Search Results (141)

Over the past decade, serious games and virtual reality have gained increasing relevance in upper-limb rehabilitation, yet desktop virtual reality solutions often suffer from reduced spatial correspondence and limited sensory feedback. This work presents the design and preliminary evaluation of a desktop virtual reality-based serious game that combines Leap Motion Controller hand tracking with a custom wireless vibrotactile wearable device to support upper-limb rehabilitation training. Three training scenarios were implemented to target pronation/supination, pinch grip, ulnar/radial deviation, and wrist, elbow, and finger flexion/extension. Usability (System Usability Scale, SUS), user experience (short AttrakDiff), and perceived workload (Raw NASA-TLX), together with functionality and perception questionnaires, were collected from healthy participants randomly assigned to two groups (Group 1: $n=13$, LMC only; Group 2: $n=9$, LMC plus wearable). Across all instruments, the configuration including the wearable device tended to obtain higher usability ratings, more desirable pragmatic and hedonic quality scores, and lower overall workload means than the LMC-only configuration, with moderate effect sizes but limited statistical power due to the small samples. Participants in the wearable condition also reported clearer feedback, a perceived improvement in movement precision, and a stronger perceived alignment between real and virtual actions. These findings suggest that the proposed system may serve as a promising user-centered prototype for desktop VR-based upper-limb rehabilitation and provide preliminary design evidence to support future clinical and kinematic validation studies with larger cohorts. Full article

Hand range of motion (ROM) measurement is crucial for diagnosing joint limitations, tracking rehabilitation progress, and creating personalized treatment plans. In recent years, exergames combined with dedicated game controllers have emerged as promising tools to complement traditional hand rehabilitation; however, their validity as motor function assessment tools remains insufficiently explored. This study evaluates the validity of the eJamar game controller as a tool for measuring hand ROM and hand grip strength (HGS), by comparing its outputs with standard goniometry and dynamometry. In a prior technical validation using a robotic arm under controlled conditions, the device showed a mean error of approximately 1.5°, indicating high measurement precision under ideal conditions. In the clinical validation with 32 patients undergoing hand rehabilitation, performance was movement-dependent. Pronation and supination showed strong agreement (MAE < 3°) and higher agreement compared with other movements, whereas flexion, extension, and radial-ulnar deviation exhibited weaker correlations and substantially higher errors (around 20°). In contrast, grip strength measurements for more and less affected hands, respectively, showed high correlation (0.88–0.91) and moderate agreement (ICC 0.81–0.66) with MAE values around 4 kg-f. Overall, results suggest that the eJamar shows preliminary suitability for assessing HGS and forearm pronation and supination in clinical settings. However, for HGS, agreement should be interpreted with caution due to the observed bias and error levels, indicating that further validation and calibration are required before stronger clinical claims can be made. For wrist flexion, extension, and radial-ulnar deviation, the device currently shows limited accuracy and requires further improvement. Full article

Introduction: Although gait alterations associated with excess body weight have been widely studied, most available evidence comes from laboratory-based analyses, which limit ecological validity and the translation of findings into clinical practice. This study addresses this gap by examining gait biomechanics across BMI categories using portable sensor-based insoles that allow gait assessment in real-world conditions. Methods: A cross-sectional study including 96 adults categorized as normal weight (NW), overweight (OW), or obese (OB) was conducted. Gait biomechanics were recorded using PODOSmart^® intelligent insoles, which capture spatiotemporal and angular parameters during natural walking. Foot health, quality of life and comorbildities were evaluated throught valeted questionnarires. Differences between groups were analyzed using ANOVA and chi-square tests. Age and sex, known to influence gait, were comparable across BMI groups and were considered in the interpretation of the results. Results: Overall, the participants in the OB group exhibited reduced stride length, gait speed, and swing time, increased double-support time, and greater pronation–supination and progression angles than OW and NW participants. Partial eta-squared values (η²p) were predominantly medium to large, reinforcing the robustness of these between-group differences (e.g., double-support time, p > 0.001; η²p = 0.19). Individuals with obesity reported poorer general and foot health and more difficulty finding suitable footwear. BMI was also significantly associated with hypertension, dyslipidemia, arthritis, and depression (all p <0.05), whereas diabetes, cardiopathies, knee pain, and fatigue andwalking or social activity limitations showed no significant differences. Conclusions: By using portable gait analysis technology in ecological conditions, this study provides novel evidence of clinically meaningful gait impairments across BMI groups. Higher BMI is associated with clinically relevant gait impairments, poorer perceptions of foot and general health, and a higher prevalence of several comorbidities. Full article

