, studies involving other upper motor neuron disorders, including stroke, cerebral palsy, traumatic brain injury, and spinal cord injury, were also considered to provide a broader overview of current clinical applications, procedural techniques, safety, and functional outcomes. Results: The available evidence includes case reports, case series, and prospective and retrospective observational studies, together with recent evidence syntheses. Across different neurological conditions, ultrasound-guided cryoneurolysis has consistently demonstrated technical feasibility and a favorable safety profile, with reported reductions in spasticity, improvements in passive range of motion, pain reduction, facilitation of positioning and nursing care, and, in selected studies, improved functional performance. Recent observational cohorts and prospective studies have expanded the evidence base by providing larger patient populations and longer follow-up, while systematic evidence syntheses have confirmed the growing clinical interest in this technique. Nevertheless, substantial heterogeneity persists regarding patient selection, target nerves, procedural protocols, outcome measures, and duration of follow-up. Evidence specifically addressing patients with MS remains limited and is currently derived primarily from individual case reports and small clinical series. Conclusions: Current evidence suggests that percutaneous cryoneurolysis represents a promising minimally invasive adjunctive treatment for selected patients with focal or multifocal neurological spasticity, including those with multiple sclerosis. However, the available evidence remains predominantly observational, and randomized controlled trials comparing cryoneurolysis with established therapies are still lacking. Future multicenter prospective studies, standardized treatment protocols, and disease-specific investigations are required to better define patient selection, long-term efficacy, safety, and the role of cryoneurolysis within contemporary multidisciplinary spasticity management. Full article

Background/Objectives: Cerebral palsy is a lifelong neurodevelopmental condition associated with motor impairment and activity limitation, and adolescence is a clinically important period during which functional decline or plateau may occur. Virtual reality-assisted rehabilitation may provide task-specific practice with augmented feedback and enhanced engagement. This systematic review and meta-analysis aimed to evaluate the effects of virtual reality-assisted rehabilitation on functional outcomes in adolescents aged 10 to 19 years with cerebral palsy. Methods: Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials were searched from inception to 25 February 2026 for studies enrolling adolescents with cerebral palsy or mixed-age samples with extractable adolescent data. Two reviewers independently screened studies and extracted data. Primary domains were lower-limb/balance-related function and upper-limb function. Within-group pre–post standardised mean differences were pooled using random-effects models, and certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Results: Eight studies including 83 participants were eligible; seven studies including 68 participants contributed to the meta-analysis. The pooled effect was small and uncertain for lower-limb/balance-related outcomes (Hedges’ g = 0.21, 95% confidence interval −0.17 to 0.58) and moderate for upper-limb outcomes (Hedges’ g = 0.47, 95% confidence interval 0.09 to 0.84). The overall pooled estimate was positive after virtual reality-assisted rehabilitation (Hedges’ g = 0.34, 95% confidence interval 0.07 to 0.60). Certainty of evidence for both primary domains was very low. Conclusions: Virtual reality-assisted rehabilitation may be associated with post-intervention functional gains in adolescents with cerebral palsy, with more consistent findings for upper-limb than lower-limb/balance-related outcomes. However, the certainty of evidence was very low, and the predominantly pre–post evidence cannot establish comparative treatment efficacy. VR-assisted rehabilitation may be considered an adjunct to conventional rehabilitation to increase task-specific practice and engagement, but adolescent-focused controlled studies with harmonised outcomes and clinically meaningful follow-up are needed. Full article

In recent years, the application of virtual reality (VR) in rehabilitation medicine has gained increasing attention. VR is generally classified into two types: non-immersive and immersive systems. Non-immersive VR allows patients to interact with virtual environments through screens while maintaining a connection with the real world. Several studies have reported that the combined application of non-immersive VR and adjunctive technologies such as transcranial direct current stimulation and hand exoskeleton devices could facilitate functional recovery of hemiparetic limbs after stroke. In contrast, immersive VR is applied with the use of head-mounted displays to encompass the user’s visual field, providing a high level of immersion and an enhanced sense of presence. This enhanced experience has been shown to promote patients’ attention and motivation, which are important factors in motor learning. Emerging evidence suggests that immersive VR is effective for improving upper limb motor function in post-stroke hemiparetic patients. Furthermore, rehabilitative training performed in immersive virtual environments may facilitate the transfer of acquired motor skills to real activities of daily living. Future research should aim to generate high-quality evidence through large-scale, multicenter randomized controlled trials to better establish the clinical efficacy and optimal implementation of VR-based interventions in stroke rehabilitation. Full article

