Search Results (125)

Essential tremor (ET) is among the most prevalent movement disorders, causing significant impairment in manual dexterity and daily functioning. Although ET affects individuals across the lifespan, exercise intervention research has focused almost exclusively on older adults, leaving young adults, for whom early intervention may prevent long-term neuromuscular deterioration, critically underrepresented. Furthermore, the effects of strength–endurance oriented exercise combined with task-specific motor activities remain insufficiently explored in any ET population. This quasi-experimental pre-test–post-test study investigated the effects of a 6-week progressive strength–endurance and task-specific exercise program on tremor severity, manual dexterity, and upper extremity functional performance in young adult males with ET (n = 18; mean age: 22.6 ± 4.1 years). The 24-session intervention (four sessions/week) combined proximal upper extremity strength–endurance exercises with seven ADL-specific fine motor tasks. Tremor severity was assessed using the Fahn–Tolosa–Marin Tremor Rating Scale (FTMTRS), manual dexterity using the Nine-Hole Peg Test (NHPT), and upper extremity stability using the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). The Wilcoxon signed-rank test was used for within-group comparisons, with rank biserial correlation (r) and Cohen’s d reported as effect size indices. Significant pre-to-post improvements were observed across nearly all outcome measures, with medium-to-large effect sizes. Spiral drawing performance improved significantly in five of six conditions (r = 0.47–0.62), with the exception of the Spiral left–B task (p = 0.083). Postural tremor, NHPT (both hands), and CKCUEST also showed significant improvements (r = 0.47–0.73). A composite tremor score, integrating all tremor sub-scores, demonstrated a 14.1% overall reduction (p = 0.001, r = 0.83), providing strong evidence of program-wide effectiveness. Session adherence was 95.8%. To our knowledge, this is one of the first studies to show that a structured strength–endurance and task-specific exercise program was associated with reductions in tremor severity and improvements in upper extremity function, specifically in young adults with ET. These findings support the clinical utility of exercise as a non-pharmacological intervention in this underserved population and highlight the importance of early, targeted intervention during young adulthood. Full article

The Nine-Hole Peg Test (9-HPT) is widely used in clinical settings but typically relies on the assessor’s expertise to record execution time. Here, we propose a novel sensorized 9-HPT capable of automatically measuring total execution time and, importantly, extracting a set of newly defined temporal parameters that enable a more detailed and objective characterization of task performance. We first demonstrated concurrent validity between the sensorized 9-HPT and stopwatch-based measurements recorded by an assessor (ρ always > 0.98; p < 0.001) in healthy participants. Agreement between methods was further supported by the Bland–Altman analysis, showing negligible bias and narrow limits of agreement. A linear mixed-effects model confirmed no systematic differences between methods but showed significant differences between dominant and non-dominant hands. Test–retest reliability of total completion time, assessed across two sessions, was good for both the dominant (ICC = 0.81) and non-dominant (ICC = 0.74) hands. The newly introduced temporal parameters also showed significant reliability (ICC = 0.73–0.78), particularly for the dominant hand. Overall, these findings support the reliability of the sensorized 9-HPT for standard outcome measures and highlight its added value in providing novel temporal metrics that more precisely capture the different phases of task execution. Full article

Background and Objectives: Multiple sclerosis (MS) is characterized by progressive disability and a spectrum of motor and cognitive impairments. Exergames and virtual reality (VR) are proposed as motivating exercise tools, potentially useful for improving adherence and expanding access to rehabilitation. The objectives are to explore the feasibility and safety of a supervised rehabilitation program based on a high-intensity exercise program with immersive virtual reality (IVR) in people with MS and to describe its effects on physical, cognitive, and functional domains, as well as on the serum biomarker neurofilament light chain (sNfL). Materials and Methods: Pre–post exploratory study in five volunteers from a local MS Association [Vigo, Spain]. Intervention: 8 weeks, two sessions/week, 10 min/session of an IVR boxing-based exergame combined with usual rehabilitation, supervised by a physiotherapist. The variables studied were safety (Simulator Sickness Questionnaire [SSQ]), usability (System Usability Scale [SUS]), disability (Expanded Disability Status Scale [EDSS]), gait (25-Foot Walk Test [25FWT]), manual dexterity (9 Hole Peg Test [9HPT]), cognition (Symbol Digit Modalities Test [SDMT]), and axonal damage biomarker (sNfL). Results: The intervention could be feasible and safe (100% adherence, no adverse events (without SSQ symptoms), 95% usability [SUS]). There were positive changes in all variables studied (mean ± SD): EDSS −0.5 ± 0.9; 25FWT −4.9 ± 9.8 s; right 9HPT −3.3 ± 0.9 s; sNfL −4.4 ± 4.5 pg/mL, except for left 9HPT +0.5 ± 5.0 s and cognition (SDMT −2.4 ± 1.3 points). Conclusions: A brief, supervised exercise program combing an IVR exergame with standard rehabilitation was feasible and safe in people with MS. Although the results seem promising with the proposed design, the clinical and biological changes are merely exploratory, and it is not possible to infer their efficacy. Our findings open the door to future controlled studies including perceived high-intensity exercise programs and larger sample sizes to explore efficacy and estimate clinically relevant effect sizes. Full article

