Search Results (136)

Background: Post-stroke spasticity is a frequent and disabling consequence of stroke, including when affecting the lower limbs, where it may impair stance, gait, balance, postural control, functional independence and quality of life. Botulinum toxin type A (BoNT-A) is widely used as a focal neuromodulatory treatment for post-stroke spasticity. However, the relationship between BoNT-A-induced reduction in muscle hypertonia, objective changes in spastic muscle’s biomechanical properties, and functional outcomes such as mobility and balance remains insufficiently clarified. This systematic review aimed to synthesize recent evidence regarding the non-invasive assessment of spastic muscle properties following BoNT-A administration in post-stroke patients, with emphasis on mobility and balance outcomes. Methods: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in international electronic databases and included studies published between 1 January 2023 and 31 December 2025. The search strategy used specific keywords and keyword combinations/syntaxes, contextually, related to the topic of interest. Results: A total of 32 studies met the eligibility criteria and were included in the final data analysis and synthesis, comprising 13 primary clinical studies—6 randomized or controlled interventional studies and 7 observational studies—together with 12 reviews or evidence syntheses, 3 technical or clinical framework papers, and 4 survey, epidemiological, health-services or health-economic studies. Overall, the included articles addressed BoNT-A treatment in post-stroke spasticity, with partial focus on muscle properties, gait, mobility, and functional outcomes. However, only a limited number of studies investigated objective non-invasive assessment methods, and few directly related muscle-property changes in balance and mobility outcomes. Formal risk-of-bias assessment and quantitative synthesis were not performed because of the substantial heterogeneity of the included evidence, with only two studies being potentially suitable for pooling and these addressing different muscle groups, interventions, and outcome domains. Discussion and Conclusions: The reviewed literature confirms the clinical relevance of BoNT-A in the management of post-stroke spasticity. However, most studies assess treatment effects mainly through clinical scales, while objective evaluation of muscle stiffness, elasticity, viscoelastic properties, and their relationship with mobility and balance remains limited. Although some studies address gait, functional recovery, or muscle-related changes, the combined use of BoNT-A treatment, myotonometric assessment, and proprioceptive–stabilometric evaluation is largely absent. Therefore, current evidence highlights an important research gap and supports the need for future longitudinal studies integrating non-invasive biomechanical and balance assessment tools to better monitor treatment response and guide individualized neurorehabilitation in post-stroke patients. Full article

As accessibility development in public buildings has gradually shifted from facility compliance toward experience- and performance-oriented evaluation, the quantitative assessment of indoor mobility experiences among blind users still lacks a systematic sensor-supported analytical framework. To address this gap, this study proposes an indoor accessibility assessment approach that integrates multi-sensor data acquisition with explainable machine learning, using a tactile museum as the experimental setting. Sixty-four participants with first-level blindness were recruited to complete a real-world directed walking task. A multimodal database was constructed by integrating objective data collected from an ultra-wideband (UWB) indoor positioning system, an intelligent gait analysis system, and video-based behavioral recording, including spatiotemporal trajectories, gait characteristics, and behavioral events, together with post-task accessibility satisfaction ratings. Based on this dataset, a random forest model was developed using the Overall Accessibility Satisfaction Score (OAS) as the response variable. SHAP, partial dependence analysis, and GAM smoothing were further applied to interpret the associations between key variables and predicted satisfaction. The results showed that walking distance, number of turns, self-reported collision perception, and selected gait indicators made relatively high contributions to the model interpretation, and these variables exhibited certain nonlinear associations with predicted satisfaction. These findings suggest that combining multi-source sensor-based behavioral measurement with explainable machine learning has potential for sensor-supported post-occupancy evaluation of indoor accessibility environments and can provide exploratory references for the quantitative assessment and optimization of accessibility in public buildings. Full article