Soft wearable actuators offer compliant, lightweight assistance for rehabilitation and motor support, but their translation beyond controlled laboratories depends on reliable sensing, fault management, and adaptive control. This systematic review maps the evidence across three linked domains: fault detection and diagnosis (FDD), sensing, and intelligent control. Owing to marked heterogeneity in actuator types, validation settings, and reported outcomes, the evidence was synthesised narratively and described using publication counts and proportions rather than pooled performance estimates. The study-level supplementary appraisal covers all 106 publications included in the review. Four normative standards were retained within this total as normative context and were marked as not applicable for empirical methodological appraisal; they were not subtracted from the corpus count. Across the 106 included records, 40 were classified as direct, 57 as adjacent, five as indirect, and four as normative context. The FDD subset was especially limited: nine records provided adjacent evidence and five were indirect under the strict soft-wearable rehabilitation criterion. The review therefore identifies soft-actuator-specific FDD benchmarks, multimodal health-state estimation, and fault-aware control as actionable priorities, while distinguishing these structural gaps from constraints expected in a technologically young field. The completed review was retrospectively registered in the OSF Registries on 21 July 2026 using the Open-Ended Registration template. Full article

The assessment and rehabilitation of fine motor skills are essential in clinical practice, particularly for individuals with neurological or musculoskeletal impairments. The Box and Block Test (BBT) is a widely used standard tool; however, it lacks digital capabilities for automated measurement and remote monitoring. This study presents two digital serious games designed to assess and support fine motor skills. The first game is a direct digital adaptation of the BBT, while the second mimics its core movements while introducing enhanced interaction features and flexibility. A total of 50 participants performed the conventional BBT and both digital games. The present evaluation represents a preliminary validation in healthy adults and provides a foundation for future clinical studies involving individuals with motor impairments. Performance metrics were collected and analyzed to compare outcomes and examine correlations between real-world and digital assessments. The results indicate significant correlations between BBT scores and performance in both digital serious games, supporting their validity as assessment tools. Additionally, the second game provided richer interaction data, suggesting potential for more comprehensive evaluation. These findings highlight the potential of serious games as reliable and engaging tools for fine motor assessment and rehabilitation in both clinical and remote settings. Full article

Background/objectives: Thermal asymmetries between the affected and unaffected sides of the body are common after stroke and can be detected using infrared thermography; however, their responsiveness to rehabilitation and its relationship with motor and functional performance remain unclear. This study investigated whether the addition of treadmill training to conventional physiotherapy modifies lower-limb thermal asymmetry and explored its relationship with functional outcomes in individuals with chronic stroke. Methods: A randomized controlled trial was conducted in 22 individuals with chronic stroke randomly assigned to either an intervention group [n = 12] or a control group [n = 10]. All participants received conventional physiotherapy twice weekly for 12 weeks, while the intervention group additionally performed treadmill training. Thermal asymmetry was assessed using infrared thermography, whereas motor function and walking capacity were evaluated using the Fugl–Meyer Assessment for the Lower Extremity and the Six-Minute Walk Test. Results: Both groups showed reduced thermal asymmetry after the intervention, with no significant between-group differences. Significant improvements in motor function (p = 0.016) and walking distance (p = 0.016) were observed only in the intervention group. Between-group analysis revealed greater motor improvement in the intervention group (p = 0.017). Baseline-adjusted analyses confirmed superior motor function and walking capacity outcomes in the intervention group. Conclusions: Infrared thermography detected changes in lower-limb thermal asymmetry following the 12-week physiotherapy program in individuals with chronic stroke, with no significant between-group differences. In contrast, treadmill training produced superior improvements in motor function and walking capacity. These differing patterns suggest that thermographic and functional assessments may provide complementary information regarding recovery after chronic stroke. Full article

Background/Objectives: Healthcare professionals have begun utilizing a wheelie task for balance assessment in para sport athletes. With recent advancements to incorporate dual-task exercises, the purpose of this study was to evaluate baseline wheelie performance during single and dual-task and measure 1-week and 45-day reliability in a sample of collegiate para sport athletes. Methods: Twenty-five (male n = 14, 56.0%) collegiate para sport athletes completed a wheelie assessment under single and dual-task conditions. Measures consisted of standardized biomechanical errors (e.g., front wheels touching ground, changing grip on wheel) as scored by a single clinician during eyes-open and eyes-closed positions. Assessments were repeated 7 ± 2 days and 45 ± 7 days later. Results: At baseline, there were no differences with dual-task exercise during eyes-open wheelie balancing (p = 0.096). No differences were observed from single to dual-task in the eyes-closed position (p = 0.154) at baseline, but there were significantly more errors during this position at both the 1-week (p = 0.005) and 45-day (p = 0.004) retest intervals. Fair to moderate correlations existed for both eyes-open and eyes-closed positions during single and dual task across 1-week (rs ≥ 0.49) and 45-day (rs ≥ 0.40) retest intervals. Conclusions: The incorporation of dual-task exercises during the eyes-closed wheelie position appears to increase the difficulty of balance compared to single-task, possibly making it a useful assessment to evaluate balance in para-athletes. There is fair to moderate correlation of the wheelie during single and dual tasks over time. Future research is needed on dual-task compensation post-injury. Full article