Background: Multiple sclerosis (MS) is a chronic disease of the central nervous system, characterised by high variability in both its progression and symptoms. The disease leads to progressive disability, which manifests itself as slow walking, low muscle mass and impaired manual dexterity, causing difficulties in performing everyday activities and reducing a patient’s social activity and quality of life. The aim of this study is to assess the relationships between muscle mass, physical activity and the food frequency of protein-rich products and the functional fitness of patients with MS. Methods: The study comprised 106 patients with MS (83 women and 23 men) aged 18–65 years. Measurements of their weight and body composition, motor function of the lower limbs using the Timed 25-Foot Walking Test (T25FW), and motor function of the upper limbs using the 9-Hole Peg Test (9-HPT) and the Handgrip Strength (HGS) test were performed. Daily moderate-to-vigorous physical activity (MVPA) and the consumption frequency of protein-rich products were also assessed. Results: Low muscle mass was associated with worse performance in the HGS test (non-dominant hand p = 0.001, dominant hand p = 0.001), while no significant associations were observed for manual dexterity or T25FW performance.. The second tercile of MVPA was significantly associated with reduced HGS in the dominant (p = 0.037) and non-dominant hands (p = 0.015). Conversely, the third tercile of the MVPA compared to the lower tertile was associated with better HGS of the non-dominant hand (p = 0.022) and faster completion of the 9-HPT with the non-dominant (p = 0.010) and dominant hands (p = 0.029). Furthermore, frequent consumption of protein-rich products was correlated with faster completion of the T25FW test (p = 0.033). Conclusions: Regular physical activity is associated with better functional fitness, while more frequent consumption of protein-rich foods may be associated with higher muscle mass of major muscle groups, which is important for effective locomotion. This study has a cross-sectional and exploratory design; therefore, the findings reflect associations only and do not allow casual inferences. Full article

Objective: The aim of this study will be to evaluate the effectiveness of a task-oriented training program in improving functional performance and health outcomes in patients with MS. Methods: A pilot randomized clinical trial will be conducted according to SPIRIT guidelines. Participants will be randomly assigned to the experimental group or the control group. Assessment and treatment will take place at patient association facilities or research center. Participants diagnosed with MS by a neurologist and meeting the inclusion criteria will be invited to participate voluntarily. The experimental group will undergo an 8-week TOT intervention, twice weekly, 45 min. The control group will maintain usual care and be given a fatigue management pamphlet. The main variable in this study will be the Canadian Occupational Performance Measure. The level of fatigue will be assessed with the Modified Impact Fatigue Scale and the Fatigue Severity Scale, upper limb strength using the Arm Curl Test, hand and pinch dynamometer, motor speed with the Finger Tapping Test, manual dexterity with the Nine Hole Peg Test, Purdue Pegboard Test and the Coin Rotation Test. Satisfaction and adherence with the intervention will be recorded with the Sport Injury Rehabilitation Adherence Scale. Results: The results will be published as a peer-reviewed article. Conclusions: The present protocol aims to fill a relevant gap in the literature, offering a structured intervention based on task-oriented training principles, specifically tailored to the functional and occupational needs of people with MS. Full article

