Search Results (27)

Background. Today, the public does not want to be just a passive consumer of health services. Patients often expect to be informed and involved in decisions about their health. With better doctor–patient communication, patients are more likely to follow treatment recommendations. Material and methods. The study was conducted using a face-to-face survey method on a group of 203 adult, independent patients from 2021 to 2022 at a medical facility, i.e., a rehabilitation clinic. Objective. The purpose of this study was to assess the determinants of doctor–patient communication in terms of patient rights. One of patients’ rights is the right to information about their health condition and treatment methods and the right to ask questions when the doctor does not provide details about the treatment or diagnosis or when it is not understandable. Doctors providing information to the patient and the opportunity for the patient to ask questions are key elements in the process of making informed decisions regarding further medical treatment. Therefore, patients were divided into two groups: active (+) and passive in communication (−) with doctors. Results. Patients who were active in communication (33%) wanted to ask questions or had the opportunity to ask the doctor questions, and thus, they were able to take an active part in the discussion with the doctor. In contrast, patients who were passive in communication (67%) did not want to ask questions or did not have the opportunity to ask the doctor questions, and therefore, their active participation in the discussion and thus their right to ask questions may have been limited. The authors’ survey shows that respondents with active communication were significantly more likely than patients with passive communication (almost 100% vs. 86%) to obtain information about their condition (p = 0.002), diagnostic methods (p = 0.003), therapeutic methods (p = 0.00007), treatment results, and prognosis (p = 0.0008). Moreover, almost all respondents with active communication as opposed to respondents with passive communication (95% vs. 52%) rated communication with doctors highest (on a scale from 0 to 5), including credible and professional approach to patients (p < 0.0001), providing information in clear and simple language (p < 0.0001), answering questions asked by patients (p < 0.0001), openness and kindness (p < 0.0001), maintaining professional confidentiality (p < 0.0001), or emotional support (p < 0.0001). Conclusions. Hence, the primary key element of the medical consultation is appropriate amount and content of information given to the patient, providing explanations and answering questions. Also importantly, according to the results, active communication between patients and doctors was significantly influenced by female gender, higher education, and a positive evaluation of communication with doctors. Full article

Background/Objectives: Patellofemoral syndrome is a common osteoarticular condition that affects many individuals. Various treatment options are available, with a significant emphasis on targeted muscle-strengthening exercises. The purpose of this study was to investigate the effect of isokinetic muscle strengthening on muscle strength, joint range of motion, quality of life, physical performance, and pain tolerance in overweight/obese women with patellofemoral syndrome. Methods: Twenty-four overweight or obese women with patellofemoral syndrome participated in the study during September and October 2023 in a private medical facility for physical medicine and functional rehabilitation. They were randomly assigned to one of two groups for six weeks of isokinetic muscle strengthening. The first group (ISO.G) followed a rehabilitation program combined with isokinetic muscle strengthening. A second group (PCM.G) followed a rehabilitation program that includes an isokinetic protocol in passive compensation movement. The extensors’ peak torque was measured before and after training. Results: The flexors’ peak torque, stair climbing test, 10 m walk, chair lift, monopodal support, goniometric knee flexion test, heel–buttock distance measurement, pain, and quality of life scores improved significantly in both groups. The ISO.G, on the other hand, benefited from a significant increase in quadriceps muscle strength revealed by the extensors’ peak torque. Conclusions: For the treatment of patellofemoral syndrome, isokinetic muscle strengthening in concentric mode appears to have a significant advantage over the classic rehabilitation program with isokinetic passive compensation, particularly in muscle strength gain, in addition to the improvement of joint range of motion, quality of life, physical performance, and pain tolerance. Isokinetic training may be recommended as a beneficial approach for the rehabilitative treatment of patellofemoral pain syndrome in overweight/obese women. Full article

