Search Results (891)

Analyzing the dynamics of muscle activation patterns and joint range of motion is essential to understanding human movement during complex tasks such as tooth brushing Activities of Daily Living (ADLs). In individuals with neuromotor impairments, accurate assessment of upper limb motor patterns plays a critical role in rehabilitation, supporting the identification of compensatory strategies and informing clinical interventions. This study presents the validation of a previously developed novel, low-cost, wearable, and portable multimodal prototype that integrates inertial measurement units (IMU) and surface electromyography (sEMG) sensors into a single device. The system enables bilateral monitoring of arm segment kinematics and muscle activation amplitudes from six major agonist muscles during ADLs. Eleven healthy participants performed a functional task, tooth brushing, while wearing the prototype. The recorded data were compared with two established gold-standard systems, Qualisys^® motion capture system and Biosignalsplux^®, for validation of kinematic and electrophysiological measurements, respectively. This study provides technical insights into the device’s architecture. The developed system demonstrates potential for clinical and research applications, particularly for monitoring upper limb function and evaluating rehabilitation outcomes in populations with neurological disorders. Full article

We analysed data collected at the Innsbruck Alpenzoo (Tyrol, Austria) over 33 years (1988–2020). We examined data from 4542 wild birds of 137 species that were rescued in the increasingly urbanised and densely populated Inn Valley around Innsbruck and examined the outcome of hospital treatment (survival or death); for a subgroup of 3440 birds, we examined the length of stay at the zoo. The birds were divided into nine different groups, and the reasons for admission were divided into nine categories to analyse how the reasons for admission and membership of a bird group influences rehabilitation success and the duration of care required. Orphaned birds, birds that had become entangled in man-made structures, and birds with unknown reasons for admission had the best survival rates (60%), while birds with physical injuries, victims of collisions, and attacks by cats had the lowest survival rates (37%). Survival rates were highest among areal insectivores (66%) and waterbirds (62%), and lowest among small songbirds (45%) and woodpeckers (<39%), which suffered disproportionately from the consequences of window collisions. The overall survival rate of hospitalised birds (51%) was higher, and the duration of care required (median 11 days) was especially shorter at Innsbruck Alpenzoo than at most other rehabilitation centres. We attribute this mainly to the professional care and varied, group-specific diet provided to the patients, which we describe in detail. We also discuss the problems and limitations of wild bird care for zoo staff in addition to their daily tasks. Thereby, it became apparent that the retirement of experienced bird carers at the beginning of the study period and the subsequent steady changeover of staff members had a negative impact on success rates. Full article

Stroke is a leading cause of long-term disability worldwide, and new technologies such as Fully Immersive Virtual Reality (FIVR) are being explored to promote functional recovery as well as optimize rehabilitation outcomes. The aim of the present study was to explore Greek OTs’ perspectives on the use of FIVR in rehabilitation of the upper limb after stroke. Two focus groups took place with six experienced OTs, who were recruited from diverse clinical settings across Greece. The interviews were facilitated using a semi-structured guide and inductively coded using thematic analysis following Braun and Clarke’s six-stage process. Six theme-rich findings were elicited. Therapists identified FIVR’s potential to enable patient involvement, motivation, and recovery of function through the use of immersion and feedback-based practice. They reported significant barriers, however, in terms of technical challenges, safety issues, and costly equipment. OTs also highlighted the fact that occupation-based, culturally sensitive task design is central to ensuring ecological validity and transfer to naturalistic settings. There is a high potential for FIVR in stroke rehabilitation, but it requires user-centered design, cultural adaptation, adequate training, and systemic support towards long-term implementation. Full article