Objective: To determine which physical clinical test best differentiates minimally impaired people with MS (pwMS) from healthy controls and to compare the discriminatory value of upper limb clinical assessments with sensor-based gait and postural control measures. Methods: Forty-one participants (21 pwMS, 20 matched healthy controls) completed a single testing session including upper limb clinical assessments (Nine-Hole Peg Test [9HPT], grip strength), gait (Timed 25-Foot Walk, Six-Minute Walk Test, and cognitive–walking dual task), and static balance assessments using wearable inertial sensors (APDM Mobility Lab system). Dual-task costs (DTCs) were calculated for gait parameters. Between-group comparisons were performed using independent t-tests. Pearson correlation analyses were conducted to examine interrelationships among gait variables, and a parsimonious binary logistic regression model was constructed, including non-dominant 9HPT and dual-task walking speed. Receiver operating characteristic (ROC) analyses were performed to evaluate discriminative performance and determine the optimal 9HPT cutoff. Results: PwMS performed significantly slower on the 9HPT for both hands (p ≤ 0.006) and demonstrated reduced walking performance and higher gait DTCs (p ≤ 0.041) compared with controls. No significant group differences were observed in grip strength or sensor-based postural control. In multivariable analysis, the overall model was significant (p < 0.001; Nagelkerke R² = 0.49), and the non-dominant 9HPT remained the only independent predictor of group status (OR = 1.75, 95% CI [1.17–2.61]), whereas dual-task walking speed was not significant after adjustment. ROC analysis demonstrated good discriminative ability for the non-dominant 9HPT (AUC = 0.84, 95% CI [0.71–0.97]) and acceptable discrimination for dual-task walking speed (AUC = 0.75, 95% CI [0.60–0.90]). The optimal 9HPT cutoff was ≥21.4 s, yielding 71% sensitivity and 100% specificity in this cohort. Conclusions: Manual dexterity of the non-dominant hand may serve as a sensitive screening marker of early functional impairment in MS, demonstrating greater discriminatory value than sensor-based gait and balance measures. These findings support the inclusion of upper limb dexterity testing in the routine assessment of minimally impaired pwMS. Validation in larger, longitudinal cohorts is warranted. Full article

Background: Disability progression in multiple sclerosis (MS) is increasingly recognized as a consequence of large-scale brain network disruption rather than isolated regional damage. Although diffusion tensor imaging (DTI) is the reference method for assessing structural connectivity, its limited availability restricts widespread clinical application. There is therefore a critical need for alternative approaches capable of capturing network-level alterations using routinely acquired MRI data. Objective: This study aimed to determine whether synthetic structural connectivity matrices derived from standard regional volumetric MRI can capture clinically meaningful network alterations in MS and predict subsequent functional progression, particularly upper limb decline. Methods: Regional brain volumetry was obtained from routine T1-weighted MRI using an automated, clinically approved volumetric pipeline. Synthetic structural connectivity matrices were generated by integrating principles of structural covariance, distance-dependent connectivity, and disease-specific vulnerability patterns. Graph-theoretical network metrics were extracted to characterize global and regional topology. Machine learning models including logistic regression, support vector machines, random forests, and gradient boosting were trained to predict clinical progression defined by worsening on the 9-Hole Peg Test. Dimensionality reduction was performed using principal component analysis, and model performance was evaluated using balanced accuracy, AUC-ROC, and resampling-based validation. Feature importance analyses were conducted to identify network vulnerability patterns. Results: Synthetic connectivity networks exhibited biologically plausible properties, including preserved but attenuated small-world organization. Global efficiency showed a strong inverse correlation with disability severity (EDSS). Patients with clinical progression demonstrated marked reductions in network integration and segregation, alongside increased characteristic path length. Machine learning models achieved robust prediction of upper limb functional decline, with ensemble-based methods performing best (balanced accuracy > 80%, AUC-ROC up to 0.85). A limited subset of connections accounted for a disproportionate share of predictive power, predominantly involving frontoparietal associative networks, thalamocortical pathways, and inter-hemispheric connections. In a longitudinal subset, network-level alterations preceded measurable clinical deterioration by several months. Conclusions: Synthetic structural connectivity derived from routine volumetric MRI captures clinically relevant network-level disruption in multiple sclerosis and enables accurate prediction of functional progression. By bridging network neuroscience with widely accessible imaging data, this framework provides a pragmatic alternative for connectomic analysis when diffusion imaging is unavailable and supports a network-based understanding of disease evolution in MS. Full article

Background: The eye has shown potential as a reliable, readily accessible and clinically relevant site for investigating patients with multiple sclerosis (pwMS). Optical coherence tomography angiography (OCTA) shows promise in revealing new metabolic and vascular elements driving multiple sclerosis (MS) disease pathology. This study aimed to explore correlations between OCTA parameters and clinical characteristics in newly diagnosed relapsing–remitting MS (RRMS) patients. Methods: In this cross-sectional study, forty-one newly diagnosed RRMS patients underwent comprehensive evaluations, including neurological examinations, functional and cognitive tests (9-Hole Peg Test, Montreal Cognitive Assessment), and OCT/OCTA scans. Multiple regression analyses assessed correlations between OCT/OCTA parameters and baseline clinical characteristics. Results: Lower superficial capillary plexus (SCP) vessel density was associated with longer disease duration, higher EDSS scores (visual, pyramidal, cerebellar, ambulation), and impaired 9-Hole Peg Test performance, especially in the non-dominant hand. Higher values of choriocapillaris (CC) flow voids correlated with worse cognitive performance (MoCA). Structural OCT parameters showed limited clinical correlations. Conclusions: OCTA-derived parameters are associated with disability, fine motor function, and cognitive performance in newly diagnosed RRMS patients without prior ON. These findings suggest that retinal vascular alterations may reflect early neurodegenerative processes and provide complementary information beyond structural OCT metrics. OCTA may represent a sensitive, non-invasive imaging biomarker for patient assessment in early MS. Full article