The motor features of people with cerebellar ataxia suggest that locomotion is substantially impaired due to incoordination of the head, trunk, and limbs. The purpose of this study was to investigate how well a wearable soft passive exoskeleton worked for motor coordination in these patients. We used an optoelectronic system to examine the gait of nine ataxic people in three different conditions: without an exoskeleton and with two variants of the exoskeleton, one less and the other more flexible. We investigated kinematics using trunk ranges of motion, the displacement of the center of mass in the medio-lateral direction, and the parameters of mechanical energy consumption and recovery. Furthermore, we investigated the lower limb and trunk muscle coactivation. The results revealed a reduction of the medio-lateral sway of the center of mass, a more efficient behavior of the body in the antero-posterior direction, an energy expenditure optimization, a reduction of muscle coactivation and a better coordination between muscle activations. As a result, the findings laid the groundwork for the device to be used in the rehabilitation of individuals with cerebellar ataxia. Full article

As important auxiliary equipment, rehabilitation robots are widely used in rehabilitation treatment and daily life assistance. The rehabilitation robot proposed in this paper is mainly composed of an omnidirectional mobile platform module, a lower limb exoskeleton module, and a support module. According to the characteristics of the robot’s omnidirectional mobility and good stiffness, the overall kinematic model of the robot is established using the analytical method. Passive and active training control strategies for an omnidirectional mobile lower limb exoskeleton robot are proposed. The passive training mode facilitates the realization of the goal of walking guidance and assistance to the human lower limb. The active training mode can realize the cooperative movement between the robot and the human through the admittance controller and the tension sensor and enhance the active participation of the patient. In the simulation experiment, a set of optimal admittance parameters was obtained, and the parameters were substituted into the controller for the prototype experiment. The experimental results show that the admittance-controlled rehabilitation robot can perceive the patient’s motion intention and realize the two walking training modes. In summary, the passive and active training control strategies based on admittance control proposed in this paper achieve the expected purpose and effectively improve the patient’s active rehabilitation willingness and rehabilitation effect. Full article

(1) Background: Recent digital workflows are being developed for full-arch rehabilitations supported by implants with immediate function. The purpose of this case series is to describe a new digital workflow for the All-on-4 concept. (2) Methods: The patients were rehabilitated using the All-on-4 concept with a digital workflow including computerized tomography scanning, intra-oral scanning, and CAD-CAM production of the temporary prosthesis, with the 3D printing of stackable guides (base guide, implant guide, and prosthetic guide). The passive fit of the prostheses and the time to perform the rehabilitations were evaluated. (3) Results: The digital workflow allowed for predictable bone reduction, the insertion of implants with immediate function, and the connection of an implant-supported prosthesis with immediate loading. The time registered to perform the full-arch rehabilitations (implant insertion, abutment connection, prosthesis connection) was below 2 hours and 30 min. No passive fit issues were noted. (4) Conclusions: within the limitation of this case series, the digital workflow applied to the All-on-4 concept using stackable base-, implant-, and prosthetic guides constitutes a potential alternative with decreased time for the procedure without prejudice of the outcome. Full article

