Search Results (1,217)

Total knee replacement (TKR) is a common procedure for pain relief and restoration of the mobility of the knee joint in patients with severe knee joint problems. Despite this, some patients still suffer from stiffness, instability, or pain caused by soft tissue imbalance, malalignment, or implant-related issues. Previously, surgeons have had to use their experience and visual judgment to balance the knee, which has resulted in variability of outcomes. Smart knee implants are addressing these issues by using sensor technology to provide real-time feedback on joint motion, pressure distribution, and loading forces. This enables more accurate intra-operative adjustment, enhancing implant positioning and soft tissue balance and eliminating post-operative adjustment. These implants also enable post-operative monitoring, simplifying the ability to have more effective individualized rehabilitation programs directed at optimizing patient mobility and minimizing complications. While the patient pool for smart knee implantation remains not commonly documented, it was found in a study that 83.6% of the patients would opt to have the monitoring device implemented, and nearly 90% find reassurance in monitoring their healing indicators. As the number of knee replacements is likely to rise due to aging populations and the rising prevalence of joint disease, smart implants are a welcome development in orthopedics, optimizing long-term success and patient satisfaction. Smart knee implants are built with embedded sensors such as force, motion, temperature, and pressure detectors placed within the implant structure. These sensors provide real-time data during surgery and recovery, allowing earlier detection of complications and supporting tailored rehabilitation. The design aims to improve outcomes through better monitoring and personalized care. Full article

Amblyopia, commonly affecting children aged 0–6 years, results from disrupted visual processing during early development and often leads to reduced visual acuity in one eye. This study presents the development and preliminary usability assessment of a non-invasive ocular monitoring device designed to support oculomotor engagement and therapy adherence in amblyopia management. The system incorporates an interactive maze-navigation task controlled via gaze direction, implemented during monocular and binocular sessions. The device tracks lateral and anteroposterior eye movements and generates visual reports, including displacement metrics and elliptical movement graphs. Usability testing was conducted with a non-probabilistic adult sample (n = 15), including individuals with and without amblyopia. The System Usability Scale (SUS) yielded an average score of 75, indicating good usability. Preliminary tests with two adults diagnosed with amblyopia suggested increased eye displacement during monocular sessions, potentially reflecting enhanced engagement rather than direct therapeutic improvement. This feasibility study demonstrates the device’s potential as a supportive, gaze-controlled platform for visual engagement monitoring in amblyopia rehabilitation. Future clinical studies involving pediatric populations and integration of visual stimuli modulation are recommended to evaluate therapeutic efficacy and adaptability for early intervention. Full article

Sleep disorders and stroke are intricately linked through a complex, bidirectional relationship. Sleep disturbances such as obstructive sleep apnea (OSA), insomnia, and restless legs syndrome (RLS) not only increase the risk of stroke but also frequently emerge as consequences of cerebrovascular events. OSA, in particular, is associated with a two- to three-fold increased risk of incident stroke, primarily through mechanisms involving intermittent hypoxia, systemic inflammation, endothelial dysfunction, and autonomic dysregulation. Conversely, stroke can disrupt sleep architecture and trigger or exacerbate sleep disorders, including insomnia, hypersomnia, circadian rhythm disturbances, and breathing-related sleep disorders. These post-stroke sleep disturbances are common and significantly impair rehabilitation, cognitive recovery, and quality of life, yet they remain underdiagnosed and undertreated. Early identification and management of sleep disorders in stroke patients are essential to optimize recovery and reduce the risk of recurrence. Therapeutic strategies include lifestyle modifications, pharmacological treatments, medical devices such as continuous positive airway pressure (CPAP), and emerging alternatives for CPAP-intolerant individuals. Despite growing awareness, significant knowledge gaps persist, particularly regarding non-OSA sleep disorders and their impact on stroke outcomes. Improved diagnostic tools, broader screening protocols, and greater integration of sleep assessments into stroke care are urgently needed. This narrative review synthesizes current evidence on the interplay between sleep and stroke, emphasizing the importance of personalized, multidisciplinary approaches to diagnosis and treatment. Advancing research in this field holds promise for reducing the global burden of stroke and improving long-term outcomes through targeted sleep interventions. Full article