Human gait analysis is a key component of rehabilitation medicine, enabling objective assessment of patient recovery. In crutch-assisted locomotion, however, conventional forearm crutches operate as passive devices, providing no quantitative information on load distribution or patient adherence to partial weight-bearing (PWB) prescriptions. This work presents the design and dynamic validation of a sensorized forearm crutch system for biomechanical monitoring during assisted gait. The proposed device combines a force-sensing module based on a full Wheatstone bridge strain-gauge configuration with a 6-axis inertial measurement unit (IMU) to capture both axial load and crutch orientation. Sensor fusion was implemented through a complementary filter to estimate pitch and roll angles under dynamic conditions. The system was calibrated through static loading procedures and validated against reference instrumentation, including an optoelectronic motion capture system and an instrumented dual-belt treadmill with force platforms. Unlike previous studies relying on stationary force platforms that capture discrete steps and may alter natural gait, this validation approach enabled continuous, stride-by-stride force and orientation measurements without restricting foot placement. Experimental trials were conducted with unimpaired participants performing assisted gait using 2-point and 3-point patterns at two partial weight-bearing levels (20% and 40% body weight) and two walking speeds (0.80 m/s and 1.20 m/s). Dynamic validation showed good agreement with the treadmill reference, with force RMSE values of $9.33\pm 1.70$ N for the left crutch and $12.90\pm 2.85$ N for the right crutch, and with coefficients of determination of $R^2=0.9956$ and $R^2=0.9927$, respectively. Orientation RMSE values were $1.08\pm 0.44$° (roll, right), $2.06\pm 0.56$° (roll, left), $1.79\pm 0.55$° (pitch, right), and $1.66\pm 0.37$° (pitch, left). Beyond validation accuracy, the system enabled extraction of a set of quantitative biomechanical descriptors directly from crutch signals, axial load, cadence, crutch contact variability, load asymmetry, pitch asymmetry, and crutch stance/swing asymmetries, characterizing walking stability, bilateral coordination, and gait regularity during continuous assisted locomotion. These results demonstrate the feasibility of integrating force and inertial sensors into forearm crutches to enable quantitative monitoring of assisted gait, with potential applications in rehabilitation assessment and real-time feedback. Full article

Background/Objectives: Previous studies have measured a limited number of biomechanical parameters during medical rehabilitation of an anterior cruciate ligament (ACL) rupture. This study aimed to quantitatively assess changes in gait biomechanics, knee function, and lower-extremity muscle activity during after ACL reconstruction. Methods: The study included 32 patients after arthroscopic ACL reconstruction. The patients were divided into three groups based on postoperative time points: 0.5 year (12 men), 1 year (7), and over 1 year (9). Gait analysis at both self-selected and fast speeds was performed using an inertial system. Statistical analysis was performed using rank models and full-factorial orthogonal designs. Results: After 0.5 year, the timing of the gait cycle at self-selected speed was within the control group’s range and showed no significant asymmetry. With increasing speed, a decrease in knee joint range of motion was observed in the 0.5 year and 1-year groups, without achieving a full physiological increase in range of motion at long-term follow-up. Multivariate analysis revealed the greatest biomechanical imbalance during fast walking at one year and a phase-dependent effect of time after surgery, speed, and limb status on kinematics and EMG, particularly in the quadriceps. Conclusions: Basic temporal gait parameters during self-selected walking were within the control range by 0.5 year, but load-dependent knee kinematic and EMG abnormalities persisted. The knee joint’s response to increased loads remained impaired for at least one year. The persistence of phase-specific compensatory changes in kinematics and muscle activity at later stages can be assessed using exercise testing. Full article