Background: Deep brain stimulation (DBS) is increasingly understood as a precision-oriented neuromodulation therapy capable of influencing distributed basal ganglia–thalamo–cortical and cerebellothalamic networks. Although its symptomatic benefits in Parkinson’s disease, essential tremor, and dystonia are well established, the extent to which DBS supports motor learning, adaptive plasticity, and participation in rehabilitation remains insufficiently defined. Traditional interpretations of DBS as a focal or lesion-like intervention are being challenged by electrophysiological and imaging evidence demonstrating multiscale modulation of circuit dynamics. Objectives and methods: DBS may enhance rehabilitation outcomes by stabilizing pathological oscillations and reducing moment-to-moment variability in motor performance, thereby enabling more consistent task execution and more effective physiotherapy, occupational therapy, and speech–language interventions. However, direct comparative evidence demonstrating additive or synergistic effects of DBS combined with rehabilitation remains limited. As a result, this potential is not fully realized in clinical practice due to interindividual variability, limited insight into how individual circuit architecture shapes therapeutic response, and the limited specificity of current connectomic biomarkers for predicting functional gains. Results: Technological advances such as tractography-guided targeting, directional leads, sensing-enabled devices, and adaptive stimulation are expanding opportunities to align neuromodulation with individualized circuit dysfunction. Despite these developments, major conceptual and empirical gaps persist. Few controlled studies directly compare outcomes with versus without structured rehabilitation following DBS. Heterogeneity in therapeutic response and rehabilitation access further complicates the interpretation of outcomes. Clarifying these relationships is essential for developing precision-informed frameworks that integrate DBS with rehabilitative strategies, recognizing that current connectomic and physiological biomarkers remain incompletely validated for predicting functional outcomes. Conclusions: This review synthesizes mechanistic, imaging, and technological evidence to outline a network-informed perspective of DBS as a potential facilitator of rehabilitation-driven functional improvement and identifies priorities for future research aimed at optimizing durable functional restoration. 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

Introduction: Stroke is a leading cause of adult-onset disability. Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous vagus nerve stimulation (tVNS) are promising adjuncts to upper limb rehabilitation. The use of functional neuroimaging through task functional MRI (fMRI) or functional near-infrared spectroscopy (fNIRS) allows the visualisation of cortical activation patterns associated with stroke-related impairment and recovery. The present study comprehensively reviews the evidence base for the effects of NIBS on clinical and functional neuroimaging outcomes after stroke. Methods: Systematic searches were carried out in MEDLINE and EMBASE via Ovid. Inclusion criteria were clinical trials of adults with stroke and arm weakness undergoing NIBS, with clinical measures of arm function and neuroimaging outcome measures that included either task fMRI or task fNIRS. Two authors independently carried out study screening, risk of bias assessments, and data collection for clinical and neuroimaging outcomes pre- and post-intervention. Results: A total of 17 studies (12 rTMS, 5 tDCS), including 495 participants, met the inclusion criteria. Fifteen studies used task fMRI and four used task fNIRS. Improvements in arm-related motor activity were observed following both rTMS and tDCS. Most studies reported increased activation in ipsilesional sensorimotor areas alongside reductions in contralesional activation. Discussion: rTMS and tDCS may improve upper limb recovery in people with stroke. The increase in the laterality index towards activation of the ipsilesional hemisphere suggests that these NIBS techniques may facilitate neural reorganisation and restoration of motor networks in the affected hemisphere. Full article

Background/Objectives: Children with Down Syndrome (DS) exhibit difficulties in maintaining balance and coordination in addition to limitations in functional mobility. The Cognitive–Motor Dual-Task Exercise Program (CMDT) has shown the ability to improve balance and functional mobility. This study aimed to compare the effect of CMDT versus exergaming on the balance and functional mobility of children with Down Syndrome aged 8–14 years. Methods: A randomized comparative trial was conducted, dividing participants’ children with DS into two intervention groups: CMDT group and exergaming group. Participants were recruited using convenience sampling methods from the Voice of Down Syndrome Association and the Down Syndrome Charitable Association in Riyadh, Saudi Arabia. Both interventions were implemented over a period of six weeks. Outcome measures included the Timed Up and Go (TUG), Four Square Step Test (FSST), and Pediatric Balance Scale (PBS). Results: A total of 23 children with DS participated in the study. A mixed repeated measures ANCOVA shows a significant effect of time across the two groups (p < 0.001) for TUG, FSST, and PBS, indicating improvements in balance and functional mobility. There were no significant differences between the two group interventions. Conclusions: CMDT and exergaming were equally effective in improving balance and functional mobility in children with DS. Trial Registration: Clinicaltrials.gov with ID NCT06146907. Full article