In this paper, we present a physical interaction scheme for omnidirectional multirotor aerial vehicles (MRAVs) equipped with fixedly tilted non-coplanar propellers, based on an admittance control architecture. An external wrench observer is employed to estimate the interaction wrench at the end-effector, hence eliminating the need for an additional force/torque sensor. We show that using the nominal allocation matrix in this class of admittance controllers can lead to a contact loss during complex interaction scenarios due to unmodeled and state-dependent aerodynamics effects. To address this issue, we propose a method for identifying the wrench map across different regions of the vehicle’s orientation in $SO\left(3\right)$ using free-flight experimental data. This is achieved by formulating a Quadratic Programming (QP) optimization whose solution provides the best approximation of the wrench map for a given orientation of the MRAV. The effectiveness of this approach is experimentally demonstrated, including static point contacts at various orientations, sliding contact, and peg-in-hole tasks. Full article

Background/Objectives: The impact of stroke on upper extremity function in the older adult population underscores the need for accurate recovery prediction. Motor evoked potential (MEP) has been explored as a predictor of upper extremity function recovery in patients with stroke. However, research specifically targeting the geriatric population remains limited. Therefore, this study focused specifically on patients aged 65 years and older to investigate correlations between MEP parameters and upper extremity function. This study investigates correlations between MEP parameters (amplitude and latency) and upper extremity function-related measures, including Medical Research Council (MRC) scale, the Korean version of the Modified Barthel Index (K-MBI), and the Hand Function Test (HFT), including grip strength, pinch strength, the Box and Block Test, and the 9-Hole Peg Test, in older adults with stroke. Methods: A multiple linear regression model predicts upper extremity outcomes using initial MEP parameters, time, and function. The dataset includes 90 patients with stroke categorized by timing of the first MEP assessment: ≤3 months (n = 42) or >3 months (n = 48). Results: MEP amplitude and latency were significantly correlated with upper extremity function in both groups. No significant correlations were found between MEP amplitude or latency and outcome measures. Regression analysis showed that initial MEP amplitude had a limited association with outcomes, whereas latency was significantly associated with grip strength (β: −10.205, 95% CI: −19.374~−1.036) and the Box and Block Test (β: −10.204, 95% CI: −20.254~−0.154). Initial upper extremity parameters were significantly associated with K-MBI and HFT follow-up results (p < 0.05). Conclusions: Larger MEP amplitude and faster initial MEP latency were associated with improved upper extremity function in patients with stroke. In older patients, MEP latency, rather than amplitude, demonstrated greater predictive value for upper extremity function recovery, possibly due to age-related muscle atrophy, a factor not fully addressed in existing prognostic frameworks such as PREP2. These findings support the integration of MEP latency assessment into geriatric stroke prognostication, complementing existing frameworks such as PREP2, and may guide personalized rehabilitation planning to optimize functional recovery and independence. Full article

Humanoid mobile manipulators integrate a humanoid upper body with a mobile platform, forming a highly redundant system capable of performing complex manipulation tasks. To address the redundancy arising from the coordinated motion of the wheeled base, waist, and dual arms, this study proposes a human-inspired holistic control method based on multi-objective optimization. The degrees of freedom (DOF) of the upper limbs and the mobile base are unified within a single control framework, thereby enhancing overall motion coordination. Specifically, the controller is formulated as a strictly convex quadratic program (QP) that ensures accurate end-effector tracking while effectively handling joint position and velocity constraints. Inspired by human motor characteristics, the method incorporates a hierarchical weight assignment strategy and base DOF optimization to preserve arm manipulability while achieving effective coordination between the base and waist. Simulation studies of dual-arm handling tasks and real-world experiments involving mobile handling and peg-in-hole assembly demonstrate that the proposed method generates smooth, humanoid-like motions, thereby validating the effectiveness of the proposed control framework. Full article