Introduction: Despite clinical evidence for efficacy, there has been minimal uptake of transcranial direct current stimulation (tDCS) for musculoskeletal conditions. Thus, our objective was to explore the perceptions and experiences of people living with lower-limb musculoskeletal injury as well as healthy physically active populations and relate this to the usage of tDCS and key aspects of tDCS design that would improve the capacity for implementation. Methods: We conducted a qualitative descriptive study of 16 participants (44% women) using semi-structured focus groups to identify the descriptions and experiences of people living with lower-limb musculoskeletal injury and healthy physically active populations. A thematic template was used to create a coding structure. Codes were then grouped, and key themes were derived from the data. Results: Four primary themes were identified from focus groups. These were (i) the impact of musculoskeletal injuries on health and quality of life, (ii) performance and injury recovery as facilitators to using tDCS, (iii) barriers and facilitators to tCDS application and (iv) design and aesthetic factors for a tDCS device. Discussion: Our qualitative descriptive study identified four themes relevant to the successful implementation of tDCS into rehabilitative and performance practice. To increase the likelihood of successful tDCS implementation, these barriers should be addressed and facilitators promoted. This should include innovative approaches to device application and structure that allow for a stylish, user-friendly design. Full article

Rehabilitation devices such as actuated lower-limb exoskeletons can provide essential mobility assistance for pediatric patients with gait impairments. Enhancing their control systems under conditions of user variability and dynamic disturbances remains a significant challenge, particularly in active-assist modes. This study presents a human-in-the-loop control architecture for a pediatric lower-limb exoskeleton, combining outer-loop admittance control with robust inner-loop trajectory tracking via a non-singular terminal sliding-mode (NSTSM) controller. Designed for active-assist gait rehabilitation in children aged 8–12 years, the exoskeleton dynamically responds to user interaction forces while ensuring finite-time convergence under system uncertainties. To enhance adaptability, we augment the inner-loop control with a twin delayed deep deterministic policy gradient (TD3) reinforcement learning framework. The actor–critic RL agent tunes NSTSM gains in real-time, enabling personalized model-free adaptation to subject-specific gait dynamics and external disturbances. The numerical simulations show improved trajectory tracking, with RMSE reductions of 27.82% (hip) and 5.43% (knee), and IAE improvements of 40.85% and 10.20%, respectively, over the baseline NSTSM controller. The proposed approach also reduced the peak interaction torques across all the joints, suggesting more compliant and comfortable assistance for users. While minor degradation is observed at the ankle joint, the TD3-NSTSM controller demonstrates improved responsiveness and stability, particularly in high-load joints. This research contributes to advancing pediatric gait rehabilitation using RL-enhanced control, offering improved mobility support and adaptive rehabilitation outcomes. Full article

Brain–computer interface (BCI) technology holds promise for improving motor rehabilitation in stroke patients. This review explores the immediate and long-term effects of BCI training, shedding light on the potential benefits and challenges. Clinical studies have demonstrated that BCIs yield significant immediate improvements in motor functions following stroke. Patients can engage in BCI training safely, making it a viable option for rehabilitation. Evidence from single-group studies consistently supports the effectiveness of BCIs in enhancing patients’ performance. Despite these promising findings, the evidence regarding long-term effects remains less robust. Further studies are needed to determine whether BCI-induced changes are permanent or only last for short durations. While evaluating the outcomes of BCI, one must consider that different BCI training protocols may influence functional recovery. The characteristics of some of the paradigms that we discuss are motor imagery-based BCIs, movement-attempt-based BCIs, and brain-rhythm-based BCIs. Finally, we examine studies suggesting that integrating BCIs with other devices, such as those used for functional electrical stimulation, has the potential to enhance recovery outcomes. We conclude that, while BCIs offer immediate benefits for stroke rehabilitation, addressing long-term effects and optimizing clinical implementation remain critical areas for further investigation. Full article