Background and Objectives: Psychiatric symptoms and multidimensional impulsivity may be associated with the clinical and functional heterogeneity of substance use disorders (SUDs), but evidence from Saudi Arabian treatment populations remains limited. This study examined concurrent associations with a study-specific aggregate of Addiction Severity Index (ASI-5) interviewer severity ratings. Materials and Methods: This cross-sectional study included 204 adults receiving inpatient detoxification or residential rehabilitation services in Najran, Saudi Arabia. The seven ASI interviewer ratings were summed as an aggregate score. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and impulsiveness using the Barratt Impulsiveness Scale-11 (BIS-11). Analyses included age- and sex-adjusted analyses of covariance, false-discovery-rate correction, bootstrap Spearman correlations, an a priori multivariable model with HC3 robust confidence intervals, and sensitivity analyses addressing content overlap, multicollinearity, influential observations, functional form, and the bounded outcome distribution. Results: The mean age was 34.4 ± 7.3 years; 78.9% were male. The aggregate score was 26.33 ± 4.15. It correlated strongly with BPRS total (ρ = 0.874, 95% CI 0.827–0.908) and moderately with BIS-11 total (ρ = 0.590, 95% CI 0.494–0.669). In the primary model (adjusted R² = 0.864), age, BPRS total, motor impulsiveness, and non-planning impulsiveness were conditional correlates of greater aggregate burden; male sex was inversely associated, and polysubstance use was not. BPRS remained associated after exclusion of the ASI psychiatric domain. Separate impulsivity-domain and BIS-11 total models, 5000-resample bootstrap analysis, median regression, and fractional-logit analysis retained the principal psychiatric and impulsivity directions. The polysubstance coefficient varied across sensitivity models. Conclusions: Psychiatric symptom burden and selected impulsivity dimensions were concurrently associated with higher study-specific aggregate ASI interviewer severity scores. Integrated psychiatric and impulsivity assessment may help characterize patients with greater concurrent multidomain clinical burden; the aggregate score should not be interpreted as a validated global severity or prediction measure. Full article

Purpose: Upper extremity motor impairments following stroke substantially limit independence in daily living. Hand-tracking virtual reality (VR) rehabilitation systems may support intensive task-oriented practice while enhancing motivation; however, evidence integrating objective kinematic indicators with usability and patient-reported outcomes for controller-free consumer-grade VR remains limited. The primary aim of this single-arm pilot study was to evaluate the feasibility, safety (tolerability), and usability of a hand-tracking VR rehabilitation system delivered as an adjunct to conventional physiotherapy in individuals with stroke; describing its preliminary in-game kinematic profile and exploring participants’ experiences through open-ended feedback were secondary aims. The study was explicitly not designed or powered to test clinical efficacy. Materials and Methods: Ten individuals with stroke completed a 20-session (8-week) single-arm pilot intervention; all participants concurrently received standard hospital-based physiotherapy (median 3 sessions/week, ∼45 min/session). Early-phase (sessions 1–5) and late-phase (sessions 16–20) within-subject performance were compared using the Wilcoxon signed-rank test with Holm–Bonferroni correction across four pre-specified primary outcomes. Movement smoothness was assessed using the Spectral Arc Length (SPARC), usability was evaluated using the System Usability Scale (SUS), and cybersickness was monitored with the Simulator Sickness Questionnaire (SSQ). Results: Sixteen patients were screened, of whom fourteen started the intervention and ten completed the 8-week per-protocol program (intervention completion rate, 10/14 = 71.4%; per-protocol session adherence among the ten completers, 200/200 = 100%; no SSQ-defined adverse events). Within-subject comparisons showed a $+10.6$-point increase in success rate (adjusted $p=0.020$), a $+0.10$ m/s increase in mean movement speed (adjusted $p=0.020$), a $-341$ ms reduction in pause duration (adjusted $p=0.022$), and a $+27.0$-point Hodges–Lehmann median-difference increase in SS-QOL (95% CI $14.0$–$41.0$; participant-level median $\mathsf{\Delta }$$+18.5$; adjusted $p=0.020$). The mean SUS score was $78.5\pm 5.4$, indicating “good” usability. Thematic analysis of post-intervention open-ended feedback identified three themes—motivation and engagement, the value of feedback, and design and comfort suggestions—that converged with the high adherence and good usability ratings. Correlations between VR-derived kinematic change and clinical change were non-significant trends ($p\ge 0.12$). Conclusions: A controller-free hand-tracking VR system was found to be feasible, well tolerated, and rated as having good usability when delivered as an adjunct to conventional therapy. Because the study used a single-arm design, included only ten participants, and did not control for the confounding effect of concurrent conventional physiotherapy or natural recovery, the observed within-subject changes cannot be causally attributed to the VR intervention and should be interpreted as exploratory feasibility signals. Adequately powered randomized controlled trials with stroke-specific clinical scales (e.g., FMA-UE, ARAT) are required before clinical efficacy can be claimed. Full article