Background/Objectives: Type II superior labrum anterior–posterior (SLAP) lesions of the long head of the biceps (LHB) tendon are associated with excessive tendon loading and are commonly treated surgically using SLAP repair, tenotomy, or tenodesis. These procedures alter musculotendinous length and loading and may affect functional outcomes, including forearm supination strength. Appropriate restoration of tendon tension is critical for favorable muscle adaptation and recovery. Shear wave elastography (SWE) is a non-invasive imaging technique capable of quantifying tissue stiffness as a surrogate for in vivo musculotendinous tension. This study aimed to characterize LHB tendon tension across forearm positions and loading conditions to improve the understanding of functional tendon loading relevant to postoperative activation and rehabilitation. Methods: In this controlled laboratory study, thirteen healthy female volunteers without shoulder pathology were assessed using SWE with the elbow positioned at 90° flexion. LHB tendon tension was measured in forearm pronation and supination under passive, active (unresisted), and weighted conditions. Paired t-tests were used to compare forearm positions within each loading condition. Results: LHB tendon tension was significantly greater during active and weighted conditions compared with passive loading in the pronated position (p < 0.05). During active contraction, tendon tension was significantly lower in supination than pronation (p < 0.05), whereas no positional differences were observed under passive or weighted conditions. Relative to passive loading, tendon tension increased by approximately 18.2% and 89.2% in supination, and 67.0% and 97.9% in pronation during active and weighted conditions, respectively. Conclusions: Forearm position selectively influences LHB tendon tension during active, unresisted contraction. Forearm orientation affected LHB tendon stiffness primarily during active, unweighted contraction, where pronation resulted in higher stiffness than supination. On the other hand, stiffness outcomes measured during passive and weighted positions were comparable between forearm orientations, indicating that positional effects are most evident when tendon loading is primarily muscle-driven. These findings highlight the relevance of forearm positioning during early postoperative activation and provide normative in vivo reference data to inform personalized rehabilitation strategies and future investigations of postoperative tendon loading following SLAP lesion treatment. Full article

Background: Wrist–forearm orthoses used during self-feeding may alter scapular and shoulder mechanics and increase proximal load, but this has not been quantified. Methods: Seventeen right-hand-dominant young adults performed a spoon-feeding task under free and restricted conditions. A thermoplastic wrist–forearm orthosis positioned the wrist at approximately 30° dorsiflexion at rest and was intended to constrain wrist motion during the task without rigidly immobilizing forearm pronation–supination. Three-dimensional kinematics (scapula, shoulder, trunk, and distal joints) were recorded using inertial sensors, and surface electromyography was obtained from the upper trapezius, middle deltoid, and biceps brachii. Maximum joint angles and mean %MVC over the feeding cycle were compared between conditions (α = 0.05). Results: The restriction condition resulted in a more anteriorly tilted and downwardly rotated scapular posture, greater shoulder abduction and external rotation, and increased thoracic flexion, whereas maximum distal joint angles did not differ, suggesting a functional distal constraint rather than rigid immobilization. Middle deltoid and biceps brachii activities increased significantly, with a nonsignificant trend toward higher upper trapezius activation. Conclusions: In healthy young adults, limited wrist motion and forearm rotation during spoon-feeding were associated with altered proximal coordination, including scapular, shoulder/trunk, and proximal muscle changes. Full article

Campanacci grade III giant cell tumors of the distal radius frequently require en bloc resection to achieve adequate oncologic control. Reconstruction of the resulting defect remains challenging, particularly with respect to preservation of distal radioulnar joint stability and forearm rotation. Although proximal fibular autograft reconstruction is well established, ligamentous stabilization of the distal radioulnar joint is rarely incorporated in oncologic settings. This technical note describes an integrated reconstructive strategy combining proximal fibular autograft with distal oblique bundle reconstruction, illustrated by a representative clinical case. The technique involves segmental en bloc resection of the distal radius followed by reconstruction using an ipsilateral, nonvascularized proximal fibular autograft including the fibular head. Distal radioulnar joint stability is addressed through reconstruction of the distal oblique bundle using an autologous palmaris longus tendon graft. Surgical indications, operative steps, donor site stabilization, and perioperative management are detailed. Functional evolution was assessed using the Musculoskeletal Tumor Society scoring system and range-of-motion measurements. Histopathological examination confirmed negative oncologic margins. Early postoperative events included donor-site common peroneal nerve dysfunction and radiocarpal instability requiring temporary Kirschner wire stabilization. At nine months, the Musculoskeletal Tumor Society score reached 80%, with forearm rotation preserved at 68.8% pronation and 81.3% supination of normal values. Combined osseous and ligamentous reconstruction following distal radius resection is technically feasible and may allow preservation of distal forearm mechanics while maintaining oncologic principles. Broader validation will require application in larger clinical series and longer follow-up. Full article

