Search Results (457)

This study aims to assess hand function recovery in stroke patients during the mid-to-late Brunnstrom stages and to encourage active participation in rehabilitation exercises. To this end, a deep residual network (ResNet) integrated with Focal Loss is employed for gesture recognition, achieving a Macro F1 score of 91.0% and a validation accuracy of 90.9%. Leveraging the millimetre-level precision of Leap Motion 2 hand tracking, a mapping relationship for hand skeletal joint points was established, and a static assessment gesture data set containing 502,401 frames was collected through analysis of the FMA scale. The system implements an immersive augmented reality interaction through the Unity development platform; C# algorithms were designed for real-time motion range quantification. Finally, the paper designs a rehabilitation system framework tailored for home and community environments, including system module workflows, assessment modules, and game logic. Experimental results demonstrate the technical feasibility and high accuracy of the automated system for assessment and rehabilitation training. The system is designed to support stroke patients in home and community settings, with the potential to enhance rehabilitation motivation, interactivity, and self-efficacy. This work presents an integrated research framework encompassing hand modelling and deep learning-based recognition. It offers the possibility of feasible and economical solutions for stroke survivors, laying the foundation for future clinical applications. Full article

The exploitation of hydrokinetic resources represents a sustainable and efficient alternative for renewable energy generation. This study presents the design and real-world implementation of a compact hydrokinetic system capable of converting rainwater runoff into electricity within smart homes. Unlike conventional large-scale hydrokinetic technologies, this system was specifically engineered for intermittent, low-flow conditions typical of residential rainwater collection networks. The turbine was manufactured using 3D-printed biodegradable materials to promote environmental sustainability and facilitate rapid prototyping. Through CFD simulations and laboratory testing, the system’s hydraulic behaviour and energy conversion efficiency were validated across different flow scenarios. The complete system, consisting of four turbines rated at 120 W each, was integrated into a real smart home without structural modifications. From an academic perspective, this study contributes a quantitatively validated hybrid hydrokinetic–low-head framework for residential rainwater energy recovery, addressing intermittent and low-flow urban conditions insufficiently explored in existing literature. Field tests demonstrated that the hydrokinetic system provides complementary energy during rainfall events, generating up to 6000 Wh per day and enhancing household energy resilience, particularly during periods of low solar availability. The results confirm the technical feasibility, sustainability, and practical viability of decentralized hydrokinetic energy generation for residential applications. Full article

Background: A childhood burn presents new and unfamiliar challenges to patients and their parents during recovery. These injuries can negatively impact activities such as independence in self-care, participation in physical activity, and social interaction. As such, pediatric burn patients are at risk of poorer quality of life (QoL) outcomes after their burn. In this longitudinal, observational cohort study, we examined the social, demographic, and clinical factors that were associated with a poor QoL at 12 months postburn for pediatric patients aged > 2 years with non-severe burns in Western Australia. Methods: Inpatients were recruited from the pediatric burn unit at Perth Children’s Hospital in Western Australia between February 2021 and September 2022. Demographic and family information (age, sex, postcode, parental education, languages spoken at home) and clinical data (burn cause, TBSA%, location, surgical interventions, length of stay) were collected at baseline. At 6 and 12 months, caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). Results: A total of 37 caregivers completed the Brisbane Burn Scar Impact Profile (BBSIP). For the child’s QoL, 57% of caregivers reported that some impact remained for overall QoL, 32% for sensory intensity, 46% for sensitivity, 22% for daily living (22%), and 19% for emotional reactions. Parent worry was impacted in 46% of caregivers. Being female was associated with greater long-term impacts, particularly in overall functioning and parental worry. The burn location also influenced outcomes, with injuries to the upper limbs linked to higher sensory intensity and emotional impact. Children from culturally and linguistically diverse (CaLD) backgrounds, indicated by those speaking a language other than English at home (LOTE), demonstrated significantly greater effects across several domains, including overall impact, daily living, appearance, and parent worry. Conclusions: A substantial proportion of children continued to experience impacts from non-severe burns across multiple domains, indicating that even small-area burns can have lasting effects. The factors associated with worse scores were the child being female, the families being linguistically diverse, and upper body burns. Full article