Neuropathic pain is a debilitating condition lacking objective and quantitative assessment tools, as current evaluations rely largely on subjective reports. Hyperspectral imaging (HSI) is a non-invasive technology that quantifies spatial and spectral tissue characteristics and has been applied in rheumatologic and metabolic disorders. This study investigated whether HSI-detected paw skin alterations correlate with graded nerve injury severity in a chronic constriction injury (CCI) model. Sprague–Dawley rats were assigned to sham or CCI groups with one to four sciatic nerve ligatures. Behavioral assessments (CatWalk XT gait analysis, thermal hyperalgesia, and mechanical allodynia) and paw HSI measurements were performed longitudinally. Histological and molecular analyses were conducted from paw skin to dorsal spinal cord tissues. At 1100 nm, HSI demonstrated progressive and significant spectral deviations proportional to injury severity across all CCI groups, whereas 1300 nm changes were only detected in severe injuries. Histology revealed increased fibrosis, NGF, TNF-α, synaptophysin, and microglial activation with greater injury severity, alongside reduced PGP9.5, neurofilament, AChR, Desmin, GAP-43, Pax3, and BDNF expression. These molecular findings were supported by electrophysiological and behavioral impairments, which correlated with injury grade by HSI. In conclusion, HSI at 1100 nm provides a sensitive and objective indicator of neuropathic pain severity and holds promise as a quantitative translational tool. Full article

Ankle dorsiflexion plays a vital role in ensuring safe and effective walking post-stroke, yet the best methods for assessing it and their clinical significance are still uncertain. This research compiles the existing sensor-based technologies used to measure ankle dorsiflexion in adults who have experienced a stroke and examines how these measurements correlate with walking performance. It also compares these findings with traditional clinical evaluation methods like manual muscle testing (MMT). We conducted a systematic search of PubMed, IEEE Xplore, and the Cochrane Library (2000–2025) for both observational and experimental studies that utilized sensor-based techniques (such as handheld or isokinetic dynamometry, load cells, and proprioceptive devices) to quantify ankle dorsiflexion and reported their relationship with gait outcomes. Additionally, studies employing conventional, non-instrumented clinical grading (e.g., ankle-dorsiflexor MMT) were included if they explored the connection between ankle function and gait, although these were not included in the quantitative analysis. Eighteen studies involving 783 stroke survivors met the inclusion criteria and were evaluated using the Newcastle–Ottawa Scale. Generally, individual studies found a positive association between ankle-dorsiflexor strength and both gait speed and endurance, although some negative correlations were noted. The strength and sometimes direction of these associations varied depending on the sensing technology, dorsiflexion index, gait outcome, and stroke chronicity. Overall, the current evidence indicates a generally positive but highly variable relationship between ankle dorsiflexion measurements and gait post-stroke, emphasizing the need to identify sources of variability and to create standardized, clinically applicable sensor-based assessment protocols. Full article

Background/Objectives: Post-stroke gait impairment is highly heterogeneous, which limits the effectiveness of standardized exoskeleton control strategies. Deep reinforcement learning offers a route to adaptive assistance, but its use in stroke rehabilitation is constrained by limited pathological gait data and the lack of interpretable transfer frameworks. We developed a data-efficient, pathology-informed reinforcement learning framework for personalized exoskeleton assistance under limited clinical gait data. Methods: The framework combines neuromuscular-inspired parametric augmentation (NIPA) with parameter-efficient transfer learning. NIPA synthesizes pathological gait trajectories by modeling weakness, stiffness or contracture, and abnormal synergies. A policy is first pretrained in simulation and then adapted to clinical gait data by freezing a shared feature extractor and fine-tuning the output heads. The framework was evaluated on a public clinical gait dataset of 50 stroke survivors using tracking error, reward, smoothness, generalization, and data efficiency as main outcomes. Results: The proposed method outperformed zero assistance, rule-based control, and reinforcement learning from scratch on the test set. Compared with scratch, it reduced total MSE from 14.8681 to 11.9369 ($p=5.96\times {10}^{-8}$) and improved reward from −21.2264 to −18.4798 ($p=3.76\times {10}^{-4}$). Hip MSE decreased from 5.9544 to 4.0143 ($p=7.51\times {10}^{-8}$) and knee MSE decreased from 6.5507 to 5.4507 ($p=1.51\times {10}^{-5}$), with significant improvements in repeated experiments. Conclusions: The proposed framework reduces reliance on large pathological training datasets and improves offline trajectory-level personalization under limited clinical data. It also provides an interpretable basis for quantitative characterization of post-stroke gait heterogeneity and may support individualized rehabilitation assessment and assistance planning. Full article