With an aging population and the high incidence of neurological diseases, rehabilitative lower limb exoskeleton robots, as a wearable assistance device, present important application prospects in gait training and human function recovery. As the core of human–computer interaction, control strategy directly determines the exoskeleton’s ability to perceive and respond to human movement intentions. This paper focuses on the control strategies of rehabilitative lower limb exoskeleton robots. Based on the typical hierarchical control architecture of “perception–decision–execution,” it systematically reviews recent research progress centered around four typical control tasks: trajectory reproduction, motion following, Assist-As-Needed (AAN), and motion intention prediction. It emphasizes analyzing the core mechanisms, applicable scenarios, and technical characteristics of different control strategies. Furthermore, from the perspectives of drive system and control coupling, multi-source perception, and the universality and individual adaptability of control algorithms, it summarizes the key challenges and common technical constraints currently faced by control strategies. This article innovatively separates the end-effector control strategy from the hardware implementation to provide support for a universal control framework for exoskeletons. Full article

Cycling-based rehabilitation is a non-invasive intervention for individuals with lower limb asymmetries. However, current cycling devices lack comprehensive biomechanical feedback and cannot assess asymmetry. Our lab has developed a novel cycle ergometer equipped with three-dimensional force pedals, a seat post and handlebar force sensors, which allow for a comprehensive analysis of asymmetry across a fatiguing task. This study assessed the reproducibility of the cycling kinetics and asymmetry index derived from this device during incremental and constant load cycling tasks to volitional failure. Eighteen participants completed incremental and constant-load tests, each across two identical sessions. Pedal forces and power were analyzed for each leg individually, and handlebar forces and seat post mediolateral sway were recorded during cycling. Normalized symmetry index (NSI), a metric quantifying the degree of asymmetry between limbs, was calculated for each variable. The reproducibility of the device was assessed using repeated measures analysis of variance and intraclass correlation coefficients (ICC). No significant session or interaction effects were found for pedal, handlebar, and seat post measures (all p > 0.05). Time effects were observed for pedal force and power in the incremental test (all p < 0.001). NSI values were reproducible with high ICC values (≥0.70) for force and power. The results suggest that this ergometer offers reproducible cycling kinetics and asymmetry measures across a fatiguing task. The findings support the application of this ergometer in research and rehabilitation settings. Full article

Action quality assessment automates the evaluation of human movement proficiency, which is vital for applications like sports training and rehabilitation, where objective feedback enhances patient outcomes. Action quality assessment processes motion capture data to generate quality scores for action execution. In rehabilitation exercises, joints typically work synergistically in functional groups. However, existing methods struggle to accurately model the collaborative relationships between joints. Fixed joint grouping is not flexible enough, while fully adaptive grouping lacks the guidance of prior knowledge. In this paper, based on rehabilitation theory in clinical medicine, we propose a dynamic, motion-aware grouping strategy. A two-stream architecture independently processes joint position and orientation information. Fused features are adaptively clustered into 6 functional groups by a joint motion energy-driven learnable mask generator, and intra-group temporal modeling and inter-group spatial projection are achieved through two-stage attention interaction. Our method achieves competitive results and obtains the best scores on most exercises of KIMORE, while remaining comparable on UI-PRMD. Experimental results using the KIMORE dataset show that the model outperforms current methods by reducing the mean absolute deviation by 26.5%. Ablation studies validate the necessity of dynamic grouping and the two-stream design. The core design principles of this study can be extended to fine-grained action-understanding tasks such as surgical operation assessment and motor skill quantification. Full article