Background and Clinical Significance: Radiocarpal fracture dislocations (RCFDs) are rare injuries of the wrist, while open RCFDs represent a small subgroup of these injuries. Limited data exists regarding the optimal method for their management. Our study’s objective is to present a rare case of an open (Gustilo–Anderson type II) dorsal radiocarpal dislocation in combination with fracture of the radial and ulnar styloid and neurologic deficits (superficial radial, median and ulnar nerve), which was treated with external fixation and Kirshner wire pinning. External fixation and Kirshner wire pinning could be a viable surgical option for complicated open RCFD. Case Presentation: Adequate reduction and ligamentotaxis using an external fixation were achieved, while the radial styloid fracture and the distal radioulnar joint (DRJ) were stabilized with Kirshner wires. Postoperative radiographs and clinical evaluation confirmed satisfactory reduction in the right wrist, without signs of intercarpal instability. Total nerve recovery was observed 6 months postoperatively and the patient was able to return to his previous occupation. At the final follow-up (4 years), the Visual Analogue Scale score was 1/10 and the Quick Dash score was 11/100 with good range of motion (flexion: 0–75°, extension: 0–70°, pronation: 0–80°, supination: 0–80°) of the affected wrist, although progressive wrist arthritis and ulnar migration was seen in the plain X-rays. Conclusions: Surgical treatment of RCFDs is required for complex or unstable fractures/dislocations to avoid possible complications, such as intercarpal instability. Full article

Background/Objectives: Foot mobility is considered an intrinsic risk factor for lower-limb injury, yet commonly used pronated/neutral/supinated classifications rely on arbitrary cut-points. This study aimed to develop a data-driven framework for characterizing a continuous SSNDT–injury risk gradient and deriving clinically interpretable relative-risk bands that define practical injury risk zones along the sit-to-stand navicular drop test (SSNDT) continuum. Methods: Data from 137 physically active male students (274 feet) were analyzed. Intra-rater reliability of the sit-to-stand navicular drop test (SSNDT) was assessed using ICC(3,1). A quadratic mixed-effects logistic regression model was used to characterize the SSNDT–injury relationship and derive odds-ratio-based risk bands for interpretive and screening purposes. Results: SSNDT demonstrated good intra-rater reliability (ICC(3,1) = 0.82). Model comparison supported a non-linear, U-shaped association between SSNDT and injury risk, with a minimum risk value at approximately 5.5 mm. Bootstrap analysis supported a smooth continuous risk gradient. Four representative OR levels (1.2, 1.5, 1.8, and 2.0) were selected to define SSNDT-based interpretative risk bands. Injury prevalence showed an overall increasing trend across these zones, ranging from 4.2% in the Safe zone to 52.4% in the Extreme zone. Conclusions: SSNDT provides a robust, data-driven basis for quantifying foot-mobility–related injury risk along a continuous non-linear gradient and for deriving clinically interpretable relative-risk bands grounded in a validated model. The proposed framework avoids arbitrary cut-points and supports individualized risk screening. Full article