Eccentric muscle actions are integral to human movement, rehabilitation, and performance training due to their characteristic high force output (overload) and low energy cost and perceived exertion. Despite the growing use of eccentric devices, a gap in the research exists exploring multi-muscle activation profiles during multi-joint eccentric-only, isokinetic exercise. This study aimed to quantify and compare surface electromyographic (EMG) activity of four leg muscles—vastus lateralis (VL), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (GM)—during a standardized (isokinetic) submaximal eccentric multi-joint exercise using the Eccentron dynamometer. Eighteen healthy adults performed eccentric exercise at 40% of their maximal eccentric strength. Surface EMG data were analyzed using root mean square (RMS) and integrated EMG (iEMG) variables. Repeated-measures ANOVAs and effect sizes (ES) were used to evaluate within-subject differences across muscles. Results showed significantly greater activation in the VL compared to all other muscles (p < 0.05; and ES of 1.28–3.17 versus all other muscles), with the TA also demonstrating higher activation than the BF (p < 0.05). The BF exhibited the lowest activation, suggesting limited hamstring engagement. These findings highlight the effectiveness of the multi-joint isokinetic eccentric leg press movement (via an Eccentron machine) in targeting the quadriceps and dorsiflexors, while indicating the possible need for supplementary hamstring and plantar flexor exercises when aiming for a comprehensive lower body training routine. This study provides important insights for optimizing eccentric training protocols and rehabilitation strategies. Full article

Background: There are only a few available options for early rehabilitation of severely impaired individuals who must remain bedbound, as most exercise paradigms focus on out-of-bed exercises. To enable these individuals to exercise, we developed a novel hybrid rehabilitation system combining a brain–computer interface (BCI), functional electrical stimulation (FES), and a robotic device. Methods: The BCI assessed the presence of a movement-related cortical potential (MRCP) and triggered the administration of FES to produce movement of the lower limb. The exercise trajectory was supported by the robotic device. To demonstrate the system, an experiment was conducted in an out-of-lab setting by ten able-bodied participants. During exercise, the performance of the BCI was assessed, and the participants evaluated the system using the NASA Task Load Index, Intrinsic Motivation Inventory, and by answering a few subjective questions. Results: The BCI reached a true positive rate of 62.6 ± 9.2% and, on average, predicted the movement initiation 595 ± 129 ms prior to the MRCP peak negativity. All questionnaires showed favorable outcomes for the use of the system. Conclusions: The developed system was usable by all participants, but its clinical feasibility is uncertain due to the total time required for setting up the system. Full article

Even for the strongest human being, maintaining an elevated arm position for an extended duration represents a significant challenge, as fatigue inevitably accumulates over time. The physical strain is further intensified when the individual is engaged in repetitive tasks, particularly those involving the use of tools or heavy equipment. Such activities increase the probability of developing muscle fatigue or injuries due to overuse or improper posture. Over time, this can result in the development of chronic conditions, which may impair the individual’s ability to perform tasks effectively and potentially lead to long-term physical impairment. Exoskeletons play a transformative role by reducing the perceived load on the muscles and providing mechanical support, mitigating the risk of injuries and alleviating the physical burden associated with strenuous activities. In addition to injury prevention, these devices also promise to facilitate the rehabilitation of individuals who have sustained musculoskeletal injuries. This document examines the various types of exoskeletons, investigating their design, functionality, and applications. The objective of this study is to present a comprehensive understanding of the current state of these devices, highlighting advancements in the field and evaluating their real-world impact. Furthermore, it analyzes the crucial insights obtained by other researchers, and by summarizing these findings, this work aims to contribute to the ongoing efforts to enhance exoskeleton performance and expand their accessibility across different sectors, including agriculture, healthcare, industrial work, and beyond. Full article