Background/Objectives: Freezing of gait (FOG) and sleep disturbances are common in people with Parkinson’s disease (PwPD). A bidirectional association between them has been suggested, but quantitative evaluations are scarce. This study aimed to compare sleep disturbances in mild-to-moderate PwPD with (PD+FOG) and without FOG (PD−FOG), and to assess the association between FOG severity and sleep parameters. Methods: Data from 54 PwPD with disease stage <4 and no severe cognitive decline were included (27 PD+FOG and 27 propensity score-matched for age, sex, and disease duration PD−FOG). Demographics and clinical variables were collected. Clinical assessment included the new freezing of gait questionnaire (NFOG-Q), Parkinson’s Disease Sleep Scale (PDSS-2), Epworth Sleepiness Scale (ESS) and Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Mann–Whitney U, Fisher’s exact and Spearman’s tests were used for group comparisons and correlations, respectively. Results: Significant differences were observed between PD+FOG and PD−FOG groups in MDS-UPDRS part II (p = 0.011) and part IV (p = 0.011), with higher scores in PD+FOG participants. No significant differences were found in PDSS-2 or ESS between the two groups. A significant moderate positive correlation was found between NFOG-Q score and PDSS-2 (ρ = 0.416; p = 0.044) in PD+FOG participants. Conclusions: FOG severity was positively associated with sleep disturbances within the PD+FOG group. However, no significant difference in sleep quality or excessive daytime sleepiness was found between PD+FOG and PD−FOG after propensity score matching. PD+FOG participants experienced more severe motor complications and greater impairment in daily activities compared to PD−FOG. Full article

To address limited segment coverage and integration drift in wearable inertial gait analysis, this work proposes a real-time multi-segment gait analysis method using seven MEMS-IMUs deployed on the pelvis and lower limbs. The method employs parameter adaptive nonlinear complementary filtering and foot-based event detection to calculate spatiotemporal parameters and joint angles. Validation against optical motion capture (OMC) showed sagittal joint angle RMSEs below 2.37°, pelvic angle RMSEs below 0.96°, and correlation coefficients above 0.89 during normal walking in healthy adults. Supported by real-time 3D skeletal visualization, the proposed system provides a low-cost and portable solution for quantitative gait assessment under controlled walking conditions, with potential for future rehabilitation monitoring after further clinical validation. Full article

Background: Adiponectin (ADPN) is a key adipokine with osteogenic potential, but its clinical translation for bone regeneration is hindered by poor in vivo stability. This study aimed to develop poly lactic-co-glycolic acid (PLGA) microparticles as a stable and biocompatible carrier for sustained ADPN delivery to enhance bone repair. Methods: ADPN-loaded PLGA microparticles (ADPN-MPs) were fabricated via emulsion solvent evaporation. Their physicochemical properties were characterized using scanning electron microscopy (SEM) and circular dichroism (CD) spectroscopy. Loading efficiency and drug loading were quantified. In vitro release kinetics and stability under physiological conditions were assessed. Biocompatibility was evaluated using MC3T3-E1 osteoblasts and BMSCs, and in vivo efficacy was tested in a fracture model via gait analysis. Results: Employing CD to evaluate the secondary structure of ADPN, emulsion solvent evaporation for microparticles preparation, and SEM for morphological analysis, we quantitatively assessed the loading efficiency (69.83 ± 4.24%) and drug loading (0.97 ± 0.06%) of ADPN-MPs. Results indicated that ADPN-MPs maintained significant stability under varied pH and temperature conditions and exhibited a controlled release profile, with an average initial rapid release of 14.25% within 24 h and an average cumulative release of 55.00% by day 28. Furthermore, ADPN-MPs promoted the proliferation of MC3T3-E1 and BMSCs without toxicity, demonstrating excellent biocompatibility. Notably, gait analysis in a fracture model showed improved healing in both ADPN and ADPN-MPs groups compared to controls, with ADPN-MPs demonstrating comparable efficacy to free ADPN, supporting its potential as a stable delivery system for bone regeneration. Conclusions: PLGA microparticles serve as an effective, stable, and biocompatible delivery platform for ADPN, significantly promoting bone regeneration in vitro and in vivo. This delivery system enhances the therapeutic potential of ADPN for clinical bone repair applications. Full article