Objectives: Shoulder joint strength and muscle activation during overhead reaching are critical for ergonomic task design, rehabilitation, and exoskeleton support. The objective of this study was to characterize maximum shoulder torque and flexor muscle activation profiles across functional elevation angles in healthy adult males. Methods: A total of 14 healthy male participants performed maximum voluntary isometric contractions at eight arm elevation angles (90–160°, sagittal plane, and standing). Shoulder torque was measured using a calibrated force sensor and normalized to each participant’s overall maximum. Electromyography (EMG) was recorded from the anterior deltoid, medial deltoid, biceps brachii, and clavicular pectoralis major; EMG for the medial deltoid, biceps brachii, and pectoralis major was normalized to muscle-specific isometric MVCs, whereas the anterior deltoid was normalized to the peak value at 90° during the main task. All EMG signals were smoothed using a 0.5 s RMS-based moving average window. Linear regression was used to analyze the torque–angle relationship, and linear mixed-effects models were used to test EMG differences across angles. Summary statistics included mean ± SD, coefficient of variation, R², p-values (significance threshold: p < 0.05), Cohen’s d, and 95% confidence intervals where appropriate. Results: Maximum torque declined with elevation angle (y = −0.6317x + 157.21; R² = 0.99), from 77.2 Nm at 90° to 43.2 Nm at 160°, with normalized values from 99.6% to 55.3%. Medial deltoid activation increased significantly with elevation (p < 0.001, from 87.5 ± 19.9% at 90° to 109.4 ± 25.6% at 150°), while pectoralis major declined sharply (p < 0.001, from 68.9 ± 24.2% at 90° to 19.8 ± 5.6% at 160°). Anterior deltoid and biceps brachii activations were high and showed no systematic change with angle (p = 0.37 and 0.81, respectively), remaining within approximately 95–102% and 70–85% of their reference levels across 90–160°. Normalization reduced inter-participant variability, clarifying muscle-specific trends. Conclusions: This study provides preliminary biomechanical reference values for shoulder torque and muscle activation across elevation angles in healthy males under isometric standing conditions, confirming an inverse torque–angle relationship and distinct muscle activation strategies at higher positions. These findings may inform ergonomic assessment and exoskeleton design, while recognizing that generalization to dynamic tasks and other populations requires caution. Full article

Stroke often results in lasting cognitive impairments that severely reduce independence and quality of life. Traditional neuropsychological assessments rely on mean scores that provide an average estimate of overall cognitive function but neglect the fluctuations in performance. The variability in performance can be captured as inconsistency, i.e., fluctuations across multiple trials within a single task or as dispersion, i.e., fluctuations across multiple tasks. While inconsistency has been extensively studied, the impact of post-stroke cognitive impairment on cognitive dispersion is unknown. In this study, ninety-five stroke survivors (41 cognitively impaired and 54 cognitively normal) completed a neuropsychological battery that captured performance across five cognitive domains: executive function, attention, memory, language, and processing speed. We compared the stroke groups on across- and within-domain cognitive dispersion. Cognitively impaired stroke individuals showed elevated dispersion within executive function compared to cognitively normal individuals. The two groups did not differ on any other within-domain or across-domain cognitive dispersion. Post-stroke cognitive impairment increased variability within executive functioning. Incorporating cognitive dispersion into routine post-stroke assessment can advance clinical practice by identifying subtle cognitive instability, anticipate supportive needs, and tailor rehabilitation plans for improving stroke care. Full article