Control of elbow exoskeletons using muscular signals, although promising for the rehabilitation of millions of patients, has not yet been widely commercialized due to challenges in real-time intention estimation and management of dynamic uncertainties. From a practical perspective, millions of patients with stroke, spinal cord injury, or neuromuscular disorders annually require active rehabilitation, and elbow exoskeletons with precise and safe motion intention tracking capabilities can restore functional independence, reduce muscle atrophy, and lower treatment costs. In this research, an intelligent control framework was developed for an elbow joint exoskeleton, designed with the aim of precise and safe real-time tracking of the user’s motion intention. The proposed framework consists of two main stages: (a) real-time estimation of desired joint angle (as a proxy for movement intention) from High-Density Surface Electromyography (HD-sEMG) signals using an LSTM network and (b) implementation and comparison of three PID, impedance, and sliding mode controllers. A public EMG dataset including signals from 12 healthy individuals in four isometric tasks (flexion, extension, pronation, supination) and three effort levels (10, 30, 50 percent MVC) is utilized. After comprehensive preprocessing (Butterworth filter, 50 Hz notch, removal of faulty channels) and extraction of 13 time-domain features with 99 percent overlapping windows, the LSTM network with optimal architecture (128 units, Dropout, batch normalization) is trained. The model attained an RMSE of 0.630 Nm, R² of 0.965, and a Pearson correlation of 0.985 for the full dataset, indicating a 47% improvement in R² relative to traditional statistical approaches, where EMG is converted to desired angle via joint stiffness. An assessment of 12 motion–effort combinations reveals that the sliding mode controller consistently surpassed the alternatives, achieving the minimal tracking errors (average RMSE = 0.21 Nm, R² ≈ 0.96) and showing superior resilience across all tasks and effort levels. The impedance controller demonstrates superior performance in flexion/extension (average RMSE ≈ 0.22 Nm, R² > 0.94) but experiences moderate deterioration in pronation/supination under increased loads, while the classical PID controller shows significant errors (RMSE reaching 17.24 Nm, negative R² in multiple scenarios) and so it is inappropriate for direct myoelectric control. The proposed LSTM–sliding mode hybrid architecture shows exceptional accuracy, robustness, and transparency in real-time intention monitoring, demonstrating promising performance in offline simulation, with potential for real-time clinical applications pending hardware validation for advanced upper-limb exoskeletons in neurorehabilitation and assistive applications. Full article

This paper presents the design, prototype, and experimental evaluation of the AlmatyExoElbow, a lightweight cable-driven robotic exoskeleton that is intended to support elbow joint rehabilitation. The device provides two active degrees of freedom for flexion/extension and pronation/supination. It also incorporates a sensor-based control system for accurate motion tracking. The mechanical structure is fabricated using 3D-printed PLA plastic, resulting in a compact, modular, and comfortable design suitable for prolonged use. The control architecture is based on an Arduino Nano microcontroller integrated with IMU sensors, enabling the real-time monitoring of elbow motion and the precise reproduction of physiologically relevant movement patterns. The results of experimental testing demonstrate smooth and stable operation, confirming reliable torque transmission through antagonistic cable mechanisms. Overall, the proposed design achieves a balanced combination of functionality, portability, and user comfort, highlighting its potential for upper-limb rehabilitation applications in both clinical and home-based settings. Full article

Stroke is a leading cause of disability, often resulting in motor, cognitive, and language deficits, with significant impact on upper-limb function. Robotic therapy (RT) has emerged as an effective strategy, providing intensive, repetitive, and adaptable practice to optimize functional recovery. This pilot study aimed to describe and evaluate the effects of robotic rehabilitation as a complement to conventional therapy, using a biomimetic activities-of-daily-living (ADL)-based protocol, on upper-limb function in post-stroke patients. Three participants (aged 30–80 years) undergoing occupational and/or physiotherapy received individualized robotic training with a lightweight cable-driven upper-limb exoskeleton, m-FLEX™, twice a week for ten weeks (30 min per session). Movements were designed to mimic natural upper-limb actions, including elbow flexion-extension, forearm pronation-supination, tripod pinch, and functional tasks such as grasping a cup. Assessments included the Fugl-Meyer (FM) scale, the Functional Independence Measure (FIM), and device satisfaction, performed at baseline, mid-intervention, and post-intervention. Descriptive analysis of the tabulated data revealed improvements in range of motion and functional outcomes. These findings suggest that biomimetic protocol of robotic rehabilitation, when combined with conventional therapy, can enhance motor and functional recovery in post-stroke patients. Full article

Objective quantification of tremor remains a challenge in Parkinson’s disease (PD) assessment, with current clinical assessments relying largely on subjective scale ratings. This study evaluates the feasibility and signal behaviour of integrating surface electromyography (sEMG) with MDS-UPDRS-aligned tasks in a healthy adult cohort, with the aim of establishing normative low-frequency muscle activation profiles. Thirty-two healthy participants (mean age 27.6 ± 5.3 years) completed seven upper-limb tasks derived from the MDS-UPDRS while sEMG data were recorded from antagonistic forearm muscles. Signals were normalised using maximum voluntary contraction, filtered at 14 Hz, and analysed using frequency-domain (FFT) and time-frequency (STFT) methods. Significant task-dependent differences were observed in both frequency occurrence and magnitude (p < 0.05), particularly within the 3.5–9 Hz range. Finger tapping elicited increased low-frequency activity compared to baseline, while pronation–supination produced the most stable and consistent muscle activation across participants. Frequencies above 12 Hz showed minimal task discrimination. These findings demonstrate that low-frequency tremor-like activity can occur during specific MDS-UPDRS tasks in healthy individuals and may require further validation before being considered suitable for PD staging. This work establishes normative sEMG benchmarks to support future clinical validation and PD cohort comparisons. Full article