Background: Flatfoot deformity is associated with altered lower extremity biomechanics and functional impairment during gait. However, evidence describing spatio-temporal gait alterations remains heterogeneous and has not been consistently synthesized across studies. Methods: A systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (via PubMed) and Scopus were searched through 24 March 2025 for studies evaluating gait characteristics in individuals with flatfoot or progressive collapsing foot deformity. Studies reporting spatio-temporal parameters in both flatfoot and healthy control cohorts were included in quantitative synthesis. Random-effects meta-analyses were performed to evaluate gait velocity, stance duration, stride length, and cadence. Results: Fifteen studies met inclusion criteria, of which five provided sufficient data for meta-analysis. Compared with healthy controls, individuals with flatfoot demonstrated longer stance duration and shorter stride length. No differences were observed in gait velocity or cadence. Substantial heterogeneity was present across all pooled outcomes (I² > 80%), reflecting variability in study populations, disease characteristics, and gait analysis methodologies. Conclusions: Flatfoot is associated with consistent spatio-temporal gait adaptations characterized by longer stance duration and reduced stride length. Despite heterogeneity among included studies, these findings suggest consistent spatio-temporal gait adaptations that may serve as clinically relevant markers of altered gait mechanics and functional impairment. Further studies with standardized protocols are needed to refine the role of gait analysis in the assessment and management of flatfoot. Full article

Background: The use of inertial measurement units (IMUs) in the Timed Up and Go (TUG) test enables the quantitative assessment of functional performance and mobility. It allows for the determination not only of the total test completion time, but also of the durations of individual phases, as well as the derivation of spatiotemporal gait parameters and turning velocity. The aim of this review article was to compile parameters of the instrumented Timed Up and Go (iTUG) test and to identify the parameters most commonly analyzed in populations of healthy adults, older adults, and patients with neurological disorders. Methods: A systematic literature search was conducted in the PubMed, Scopus, and ScienceDirect databases. The authors included studies in which commercial IMUs were used during the TUG test and quantitative parameters were analyzed. Methodological quality was assessed using the JBI Critical Appraisal Checklist for cross-sectional studies. Results: A total of 36 studies were included in the review. Only those disease entities represented by at least four studies were included in the tabular analysis. The study presents results for a total of 1268 individuals, including 192 healthy adults, 514 older adults, 230 patients with multiple sclerosis (MS), and 332 patients with Parkinson’s disease (PD). The analysis showed that temporal parameters, particularly the total test duration and the durations of individual phases, were the most commonly reported across all populations. Conclusions: Turning-related parameters were analyzed frequently, whereas spatiotemporal parameters were assessed less often. The results indicate a lack of standardization both in the selection of iTUG parameters as well as in the measurement methods and systems used. Full article

Abnormal gait associated with neuromuscular and musculoskeletal disorders represents a growing clinical burden, particularly in aging populations. This study presents a modular, low-cost Smart Rehabilitation Walker (SRW) that integrates multimodal sensing and real-time haptic feedback to enable simultaneous gait monitoring and corrective intervention in both clinical and home environments. The system combines force-sensing resistors for bilateral load symmetry assessment, inertial measurement units for fall detection, and surface electromyography (sEMG) for neuromuscular activity monitoring within a closed-loop assistive feedback architecture. A 15-day pilot study involving ten individuals with rheumatoid arthritis and clinically observed neurological gait abnormalities demonstrated measurable improvements in gait biomechanics. The Force Symmetry Index (FSI), calculated using the Robinson symmetry metric, decreased from an average of 0.9691 to 0.2019, corresponding to a 79.26% average reduction in inter-limb load asymmetry. Concurrently, sEMG measurements showed a substantial increase in neuromuscular activation (ΔEMG = 4.28), with statistical analysis confirming a significant improvement across participants (paired t-test: t(9) = 13.58, p < 0.001). To model rehabilitation trajectories, a nonlinear predictive framework based on Gaussian Process Regression achieved high predictive accuracy (R² ≈ 0.9, with a mean RMSE of 0.0385), while providing uncertainty-aware trend estimation. Validation using an independent amyotrophic lateral sclerosis gait dataset further demonstrated the transferability of the analytical pipeline. These results highlight the potential of sensor-enabled assistive walkers as scalable platforms for quantitative gait rehabilitation, adaptive feedback, and long-term mobility monitoring. Full article