This in vitro study aims to compare the trueness of digital impressions obtained using two intraoral scanners (IOS) and one photogrammetry device for full-arch implant-supported rehabilitations. According to the Caramês Classification I, three models were produced with Straumann implants arranged in different spatial distributions: Option A with six implants and Options B and C with four implants each. The three models were scanned using a 12-megapixel scanner to create digital master casts. For each reference model, 30 digital impressions were acquired: 10 with the 3Shape Trios 3 intraoral scanner, 10 with the Medit i500 intraoral scanner, and 10 with the PIC Dental photogrammetry device. Trueness was assessed through best-fit superimpositions between the digital master casts and the corresponding virtual models. The Shapiro–Wilk test was applied to assess the normality of the data distribution, and Levene’s test was used to evaluate the homogeneity of variances. The non-parametric Kruskal–Wallis test was employed to compare group differences, with post hoc adjustments made using the Bonferroni correction. A significance threshold of p = 0.05 was adopted for all statistical tests. Statistically significant differences were observed in the root mean square values among the three devices. The Medit i500 demonstrated the highest trueness, with a median (interquartile range) deviation of 24.45 (18.18) µm, whereas the PIC Dental exhibited the lowest trueness, with a median deviation of 49.45 (9.17) µm. Among the implant distribution, the Option C showed the best trueness, with a median deviation of 19.00 (27.83). Considering the results of this in vitro study, intraoral scanners demonstrated comparable trueness, whereas the photogrammetry-based system exhibited lower trueness values. Additionally, a smaller number of implants and reduced inter-implant distances were associated with improved trueness in digital impressions for full-arch implant rehabilitation. Full article

(1) Background: A severe decline in knee joint function significantly affects the mobility of the elderly, making it a key concern in the field of geriatric health. To alleviate the pressure on the knee joints of the elderly during daily movements such as sitting and standing, effective biomechanical solutions are required. (2) Methods: In this study, a biomechanical framework was established based on mechanical analysis to derive the transfer relationship between the ground reaction force and the knee joint moment. Experiments were designed to collect knee joint data on the elderly during the sit-to-stand process. Meanwhile, magnetic resonance imaging (MRI) images were processed through a medical imaging control system to construct a detailed digital 3D knee joint model. A finite element analysis was used to verify the model to ensure the accuracy of its structure and mechanical properties. An improved radial basis function was used to fit the pressure during the entire sit-to-stand conversion process to reduce the computational workload, with an error of less than 5%. In addition, a small-target human key point recognition network was developed to analyze the image sequences captured by the camera. The knee joint angle and the knee joint pressure distribution during the sit-to-stand conversion process were mapped to a three-dimensional interactive platform to form a digital twin system. (3) Results: The system can effectively capture the biomechanical behavior of the knee joint during movement and shows high accuracy in joint angle tracking and structure simulation. (4) Conclusions: This study provides an accurate and comprehensive method for analyzing the biomechanical characteristics of the knee joint during the movement of the elderly, laying a solid foundation for clinical rehabilitation research and the design of assistive devices in the field of rehabilitation medicine. Full article

Transparency is a key requirement for some classes of robots, exoskeletons, and assistive devices (READs), where safe and efficient human–robot interaction is crucial. Typical fields that require transparency are rehabilitation and industrial contexts. However, the definitions of transparency adopted in the literature are heterogeneous. It follows that there is a need to clarify, summarize, and assess how transparency is commonly defined and measured. Thus, the goal of this review is to systematically examine how transparency is conceptualized and evaluated across studies. To this end, we performed a structured search across three major scientific databases. After a thorough screening process, 20 out of 400 identified articles were further examined and included in this review. Despite being recognized as a desirable and essential characteristic of READs in many domains of application, our findings reveal that transparency is still inconsistently defined and evaluated, which limits comparability across studies and hinders the development of standardized evaluation frameworks. Indeed, our screening found significant heterogeneity in both terminology and evaluation methods. The majority of the studies used either a mechanical or a kinematic definition, mostly focusing on the intrinsic behavior of the device and frequently giving little attention to the device impact of the user and on the user’s perception. Furthermore, user-centered or physiological assessments could be examined further, since evaluation metrics are usually based on kinematic and robot mechanical metrics. Only a few studies have examined the underlying motor control strategies, using more in-depth methods such as muscle synergy analysis. These findings highlight the need for a shared taxonomy and a standardized framework for transparency evaluation. Such efforts would enable more reliable comparisons between studies and support the development of more effective and user-centered READs. Full article