Background: Accurate assessment of pediatric foot biomechanics is challenging due to growth-related variability and limited quantitative tools. The supination and pronation angles of the ankle are critical for understanding lower limb alignment and pathological gait patterns. Objectives: This study introduces a novel digital pedoscopic system designed to enhance the quantitative evaluation of foot alignment and to demonstrate its clinical utility through clustering analysis of pediatric ankle angles. Methods: Thirty-five pediatric patients (mean age = 6.17 ± 4.54 years) with neurological or developmental disorders were evaluated using a semi-automated digital pedoscopic system to obtain quantitative measurements of ankle alignment. Key anatomical landmarks, including the heel, calf, and knee centers, were manually identified from posterior images, and the system automatically calculated ankle pronation and supination angles. K-means clustering analysis was applied to classify participants based on their biomechanical profiles. Results: A total of thirty-five pediatric patients were assessed, and the revised abstract now explicitly reports this sample size to improve clarity. Data-driven k-means clustering of bilateral rearfoot angles identified three clearly defined alignment subgroups—neutral, pronated, and supinated—each exhibiting characteristic distribution patterns and degrees of inter-individual variability. These findings highlight the system’s ability to quantitatively distinguish biomechanical phenotypes within a heterogeneous pediatric population. Visualization through scatter, box, and violin plots demonstrated distinct cluster-specific distributions and inter-individual variability in rearfoot alignment, demonstrating the feasibility of objective biomechanical stratification in pediatric populations. Conclusions: The digital pedoscopic imaging system provides a reliable and reproducible approach for quantitative assessment of foot alignment in children. Clustering analysis enables stratification of biomechanical subtypes, supporting individualized rehabilitation strategies and longitudinal monitoring in pediatric clinical practice. Full article

Aims: Structural lower limb-length discrepancies (LLLD) have been classically associated with the etiology of low back pain. However, their biomechanical effects on lower-limb muscle activity during running remain unclear. This pilot crossover study aimed to evaluate the influence of orthotic interventions—designed to compensate for LLLD and modify foot biomechanics—on the electromyographic (EMG) activity of the contralateral tensor fasciae latae (TFL) in healthy runners. Methods: A total of 41 recreational male and female runners (mean age 32.27 ± 6.09) with structural LLLD were recruited and classified as neutral (Ng), supinated (SPg), or pronated (PRg) based on their foot posture. Surface EMG activity of the TFL in the longer leg was recorded with specific surface electrodes while participants ran on a treadmill at a constant speed of 9 km/h for 3 min. Each subject randomly wore standard orthoses with 5 mm pronating (PRO), supinating (SUP) wedges or orthoses with a heel lift (TAL) to compensate for the shorter leg, alongside the baseline condition (SIN). Results: Perfect reliability (close to 1) was obtained for all measurements. A statistically significant reduction in TFL EMG activity was recorded in the Ng group: SIN 105.64 ± 50.6%MVC vs. PRO 100.16 ± 48.61%MVC (p < 0.05), and SIN vs. TAL 93.49 ± 15.88%MVC (p < 0.001). A significant reduction was also observed in the PRg group: SIN 91.82 ± 40.75%MVC vs. TAL 80.08 ± 31.75%MVC (p < 0.05). Conclusion: Orthotic compensation for LLLD and foot pronation modifications produced measurable changes in TFL EMG activity during running. These findings provide mechanistic insight into the interaction between limb-length asymmetry, foot biomechanics, and proximal muscle activation in runners, and may inform future studies on overuse injuries such as iliotibial band syndrome. Full article

A traumatic elbow dislocation that remains unreduced for more than three weeks is considered a neglected elbow dislocation. We report a case of a patient with a neglected elbow dislocation combined with a terrible triad injury (elbow dislocation with fractures of the coronoid process and radial head). Initially, the patient was managed with three weeks of cast immobilization followed by physiotherapy. However, six months after the trauma, he presented to our clinic with severe heterotopic ossification, significant pain, and nearly complete elbow stiffness. An open surgical intervention was performed, involving excision of the heterotopic bone, reduction in the dislocation, and suturing of the anterior capsule to the coronoid process. Given the irreparable fracture of the radial head, radial head arthroplasty was also performed. At 18-month follow-up, the elbow was stable and pain-free, with flexion–extension of 80°, pronation of 85°, and supination of 80°. This case underscores the critical importance of early diagnosis and intervention to prevent long-term complications in neglected elbow dislocations. Full article