Manual window cleaning in high-rise urban buildings is labor-intensive, risky, and resource-inefficient. This study addresses these challenges by investigating a resource-aware mechatronic architecture through the design, development, and experimental validation of a modular Automated Window Cleaning System (AWCS). Unlike conventional open-loop solutions, the AWCS integrates mechanical scrubbing with a closed-loop fluid management system, featuring precise dispensing and vacuum-assisted recovery. The system is governed by a deterministic finite state machine implemented on an ESP32 microcontroller, enabling low-latency IoT connectivity and autonomous operation. Two implementation variants—integrated and retrofit—were validated to ensure structural adaptability. Experimental results across 30 cycles demonstrate a cleaning efficiency of ~2 min/m², a water consumption of <150 mL/m² (representing a >95% reduction compared to manual methods), and an optical cleaning efficacy of 96.9% ± 1.4%. Safety protocols were substantiated through a calculated mechanical safety factor of 6.12 for retrofit applications. This research establishes the AWCS as a sustainable, safe, and scalable solution for autonomous building maintenance, contributing to the advancement of resource-circular domestic robotics and smart home automation. Full article

Experiencing weakness or paralysis on one side of the body is a common consequence of stroke, with approximately 8 out of 10 patients experiencing some degree of Hemiparesis. Rehabilitation through physiotherapy and occupational therapy is one of the primary methods used to alleviate these conditions. However, physiotherapy, provided by a therapist, is not always readily available. Rehabilitation robots have been studied as alternatives and supplements to conventional therapy. These robots, based on their interaction with the user, can be categorized as end-effector and exoskeleton-based robots. This work aims to examine end-effector rehabilitation robots targeting hemiplegic arm’s proximal joints (shoulder and elbow) for post-stroke recovery. Additionally, we analyze their mechanical design, training modes, user interfaces, and clinical outcomes, highlighting trends and gaps in these systems. Furthermore, we suggest design considerations for home-based therapy and future integration with tele-rehabilitation, based on our findings. This review uniquely focuses on end-effector robots for proximal joints, synthesizing design trends and clinical evidence to guide future development. Full article

Stroke is a leading cause of death and long-term disability worldwide, with ischemic stroke accounting for approximately 62.4% of all cases. This condition often results in persistent motor dysfunction, significantly reducing patients’ productivity. The effectiveness of rehabilitation therapy is crucial for post-stroke motor recovery. However, limited access to rehabilitation services particularly in low- and middle-income countries remains a major barrier due to a shortage of experienced professionals. This challenge also affects home-based rehabilitation, an alternative to conventional therapy, which primarily relies on standard evaluation methods that are heavily dependent on expert interpretation. Electromyography (EMG) offers an objective and alternative approach to assessing muscle activity during stroke therapy in home environments. Recent advancements in deep learning (DL) have opened new avenues for automating the classification of EMG data, enabling differentiation between post-stroke patients and healthy individuals. This study introduces a novel methodology for transforming EMG signals into time–frequency representation (TFR) spectrograms, which serve as input for a convolutional neural network (CNN) model. The proposed Tri-CCNN model achieved the highest classification accuracy of 93.33%, outperforming both the Shallow CNN and the classic LeNet-5 architecture. Furthermore, an in-depth analysis of spectrogram amplitude distributions revealed distinct patterns in stroke patients, demonstrating the method’s potential for objective stroke assessment. These findings suggest that the proposed approach could serve as an effective tool for enhancing stroke classification and rehabilitation procedures, with significant implications for automating rehabilitation monitoring in home-based rehabilitation (HBR) settings. Full article

Background/Objectives: Non-traumatic (degenerative) rotator cuff tendinopathy with partial supraspinatus tear (NT-RCTT) is a common source of shoulder pain and disability. Comparative evidence between radial extracorporeal shock wave therapy (rESWT) and multimodal physical therapy modalities (PTMs) remains scarce. Methods: In this single-center randomized controlled trial, 60 adults with MRI-confirmed NT-RCTT were assigned (1:1) to rESWT (one session weekly for six weeks; 2000 impulses per session, 2 bar air pressure, positive energy flux density 0.08 mJ/mm²; 8 impulses per second) or a multimodal PTM program (interferential current, shortwave diathermy and magnetothermal therapy; five sessions weekly for six weeks). All participants performed standardized home exercises. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) total score; secondary outcomes included pain (visual analog scale, VAS), satisfaction, range of motion (ROM), supraspinatus tendon (ST) thickness and acromiohumeral distance (AHD). Assessments were conducted at baseline, and at week 6 (W6) and week 12 (W12) post-baseline. Results: Both interventions significantly improved all outcomes, but rESWT produced greater and faster effects. Mean ASES total scores increased by 31 ± 5 points with rESWT versus 26 ± 6 with PTMs (p < 0.05). VAS pain decreased from 5.2 ± 0.7 to 1.0 ± 0.7 with rESWT and from 5.2 ± 0.8 to 1.7 ± 0.8 with PTMs (p < 0.01). rESWT achieved higher satisfaction and larger gains in abduction, flexion and external rotation. Ultrasound showed reduced ST thickness and increased AHD after rESWT but not after PTMs. No serious adverse events occurred. Conclusions: rESWT yielded superior pain relief, functional recovery and tendon remodeling compared with a multimodal PTM program, with markedly lower treatment time and excellent tolerability. Full article