Introduction. The rehabilitation medical team is responsible for the therapeutic management of post-stroke patients and, therefore, for the complex therapeutic approach of spasticity. Considering the generous arsenal at our disposal in terms of both pharmacological treatment, through the possibility of administering botulinum toxin to combat spasticity, and in terms of accurate assessment through developed functional scales such as the GAS (Goal Attainment Scale), one of our purposes is to monitor the parameters that influence the achievement of functional goals set by patients together with the medical team in order to render the patients as close as possible to achieving their proposed functional goals, thus enhancing their quality of life. By assessing and establishing statistical and clinical correlations between the GAS and quantifiable parameters related to the affected post-stroke upper limb, namely degree of spasticity, motor control, pain level and evolution of pain under treatment with BoNT-A (abobotulinum toxin A), and patients’ overall response to BoNT-A treatment, we aim to quantify the improvement of the therapeutic management of post-stroke patients with spasticity and develop a more personalized and effective approach to their disability and impairment. Results and discussions. The analysis concluded that there were two independent predictors of the Achieved GAS-T score (the study’s endpoint parameter) motor control at any level of the upper limb and number of prior BoNT-A injections. The number of prior BoNT-A injections was an independent predictor of Achieved GAS-T score improvement but had no significant influence over Baseline GAS-T score. Enhancement in proximal and intermediate motor control showed a GAS score improvement of 3.3 points and a 0.93-point GAS score improvement for wrist motor control progress. From a separate viewpoint, patients with motor deficit on the left side have shown significantly greater improvement in Changed GAS-T scores by 2.5 points compared to patients with deficits on the right side; however, we note as a study limitation the fact that there was no statistical analysis over the dominant cerebral hemisphere of each patient. Conclusions. Improvement in the Achieved GAS-T score means better achievement of patients’ goals. Thus, after the BoNT- A intervention, at follow-up evaluation, GAS was found to be directly correlated with improvement in motor control of the affected upper limb. Mobility of the corresponding limb was enhanced by pain decrease during p-ROM (passive range of motion) and by amelioration of spasticity. Materials and Methods. We conducted an observational, non-randomized clinical study on 52 stroke patients, a representative sample of patients with post-stroke spasticity and disability from our neurological rehabilitation clinic, who have been treated and undergone a specific rehabilitation program in our tertiary diagnostic and treatment medical center, including BoNT-A focal treatment for spasticity in the affected upper limb. The primary objective of the study was to assess the influence of abobotulinum toxin A treatment on the Goal Attainment Scale. Secondary objectives of the study included the assessment of BoNT-A treatment efficacy on spasticity with the MAS (Modified Ashworth Scale), pain with the NRS (Numerical Rating Scale), and joint passive range of motion (p-ROM), identifying demographic, clinical, and pharmacological factors that influence the response to BoNT-A treatment, as well as to conduct a descriptive and exploratory analysis of the studied variables. Full article

Within rehabilitation, there is a great need for a simple method to monitor wheelchair use, especially whether it is active or passive. For this purpose, an existing measurement technique was extended with a method for detecting self- or attendant-pushed wheelchair propulsion. The aim of this study was to validate this new detection method by comparison with manual annotation of wheelchair use. Twenty-four amputation and stroke patients completed a semi-structured course of active and passive wheelchair use. Based on a machine learning approach, a method was developed that detected the type of movement. The machine learning method was trained based on the data of a single-wheel sensor as well as a setup using an additional sensor on the frame. The method showed high accuracy (F1 = 0.886, frame and wheel sensor) even if only a single wheel sensor was used (F1 = 0.827). The developed and validated measurement method is ideally suited to easily determine wheelchair use and the corresponding activity level of patients in rehabilitation. Full article

Manual handling tasks, both in daily activities and at work, require high dexterity and the ability to move objects of different shapes and sizes. However, musculoskeletal disorders that can arise due to aging, disabilities, overloading, or strenuous work can impact the natural capabilities of the hand with serious repercussions both in working and daily activities. To address this, researchers have been developing and proving the benefits of wrist exoskeletons. This paper, which is Part II of a study on wrist exoskeletons, presents and summarizes wearable wrist exoskeleton devices intended for use in rehabilitation, assistance, and occupational fields. Exoskeletons considered within the study are those available either in a prototyping phase or on the market. These devices can support the human wrist by relieving pain or mitigating fatigue while allowing for at least one movement. Most of them have been designed to be active (80%) for higher force/torque transmission, and soft for better kinematic compliance, ergonomics, and safety (13 devices out of 24, more than 50%). Electric motors and cable transmission (respectively 11 and 9 devices, out of 24, i.e., almost 50% and 40%) are the most common due to their simplicity, controllability, safety, power-to-weight ratio, and the possibility of remote actuation. As sensing technologies, position and force sensors are widely used in all devices (almost 90%). The control strategy depends mainly on the application domain: for rehabilitation, CPM (control passive motion) is preferred (35% of devices), while for assistance and occupational purposes, AAN (assistance-as-needed) is more suitable (38% of the devices). What emerges from this analysis is that, while rehabilitation and training are fields in which exoskeletons have grown more easily and gained some user acceptance (almost 18 devices, of which 4 are available on the market), relatively few devices have been designed for occupational purposes (5, with only 2 available on the market) due to difficulties in meeting the acceptance and needs of users. In this perspective, as a result of the state-of-the-art analysis, the authors propose a conceptual idea for a portable soft wrist exoskeleton for occupational assistance. Full article