In recent years, the potential of exoskeletons to enhance human capabilities has attracted significant research interest. Nevertheless, the control of Rehabilitation Lower-Limb Exoskeletons (RLLEs) is challenging because of their strong nonlinear behaviour. In the paper, a Grey Fuzzy Sliding-Mode (GFSM) controller, which is designed based on the optimization accuracy and estimation capability of the fuzzy logic system, was used for trajectory tracking of a RLLE’s joints. This paper presents the tuning of the controller parameters optimally using Grey Wolf Optimization (GWO) integrated with an Interval Type-2 Fuzzy Logic System (IT2FLS) in real-time. The GFSM was selected as the controller law, in which initially, GWO was used to tune the parameters based on the estimated RLLE’s mathematical model. The optimal tuned parameters were employed to determine the defuzzification range of the fuzzy logic system. IT2FLS was provided to tune the real-time controller parameters. The performance of the GFSM was validated by human-RLLE experiments which showed superior performance compared to other conventional controllers. The experimental results show that the controller achieved reductions in the average error of 81.8%, 82.9%, 84.1%, and 80.6%, respectively, compared with conventional adaptive control methods. These findings indicate that the GFSM can be used to improve motor function recovery in individuals with hemiplegia. By integrating biomechanically inspired motion assistance with IT2FLS, our proposed GFSM controller contributes to the development of biomimetic rehabilitation exoskeletons capable of reproducing natural human gait. Full article

To address the challenges of lumped model uncertainties and tracking error constraints in biomimetic rehabilitation robot control, this paper proposes a novel high-order integral barrier function to construct an adaptive neural tracking control scheme. Radial basis function neural networks (NNs), inspired by the receptive field mechanism of motor neurons, feature local activation and can accurately approximate the nonlinear dynamics of such bionic rehabilitation devices. Distinct from traditional integral barrier Lyapunov functions, the presented high-order integral barrier function can accommodate both time-varying and time-invariant error constraints, while simplifying the controller derivation and ensuring full differentiability of virtual control laws throughout the backstepping framework. Supported by the derived barrier function theorems, the tracking error of the robot is theoretically proven to stay within predefined safe boundaries and converge exponentially to a compact neighborhood of the origin. Finally, comparative numerical simulations on a biomimetic rehabilitation robot validate the effectiveness of the proposed theorem and constrained adaptive neural control strategy. Full article

Background: Robotic rehabilitation systems for upper-limb stroke rehabilitation have been developed across diverse robotic platforms, yet cross-study comparisons remain challenging due to heterogeneous system designs and classification approaches. This brief narrative review proposes a paradigm-driven framework, categorizing robotic rehabilitation systems based on underlying therapeutic interaction principles (e.g., mirror, bimanual, mirror–bimanual hybrid) rather than implementation modality alone. Methods: A structured MEDLINE/PubMed literature search was performed to identify representative studies describing robotic system characteristics, rehabilitation task structures, clinical outcomes, and mechanistic insights within mirror, bimanual, and hybrid rehabilitation paradigms. Findings: Among the reviewed studies, mirror-based systems emphasize sensory representation and interhemispheric modulation, whereas bimanual systems target coordination and motor learning through bilateral interaction. Hybrid systems integrate these approaches by combining mirrored feedback with active bilateral engagement. Emerging neuroimaging evidence, particularly resting-state fMRI, may help relate clinical improvements to neural network changes, providing a mechanism-informed perspective on rehabilitation outcomes. Conclusions: This review highlights substantial progress in robotic upper-limb stroke rehabilitation, with current systems increasingly integrating multimodal feedback and task-oriented interaction within mirror, bimanual, and hybrid rehabilitation paradigms. Limitations include variability across studies due to differences in robotic system implementation, task design, duration, stroke chronicity, and patient engagement. Full article