The hospital-at-home (HaH) model delivers hospital-level care to patients in their homes, with point-of-care ultrasonography (PoCUS) serving as a cornerstone diagnostic tool for respiratory illnesses such as pneumonia. This review—the third in a series—addresses the prognostic, synchronous, and potential overdiagnostic concerns of lung ultrasound (LUS) in managing pneumonia within HaH settings. LUS offers advantages of safety and repeatability, allowing clinicians to identify “red flag” sonographic findings that signal complicated or severe disease, including pleural line abnormalities, fluid bronchograms, absent Doppler perfusion, or poor diaphragmatic motion. Serial LUS examinations correlate closely with clinical recovery, showing progressive resolution of consolidations, B-lines, and pleural effusions, and thus provide a non-invasive method for monitoring therapeutic response. Compared with chest radiography, LUS demonstrates superior sensitivity in detecting pneumonia, pleural effusion, and interstitial syndromes across pediatric and adult populations. However, specificity may decline in tuberculosis-endemic or obese populations due to technical limitations and overlapping imaging patterns. Overdiagnosis remains a concern, as highly sensitive ultrasonography may identify minor or clinically irrelevant lesions, potentially leading to overtreatment. To mitigate this, PoCUS should be applied in parallel with conventional diagnostics and integrated into comprehensive clinical assessment. Standardized training, multi-zone scanning protocols, and structured image acquisition are recommended to improve reproducibility and inter-operator consistency. Full article

Background: Survivors of severe traumatic brain injury (TBI) show highly heterogeneous recovery but early functional trajectories across rehabilitation, and their relationship with 1-year outcomes remain poorly characterized. Methods: We performed a secondary analysis of the Traumatic Brain Injury Model Systems (TBIMS) National Database. Adults with severe TBI (Glasgow Coma Scale ≤ 8, post-traumatic amnesia (PTA) > 7 days, or neurosurgical intervention) who received inpatient rehabilitation with Functional Independence Measure (FIM) admission and discharge totals and 1-year Glasgow Outcome Scale—Extended (GOS-E) were included (n = 9438). K-means clustering on FIM admission, FIM discharge, and 1-year GOS-E identified early functional recovery trajectories. Multinomial logistic regression related trajectory class to age, sex, PTA duration, rehabilitation length of stay (LOS), and total LOS. Logistic regression examined associations between trajectory class and 1-year home residence and rehospitalization, adjusted for age and sex. Results: Three trajectories emerged: low-functioning/limited improvers (28.0%), substantial improvers (33.7%), and high-functioning (38.3%). The low-functioning trajectory showed lower FIM scores at admission and discharge and worse 1-year GOS-E than the other trajectories. In adjusted models, older age, longer PTA, and longer LOS were associated with less favorable trajectories overall, particularly reducing the likelihood of belonging to the high-functioning trajectory. Substantial improvers and high-functioning patients had higher odds of living at home and lower odds of rehospitalization at 1 year than low-functioning patients. Conclusions: Simple routine measures can yield interpretable recovery trajectories after severe TBI that may support prognosis, discharge planning, and follow-up; these trajectories should be interpreted as population-level probabilities rather than deterministic predictions for individual patients. Full article