Background/Objectives: Accurate plantar pressure assessment is essential for injury prevention and rehabilitation monitoring in sports. Wearable sensor technologies, such as DAid^® Smart Socks, offer portable, real-time biomechanical feedback and enable data collection in field conditions. However, there is limited evidence on their level of agreement with a gold standard in measuring the foot plantar center of pressure (CoP) in football-specific tasks. This study aimed to determine the preliminary validity of DAid^® Smart Socks compared with a gold-standard force platform in measuring plantar center of pressure (CoP) during functional football FIFA 11+ Part 2 exercises. Methods: Ten male volunteer youth football players (mean age 12.2 ± 0.42 years; height 158.7 ± 7.72 cm; weight 46.46 ± 8.78 kg; shoe size EU 39.8 ± 2.68) from the Latvian Football Federation Youth League participated. Eight players had right-leg dominance, two had left-leg dominance; three reported past lower-limb injuries. Plantar pressure was measured simultaneously using DAid^® Smart Socks and a 1.5 m entry-level force platform with a calibration factor of 3.2. Center of pressure (CoP) data from the force platform were recorded using Footscan software version 9.10.4. Participants performed two selected FIFA 11+ Part 2 exercises—a single-leg squat (unilateral) and a squat with heel raise, performed bilaterally—under standardized conditions. Each exercise was performed twice, with sock removal and reapplication between trials. Agreement between the DAid^® Smart Socks and the force platform was examined using waveform synchronization, root mean square error (RMSE), Bland–Altman analysis, and Lin’s Concordance Correlation Coefficient (CCC) to quantify both relative waveform correspondence and absolute CoP measurement accuracy. Results: Across 160 paired recordings, the DAid^® Smart Socks showed moderate-to-high correlation with the force platform for relative CoP dynamics, with 79% of waveforms demonstrating CCC ≥ 0.60. Absolute agreement was limited, with only 16% of recordings reaching CCC ≥ 0.90, and RMSE values ranging from 2.1 to 18.9 mm (X) and 4.3–34.2 mm (Y). Conclusions: DAid^® Smart Socks showed moderate-to-high correspondence with the force platform in capturing the directional and temporal characteristics of plantar CoP during functional football tasks, with agreement varying across individuals. 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

Background: Recovery following incomplete spinal cord injury (iSCI) remains challenging, with conventional rehabilitation often emphasizing compensation over functional restoration. As most new spinal cord injury cases preserve some motor or sensory pathways, there is increasing interest in therapies that harness neuroplasticity. Robotic exoskeletons provide a promising means to deliver task-specific, repetitive gait training that may promote adaptive neural reorganization. This feasibility study investigates the feasibility, safety, and short-term effects of exoskeleton-assisted walking in individuals with degenerative iSCI. Methods: Two cooperative male patients (patients A and B) with degenerative iSCI (AIS C, neurological level L1) participated in a four-week intervention consisting of one hour of neuromotor physiotherapy followed by one hour of exoskeleton-assisted gait training, three times per week. Functional performance was assessed using the 10-Meter Walk Test, while gait quality was examined through spatiotemporal gait analysis. Vendor-generated surface electromyography (sEMG) plots were available only for qualitative description. Results: Patient A demonstrated a clinically meaningful increase in walking speed (+0.15 m/s). Spatiotemporal parameters showed mixed and non-uniform changes, including longer cycle, stance, and swing times, which reflect a slower stepping pattern rather than improved efficiency or coordination. Patient B showed a stable walking speed (+0.03 m/s) and persistent gait asymmetries. Qualitative sEMG plots are presented descriptively but cannot support interpretations of muscle recruitment patterns or neuromuscular changes. Conclusions: In this exploratory study, exoskeleton-assisted gait training was feasible and well tolerated when combined with conventional physiotherapy. However, observed changes were heterogeneous and do not allow causal or mechanistic interpretation related to neuromuscular control, muscle recruitment, or device-specific effects. These findings highlight substantial inter-individual variability and underscore the need for larger controlled studies to identify predictors of response and optimize rehabilitation protocols. Full article