Background/Objectives: Freezing of gait (FoG) is a disabling motor manifestation of Parkinson’s disease (PD) associated with impaired neural control of locomotion and increased gait variability. Quantitative characterization of gait kinematics may provide biomechanical insight into FoG-related instability, particularly under different dopaminergic states. Methods: This pilot study evaluated sagittal-plane knee kinematics in healthy individuals (n = 27) and patients with PD. (n = 8) under OFF and ON dopaminergic medication conditions using two-dimensional videogrammetry (Kinovea^®). Knee flexion–extension trajectories were time-normalized to 0–100% of the gait cycle, and group ensemble profiles (mean ± SD) were computed. Results: Phase-specific range of motion (ROM), within-subject variability, and interlimb coordination were quantified. Interlimb coordination was assessed using Pearson’s correlation coefficients (r) and cross-correlation lag analysis computed per subject and summarized statistically across groups. Compared with healthy participants, PD patients in the OFF state exhibited significantly reduced knee ROM during stance and swing (p < 0.05), accompanied by increased kinematic variability and disrupted temporal coordination. Interlimb correlation was significantly lower in PD OFF compared to healthy gait groups (p = 0.010), with larger temporal lags, indicating impaired bilateral synchronization. Following medication intake (ON state), knee excursion increased and interlimb coordination partially improved; however, correlation values and timing symmetry did not fully normalize to healthy levels. Conclusions: These findings demonstrate that sagittal-plane knee kinematics and interlimb coordination metrics derived from low-cost 2D videogrammetry are sensitive to the dopaminergic state and reveal persistent neuromotor deficits in PD. The proposed framework provides an interpretable and accessible approach for characterizing gait organization in Parkinson’s disease and supports future integration with clinical assessment and longitudinal monitoring. Full article

(1) Background: Gait analysis provides quantitative information on walking patterns and has proven invaluable for assessing motor function in rehabilitation programmes. A markerless motion capture system combining computer vision techniques provides low-cost, real-time, portable gait analysis. (2) Methods: The kinematics of the knee and ankle of twenty-seven healthy volunteers were assessed using a single smartphone camera combined with the MediaPipe human pose estimation framework. The system was validated using the OPAL wearable sensor system by APDM Wearable Technologies. (3) Results: Findings showed close correspondence between the two systems for knee kinematics showing a mean absolute error of 4.10° ± 2.32° and 3.15° ± 3.10° for right and left knee flexion, respectively, and a mean absolute error of 2.30° ± 2.01° and 3.12° ± 2.63° for right and left knee extension, respectively. The mean absolute error for right and left knee range of motion was found to be 4.55° ± 3.12° and 4.15° ± 3.01°, respectively. Moreover, Bland–Altman plots indicated minimal bias (average 0.6 for flexion, average 0.47 for the extension, and 0.30 for the range of motion) and excellent correlation for knee flexion bilaterally (0.916 and 0.845 for the right and left side, respectively), with slightly lower but still satisfactory agreement for knee extension (0.862 and 0.845 for the right and left side, respectively). Conversely, ankle measurements revealed poor concordance: dorsiflexion and range of motion presented significant differences and systematic errors, while plantarflexion showed no statistical difference but weak correlation. (4) Conclusions: This study demonstrated that combining a smartphone camera with a human pose estimation framework allows for low-cost, real-time, portable gait analysis, particularly of the knee joint. Full article