Background: Immersive virtual reality (VR) has emerged as a promising tool to enhance neuroplasticity, motivation, and engagement during post-stroke motor rehabilitation. However, evidence on its feasibility and data-driven integration into clinical practice remains limited. Objective: This pilot study aimed to evaluate the feasibility, usability, and short-term motor outcomes of an immersive VR-assisted rehabilitation program using the Travee-VR system. Methods: Fourteen adults with post-stroke upper-limb paresis completed a 10-day hybrid rehabilitation program combining conventional therapy with immersive VR sessions. Feasibility and tolerability were assessed through adherence, adverse events, the System Usability Scale (SUS), and the Simulator Sickness Questionnaire (SSQ). Motor outcomes included active and passive range of motion (AROM, PROM) and a derived GAP index (PROM–AROM). Correlations between clinical changes and in-game performance metrics were explored to identify potential digital performance metrics of recovery. Results: All participants completed the program without adverse events. Usability was rated as high (mean SUS = 79 ± 11.3), and cybersickness remained mild (SSQ < 40). Significant improvements were observed in shoulder abduction (+7.3°, p < 0.01) and elbow flexion (+5.8°, p < 0.05), with moderate-to-large effect sizes. Performance gains in the Fire and Fruits games correlated with clinical improvement in shoulder AROM (ρ = 0.45, p = 0.041). Cluster analysis identified distinct responder profiles, reflecting individual variability in neuroplastic adaptation. Conclusions: The Travee-VR system proved feasible, well tolerated, and associated with measurable short-term improvements in upper-limb function. By linking clinical outcomes with real-time kinematic data, this study supports the role of immersive, feedback-driven VR as a catalyst for data-informed neuroplastic recovery. These results lay the groundwork for adaptive, clinic-to-home rehabilitation models integrating clinical and exploratory digital performance metrics. Full article

Advances in robotic technology for hand rehabilitation, particularly soft robotic gloves, have significant potential to improve patient outcomes. While vision-based algorithms pave the way for fast and convenient hand pose estimation, most current models struggle to accurately track hand movements when soft robotic gloves are used, primarily due to severe occlusion. This limitation reduces the applicability of soft robotic gloves in digital and remote rehabilitation assessment. Furthermore, traditional clinical assessments like the Fugl-Meyer Assessment (FMA) rely on manual measurements and subjective scoring scales, lacking the efficiency and quantitative accuracy needed to monitor hand function recovery in data-driven personalised rehabilitation. Consequently, few integrated evaluation systems provide reliable quantitative assessments. In this work, we propose an RGB-based evaluation system for soft robotic glove applications, which is aimed at bridging these gaps in assessing hand function. By incorporating the Hand Mesh Reconstruction (HaMeR) model fine-tuned with motion capture data, our hand estimation framework overcomes occlusion and enables accurate continuous tracking of hand movements with reduced errors. The resulting functional metrics include conventional clinical benchmarks such as the mean per joint angle error (MPJAE) and range of motion (ROM), providing quantitative, consistent measures of rehabilitation progress and achieving tracking errors lower than 10°. In addition, we introduce adapted benchmarks such as the angle percentage of correct keypoints (APCK), mean per joint angular velocity error (MPJAVE) and angular spectral arc length (SPARC) error to characterise movement stability and smoothness. This extensible and adaptable solution demonstrates the potential of vision-based systems for future clinical and home-based rehabilitation assessment. Full article

Background/Objectives: Thyroidectomy is a common endocrine procedure associated with postoperative musculoskeletal symptoms such as neck stiffness, pain, and reduced cervical mobility. These sequelae, though often underrecognized, can impair recovery and quality of life. Rehabilitation strategies, including stretching, manual therapy, and kinesio taping, have emerged as potential adjuncts to enhance postoperative outcomes. This scoping review aimed to map and synthesize current evidence on postoperative rehabilitation interventions following thyroidectomy, focusing on stretching exercises, manual therapy, and kinesio taping. Methods: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive search identified studies evaluating physical therapy interventions in adult thyroidectomy patients. Fourteen studies published between 2005 and 2025 met the inclusion criteria, encompassing randomized trials, quasi-experimental designs, and one retrospective cohort study. Interventions were delivered in early postoperative settings and included supervised or home-based programs. Results: Neck stretching and range-of-motion exercises consistently demonstrated benefits in pain reduction, cervical mobility, and functional recovery. These low-cost interventions were feasible for early implementation and continuation post-discharge. Evidence for kinesio taping was mixed, with some studies reporting short-term symptom relief and others showing no significant effect. Manual therapy, assessed in a single large cohort, showed promise when combined with stretching, though its independent efficacy remains unclear. Conclusions: Structured rehabilitation—particularly stretching and mobility exercises—may enhance recovery after thyroidectomy. Kinesio taping and manual therapy appear beneficial as adjunctive measures but require further validation. The findings underscore the need for standardized protocols and high-quality trials to optimize postoperative care and long-term outcomes. Full article