Meniscal injuries are one of the most common intra-articular knee injuries. Different treatments are presented depending on the symptoms and duration of meniscus tears, such as arthroscopic partial meniscectomy, physiotherapy, or even pharmacological treatment. The purpose was to investigate the effect of a concentric isokinetic knee muscle strengthening program on strength, joint range of motion, physical performance, quality of life and pain tolerance in overweight/obese women with chronic meniscal lesions. Twenty-four overweight/obese women were randomized into two groups. A control group (CG) performed a usual rehabilitation program plus isokinetic muscle strengthening (IMS) in the continuous passive motion mode and measured with an isokinetic dynamometer. An experimental group (EG) performed the same program in combination with IMS in the isokinetic active mode. The peak torque of the knee extensors (PTE) and flexors (PTF), sit-to-stand test, stair climb test, joint amplitude, heel-to-buttock distance, Thessaly test, KOOS questionnaire of pain and quality of life were measured pre- and post-protocol. After the intervention, the sit–stand number for both groups was significantly higher (p < 0.001) and the time to climb stairs was significantly reduced for the EG (p < 0.001). A significant improvement in joint range of motion, life quality (p < 0.001), relief in knee pain (p < 0.001) and in the post-program evaluation at the EG (p < 0.05) was noted. There was no significant difference in PTE and PTF between groups at 60°/s and 180°/s. The IMS in the active mode could be an effective therapeutic modality in managing middle-aged patients suffering from a degenerative meniscal tear. Full article

(1) Background: Atidarsagene autotemcel is a hematopoietic stem and progenitor cell gene therapy (HSPC-GT) approved to treat early-onset metachromatic leukodystrophy (MLD). The purpose of this case report is to describe the long-term management of residual gait impairment of a child with late infantile MLD treated with HSPC-GT. (2) Methods: Assessment included Gross Motor Function Measure-88, nerve conduction study, body mass index (BMI), Modified Tardieu Scale, passive range of motion, modified Medical Research Council scale, and gait analysis. Interventions included orthoses, a walker, orthopedic surgery, physiotherapy, and botulinum. (3) Results: Orthoses and a walker were fundamental to maintaining ambulation. Orthopedic surgery positively influenced gait by reducing equinovarus. Nonetheless, unilateral recurrence of varo-supination was observed, attributable to spasticity and muscle imbalance. Botulinum improved foot alignment but induced transient overall weakness. A significant increase in BMI occurred. Finally, a shift to bilateral valgopronation was observed, more easily managed with orthoses. (4) Conclusions: HSPC-GT preserved survival and locomotor abilities. Rehabilitation was then considered fundamental as a complementary treatment. Muscle imbalance and increased BMI contributed to gait deterioration in the growing phase. Caution is recommended when considering botulinum in similar subjects, as the risk of inducing overall weakness can outweigh the benefits of spasticity reduction. Full article

The passive mobilization of the hand joints by means of dedicated equipment accelerates patient recovery and decreases significantly the costs of therapy. For this reason, research and development of such equipment is essential. Important reductions in the development cycle duration of such equipment can be achieved by means of a specific technique known as Model-Based Design. Starting from these considerations, this paper puts forward a Model-Based Design approach to the study of a new concept of rehabilitation equipment of the hand joints actuated by a pneumatic muscle. The originality of the paper consists in the MATLAB-based rendering of the functional model of the rehabilitation equipment actuation system and in the presented simulation results. The purpose of this research was to obtain information concerning the behavior of the proposed system and to predict its performance prior to it being built physically. After simulation, the results are compared to the operational performance of the experimental model. The conclusion shows that the proposed operational model describes accurately the actual behavior of the system and can be used for future optimization of the rehabilitation equipment. Full article