Background: Central cord syndrome (CCS) is the most common incomplete spinal cord injury, producing more severe motor deficits in the upper than lower extremities and impairing sensory and autonomic function. Although transcutaneous spinal cord stimulation (tSCS) has shown benefits in motor and sensory recovery after spinal cord injury, studies have not explicitly documented whether CCS subjects were included. The aim of this study was to assess the effects of tSCS over 12 weeks on motor and sensory outcomes in a subject with CCS. Methods: A 20-year-old male with a C7 injury was evaluated at baseline and after 12 weeks with the American Spinal Cord Injury Impairment scale, Modified Ashworth Scale, Penn and Spasm Frequency Scale, 3-Meter Walk Test and 6-Minute Walk Test, 9-Hole Peg Test, Box and Block Test, hand dynamometry, and lower-limb EMG. tSCS was applied between T9 and L1 at 30 Hz. Results: At 12 weeks, upper-limb motor and sensory scores improved, while spasm frequency and hand spasticity were reduced. Manual dexterity improved bilaterally in the 9-Hole Peg and Box and Block Tests, with a 2 kg gain in right-hand grip strength. In the 6-Minute Walk Test, the distance covered increased from 224.4 m to 295.2 m, and a 1.36 s reduction in 3-Meter walking time was achieved. Conclusions: tSCS improved motor and sensory function and reduced spasticity and spasms. These findings suggest that tSCS may serve as an effective complementary intervention for motor and sensory rehabilitation in individuals with mild cervical injuries, including CCS. Full article

Essential tremor (ET) negatively affects neuromuscular control and hand function in older adults. Resistance exercise may enhance musculoskeletal and functional capacity, yet its modality-specific effects in ET remain unclear. This study compared the effects of home-based and aquatic resistance training on tremor severity, manual dexterity, and handgrip strength in older adults with ET. Twenty-seven participants were randomly assigned using block randomization to a home-based resistance exercise group (HBREG; n = 9), an aquatic resistance exercise group (AREG; n = 9), or a control group (CG; n = 9). Both intervention groups completed an 18-session resistance exercise program, with initial sessions supervised and subsequent sessions performed independently under regular monitoring. Tremor severity (FTMTRS), manual dexterity (Nine-Hole Peg Test), and handgrip strength were assessed pre- and post-intervention. Within-group changes were analyzed using the Wilcoxon signed-rank test and between-group differences using the Kruskal–Wallis test with Bonferroni-adjusted Mann–Whitney U tests (p < 0.05). Both HBREG and AREG demonstrated significant improvements in drawing and pouring tremor tasks, manual dexterity, and handgrip strength compared with the control group, with large effect sizes across outcomes. No significant differences were observed between the two exercise modalities, and no improvement occurred in the highest-difficulty spiral-B task. These findings indicate that both home-based and aquatic resistance training are safe and effective non-pharmacological strategies for reducing tremor severity and enhancing upper-extremity function in older adults with ET. Full article

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

Objective: Gliomas disrupt functional brain networks and impair neurological functions. While left-hemispheric tumors are well-studied because of their impact on language domains, the influence of right-sided gliomas on higher cognitive functions remains less understood. This study aimed to assess pre- and postoperative neurocognitive performance and to link cognitive outcomes with structural findings derived from function-based tractography in patients with right-hemispheric gliomas. Methods: Patients with gliomas were enrolled in this prospective observational study. A structured neurocognitive test battery was administered preoperatively, postoperatively, and at 3-month follow-up. Preoperative cortical mapping using navigated transcranial magnetic stimulation (nTMS) and function-based fiber tracking, based on diffusion tensor imaging (DTI), was performed. Results: Eighteen patients aged 52.7 ± 18.3 years were included. Preoperatively, 88.8% of patients showed impairments in at least one cognitive test, most frequently in the Nine-Hole Peg Test (66.7%), Bells Test task completion time (61.1%), Trail Making Test A and B (TMT-A: 50.0%; TMT-B: 44.4%), and digit symbol substitution test (27.8%). At follow-up, task performance improved on most cognitive tests. Function-based tractography showed that involvement of the superior longitudinal fasciculi I–III (44.4% of cases) was associated with impairments in attention, executive function, visuospatial processing, and processing speed. The involvement of the inferior frontooccipital fasciculus (55.5% of cases) was related to deficits in processing speed, attention, executive function, and episodic memory. Conclusions: Neurocognitive deficits are common in patients with right-hemispheric gliomas even before surgery. Maximal safe resection and sparing of these tracts is associated with cognitive recovery at follow-up. Function-based tractography emphasizes the structural involvement of key association fibers related to these cognitive deficits. Full article