Reintroductions are essential in wildlife conservation, but their success depends not only on demographic outcomes such as survival and reproduction, but also on behavioral adjustments that determine integration into the wild. The Grey Crowned Crane (Balearica regulorum), an endangered species, has suffered dramatic declines due to habitat loss, disturbance, and illegal capture. In Rwanda, a large-scale amnesty rescued 242 cranes from captivity, with 166 rehabilitated and released into Akagera National Park. This study used GPS-GSM telemetry to investigate post-release movement of reintroduced captive-rescued cranes in comparison with wild individuals. Twenty-one cranes (10 reintroduced, 11 wild) were tracked for 5–1118 days, with 15 individuals meeting criteria for detailed analyses. Reintroduced cranes exhibited reduced dispersal, with only 2 of 7 dispersing compared to 7 of 9 wild cranes, and typically after much longer residence at the release site. Reintroduced cranes also had smaller maximum displacements (median 8.4 km) and smaller home ranges (median 3.3 km²) relative to those of wild cranes (median 24.0 km and median 22.6 km², respectively). These findings suggest that supplemental feeding and extended captivity (2 days to 10 years) of reintroduced cranes strongly influenced their high site fidelity and movement patterns. While limited dispersal may benefit short-term survival, long-term monitoring of survival, reproduction, and demographic trends is critical for assessing whether reintroduction achieves population recovery. Full article

Background/Objectives: Informal caregivers play a crucial role in healthcare, but when caregiving ends the “post-caregivers” often remain invisible and unsupported. Post-caregivers face needs such as reconstructing their identity and finding space and time to grieve. This study aimed to design a support network for informal post-caregivers by exploring perceptions of diverse stakeholders. Methods: A qualitative inductive study was conducted using three focus groups (n = 15; ages 35–70; 12 women, 3 men) held online between June and July 2023. Participants included palliative care team members, home support professionals, general practitioners, informal caregivers, post-caregivers, and members of civil society. A semi-structured guide was used, and narratives were analyzed with a Narrative Medicine-informed approach and thematic analysis. Results: Community-For-Care emerged as an overarching and distinctive concept that, while aligned with the ethos of Compassionate Communities, specifically addresses the transition after caregiving ends, a phase largely absent from existing models. It symbolizes the “living forces of the community” mobilized to accompany informal post-caregivers through identity reconstruction, bereavement, and reintegration. Three interrelated thematic axes structure this concept: (1) Compassion Axis—emphasizing a compassionate community that values caregiving; (2) Coordinated Action Axis—highlighting coordinated, continuous support across healthcare and community services; and (3) Care Literacy Axis—underscoring education and training for caregivers, post-caregivers, and professionals. These axes dynamically interact to empower post-caregivers and stitch the holes in the support network. Conclusions: A community-centered, post-caregiver-focused framework such as Community-For-Care offers a novel extension of compassionate communities by directly addressing the loneliness, identity rupture, and invisibility that often characterize the transition after caregiving. Reinforcing compassion, coordinated action, and care literacy can enable communities to better acknowledge the contributions and ongoing needs of post-caregivers, supporting their emotional recovery, social reintegration, and reconstruction of daily life. By integrating these three axes into community practice, the model introduces a post-care-specific structure that can enhance well-being, reduce preventable health decline, and relieve pressure on formal services by mobilizing local, civic, and relational assets. Full article

Background: Stroke is the leading cause of physical disability in adults in Catalonia. Despite this, there is a lack of evidence of physiotherapy interventions on functional capacity during the chronic phase of the pathology. This multicenter clinical trial will be conducted with a sample size of 75 participants. Objectives: The objective of the study is to evaluate the effectiveness of a therapeutic exercise program in physiotherapy using telerehabilitation to optimize functional recovery and quality of life in people with chronic stroke, and to determine its impact on adherence to the exercise program. Methods: This is a multicenter randomized controlled trial. Three parallel groups will be compared, and two will undergo the same type of therapy. A control group (CG) will perform conventional intervention in primary care. There will be two experimental groups; (EG1) will perform document-guided therapeutic exercises at home and (EG2) will perform therapeutic exercises at home guided by a telerehabilitation program. The outcomes to be measured are degree of independence of a person in their activities of daily living, assessed by the Barthel Index, motor function, muscle tone of the affected limbs, muscle strength of the affected limbs, balance, gait efficiency, perception of musculoskeletal pain, perception of fatigue, risk of falls, perception of quality of life, and the perception of perceived subjective change after treatment. These outcomes will be evaluated at baseline (T0), at ten weeks (T1) (end of the intervention), and at 18 weeks (T2). The study duration per patient will be 18 weeks (a ten-week intervention, followed by an eight-week intervention follow-up). The analysis will be performed using a mixed linear model (ANOVA 3X3) and significance level p < 0.05. Full article