The purpose of this study was to investigate the effects of multi-modal strength training or flexibility training on hamstring flexibility and strength in young males and females. A total of 20 male and 20 female college students (aged 18–24 years) participated in this study and were randomly assigned to either a multi-modal flexibility intervention group or strength intervention group. Passive straight leg raise and isokinetic strength test were performed before and after the intervention to determine flexibility and strength of the participants. Multivariate repeated-measure ANOVA was used to determine the effect of training group and gender on hamstring strength and flexibility. Both male and female participants in the strength intervention group significantly increased peak torque, relative peak torque, and flexibility (all p ≤ 0.029). Both male and female participants in the flexibility intervention group significantly increased flexibility (both p ≤ 0.001). Female participants in the flexibility intervention group significantly increased peak torque and relative peak torque (both p ≤ 0.023). However, no change was seen in peak torque and relative peak torque of male participants in the flexibility intervention group (p ≥ 0.676). An 8-week strength training program involving various training components can increase flexibility in both males and females, although the flexibility of male participants only increased slightly. While hamstring flexibility training protocol consisted of different types of stretching improved both flexibility and strength in female participants, male participants increased only flexibility but not strength, indicating such effects were gender-specific. For subjects with relatively low strength (e.g., older adults, sedentary women, postoperative rehabilitation population, etc.), strength training alone or flexibility training alone may increase both strength and flexibility. Full article

The use of specialized devices, such as orthopedic devices, has become indispensable in the lives of people with disabilities since ancient times. The primary purpose of such devices is to perform activities and solve problems that afflict their bearers in any extremity of their body. One of the most recurrent problems occurs in the lower extremities regarding mobility and autonomy. In addition, the use of orthopedic devices is considered a tool to lighten the repetitive and heavy rehabilitation work of physiotherapists while improving the patient’s recovery efficiency. A significant challenge is that a great variety of these devices are similar in their design and manufacture, complicating their application in rehabilitation processes. For these reasons, this article aims to provide an overview of the features and considerations made in the architecture of orthosis designs, emphasizing lower extremity orthoses for the case of knee joint analysis. A literature review of active and passive knee orthoses manufactured from the 1970s to the present was carried out, considering aspects such as manufacturing materials, mechanical systems, types of actuators, and control strategies. This review shows that the designs and development of orthoses have been abundant in these devices for lower limbs. Based on the literature collected, we have studied the main robotic devices focusing on the characteristics of design, manufacturing, and control systems to assist in human locomotion and support in rehabilitation processes. Full article

Background: The impairment of limb function and disability are among the most im portant consequences of stroke. To date, however, little research has been done on the early reha bilitation trial (ERT) after stroke in these patients. The purpose of this study was to evaluate the impact of ERT neuromuscular protocol on motor function soon after hemiparetic stroke. The sample included twelve hemiparetic patients (54.3 ± 15.4 years old) with ischemic stroke (n = 7 control, n = 5 intervention patients). ERTwas started as early as possible after stroke and included passive range of motion exercises, resistance training, assisted standing up, and active exercises of the healthy side of the body, in addition to encouraging voluntary contraction of affected limbs as much as possible. The rehabilitation was progressive and took 3 months, 6 days per week, 2–3 h per session. Fu gle-Meyer Assessment (FMA), Box and Blocks test (BBT) and Timed up and go (TUG) assessments were conducted. There was a significantly greater improvement in the intervention group com pared to control: FMA lower limbs (p = 0.001), total motor function (p = 0.002), but no significant difference in FMA upper limb between groups (p = 0.51). The analysis of data related to BBT showed no significant differences between the experimental and control groups (p = 0.3). However, TUG test showed significant differences between the experimental and control groups (p = 0.004). The most important finding of this study was to spend enough time in training sessions and provide adequate rest time for each person. Our results showed that ERT was associated with improved motor function but not with the upper limbs. This provides a basis for a definitive trial. Full article

This paper reports a new medical device together with a control strategy that focuses on the following tasks: (1) a trajectory tracking problem associated with the supination–pronation motion of the wrist–forearm for purposes of rehabilitation and (2) the adjustment of the system’s stiffness associated with the applied torque guaranteeing the angular motion of the rehabilitator as well as the resistance that potential users must overcome. These two tasks are oriented to regain the range of motion (ROM) of the wrist–forearm and to improve the strength of the associated muscles. It is worth mentioning that this device has not been clinically validated. However, the performance of the closed-loop medical device is validated with preliminary experiments with a healthy subject based on movement patterns involving passive, assisted-resisted, and active phases of rehabilitation protocols. Full article