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations. Full article

Introduction: Home-based cardiac telerehabilitation (HBCTR) is a multidisciplinary intervention aimed at optimizing functional, psychological, and social recovery in patients undergoing percutaneous coronary intervention (PCI). This rehabilitation model serves as an effective alternative to traditional center-based rehabilitation, providing a cost-effective and clinically advantageous approach. Methods: Following PRISMA guidelines, we conducted a systematic literature search across multiple databases (PubMed, CINAHL, Cochrane, Scopus, Web of Science). We included randomized controlled trials (RCTs), cohort, and observational studies assessing telerehabilitation in post-PCI patients. Primary outcomes focused on health-related quality of life (HRQoL) and adherence, while secondary outcomes included functional capacity (6 min walk test, VO₂max), cardiovascular risk factor control, and psychological well-being. Risk of bias was assessed using the Cochrane RoB 2.0 and ROBINS-I tools. Results: A total of 3575 articles were identified after removing duplicates, of which 877 were selected based on title and abstract, and 17 met the inclusion criteria, with strong RCT representation ensuring robust evidence synthesis. HBCTR was associated with significant improvements in exercise capacity, with increases in VO₂max ranging from +1.6 to +3.5 mL/kg/min and in 6 min walk distance from +34.7 to +116.6 m. HRQoL scores improved significantly, with physical and mental component scores increasing by +6.75 to +14.18 and +4.27 to +11.39 points, respectively. Adherence to telerehabilitation programs was consistently high, often exceeding 80%, and some studies reported reductions in hospital readmissions of up to 40%. Wearable devices and smartphone applications facilitated self-monitoring, enhancing adherence and reducing readmissions. Several studies also highlighted improvements in anxiety and depression scores ranging from 10% to 35%. Conclusions: HBCTR is a promising strategy for rehabilitation and quality-of-life improvement after PCI. It offers a patient-centered solution that leverages technology to enhance long-term outcomes. By integrating structured telerehabilitation programs, healthcare systems can expand accessibility, promote adherence, and improve equity in cardiovascular care. Full article

Our study explored the accuracy of Fitbit recorded step count during the use of an assistive device (two-wheeled walker and standard cane) at various body positions (wrists, hips, and ankles). Participants (n = 11) ambulated an obstacle course (50 m total, including turns and a step up/down) a total of three times (two-wheeled walker, standard cane, and a deviceless control trial). Fitbit generated step counts (at the wrists, hips, and ankles) were then compared to the individual’s “actual” step count captured through video analysis. During the cane trial and the deviceless trial, all positions were significantly correlated (r = 0.764 to 0.984; p < 0.006) with the actual step count. However, increased variability (demonstrated by increased limits of agreement) was observed when the Fitbit was worn on the wrist (compared to the hips or ankles). During the walker trial, the step count was significantly correlated to the actual step count at the ankle and hip positions (r = 0.669 to 0.888; p < 0.017) with an average error of 1.5%, while it was not statistically correlated at the wrist with a 31.2% average error. Our study suggests that Fitbits are a good predictor of actual step count, with the caveat that the location of the Fitbit should be considered if an assistive device (e.g., two-wheeled rolling walker and single-point cane) is being used. Full article