Search Results (273)

Background and Objective: Adverse pathology to high-risk prostate cancer (PCa) after radical prostatectomy (upgrading) poses a threat to risk stratification and treatment planning. The impact on sexual function, urinary continence, and health-related quality of life (HRQOL) remains unclear. Methods: From 2004 to 2024, 4189 patients with preop low-/intermediate-risk PCa (Gleason score 6 or 7a, PSA ≤ 20 ng/mL) underwent radical prostatectomy at our department and were analyzed. Primary endpoint was HRQOL, erectile function, and urinary continence. Secondary endpoint was rate of salvage therapies and biochemical-free survival. Propensity score matching was performed using “operative time”, “robot-assisted surgery”, “blood loss”, “nerve-sparing surgery”, “age”, and “BMI” to represent comparable surgical approach. Median follow-up was 39 months (Interquartile-range (IQR) 15–60). Key Findings and Limitations: Patients who were upgraded to high-risk PCa showed a higher rate of postoperative radiotherapy and androgen-deprivation therapy compared to patients who were not upgraded (21% vs. 7%, p < 0.001; 9% vs. 3%, p = 0.002). Five-year biochemical recurrence-free survival was 68% in the upgrading group vs. 84% in the no-upgrading group (p < 0.001). We saw no difference in patient-reported HRQOL, urinary continence, or erectile function. Multivariable analysis showed that postoperative upgrading was a significant risk for not achieving good overall HRQOL (OR: 0.77, 95% CI: 0.61–0.97, p = 0.028) during the follow-up. Conclusions and Clinical Implications: Although postoperative upgrading to high-risk PCa leads to worse oncologic outcomes and higher salvage therapy rates, this study indicates that its impact on health-related quality of life is minimal and should not deter a cautious approach to radical prostatectomy. Full article

Background/Objectives: Posterior inferior cerebellar artery (PICA) aneurysms are one of the most difficult cerebrovascular lesions to treat and account for 0.5–3% of all intracranial aneurysms. They have deep anatomical locations, broad-neck configurations, high perforator density, and a close association with the brainstem, which creates considerable technical challenges for either microsurgical or endovascular treatment. Despite its acceptance as the standard of care for most posterior circulation aneurysms, PICA aneurysms are often associated with flow diversion using a coil or flow diversion due to incomplete occlusions, parent vessel compromise and high rate of recurrence. This case aims to describe the utility of microsurgical clipping as a durable and definitive option demonstrating the value of tailored surgical planning, preservation of anatomy and ancillary technologies for protecting a genuine outcome in ruptured PICA aneurysms. Methods: A 66-year-old male was evaluated for an acute subarachnoid hemorrhage from a ruptured and broad-necked fusiform left PICA aneurysm at the vertebra–PICA junction. Endovascular therapy was not an option due to morphology and the center of the recurrence; therefore, a microsurgical approach was essential. A far-lateral craniotomy with a partial C1 laminectomy was carried out for proximal vascular control, with careful dissection of the perforating arteries and precise clip application for the complete exclusion of the aneurysm whilst preserving distal PICA flow. Results: Post-operative imaging demonstrated the complete obliteration of the aneurysm with unchanged cerebrovascular flow dynamics. The patient had progressive neurological recovery with no new cranial nerve deficits or ischemic complications. Long-term follow-up demonstrated stable aneurysm exclusion and full functional independence emphasizing the sustainability of microsurgical intervention in challenging PICA aneurysms. Conclusions: This case intends to highlight the current and evolving role of microsurgical practice for treating posterior circulation aneurysms, particularly at a time when endovascular alternatives are limited by anatomy and hemodynamics. Advances in artificial intelligence cerebral aneurysm rupture prediction, high-resolution vessel wall imaging, robotic-assisted microsurgery and new generation flow-modifying implants have the potential to revolutionize treatment paradigms by embedding precision medicine principles into aneurysm management. While the discipline of cerebrovascular surgery is expanding, it can be combined together with microsurgery, endovascular technologies and computational knowledge to ensure individualized, durable, and minimally invasive treatment options for high-risk PICA aneurysms. Full article

Background: Aquatic therapy (AT), immersion in hot water, and supported standing are frequently used to manage spasticity, contractures, and joint retractions in children with cerebral palsy (CP). Recently, the use of exoskeletons has been offering a new treatment option for severe CP. This study aimed to compare the post-immediate effects of four treatments on spasticity, range of motion, and the heart rate of children with severe CP. Methods: Three children with spastic CP (levels IV and V GMFCS) received a single 30-min session in consecutive weeks of robot-assisted gait training (RAGT), AT, supported standing, and immersion in hot water. Post-immediate assessments included knee flexor spasticity (modified Ashworth scale, MAS, and modified Tardieu scale, MTS); knee range of motion (ROM, in degrees (°)); and heart rate (HR). Results: AT and supported standing induced greater reductions in spasticity based on MAS scores. RAGT demonstrated superior spasticity reduction using MTS and yielded the greatest improvement in popliteal angle (mean increase: 27°). AT and RAGT induced a 14 beats-per-minute change in HR, indicating moderate cardiovascular engagement. Conclusions: RAGT appears particularly effective in improving spasticity and ROM in children with severe CP. Nonetheless, conventional treatments still offer an effective option when addressing spasticity. Full article

Background/Objectives: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population. Full article

This paper presents the development of a fuzzy-PID control able to adapt to several robot–patient interaction modes by monitoring patient evolution during the rehabilitation procedure. This control system is designed to provide targeted rehabilitation therapy through three interaction modes: passive; active–assistive; and resistive. By integrating a fuzzy inference system into the classical PID architecture, the FPID controller dynamically adjusts control gains in response to tracking error and patient effort. The simulation results indicate that, in passive mode, the FPID controller achieves a 32% lower RMSE, reduced overshoot, and a faster settling time compared to the conventional PID. In the active–assistive mode, the FPID demonstrates enhanced responsiveness and reduced error lag when tracking a sinusoidal reference, while in resistive mode, it more effectively compensates for imposed load disturbances. A rehabilitation scenario simulating repeated motion cycles on a healthy subject further confirms that the FPID controller consistently produces a lower overall RMSE and variability. Full article

Currently, high-tech assistive technologies (ATs), particularly Socially Assistive Robots (SARs), virtual reality (VR) and conversational AI (ConvAI), are considered very useful in supporting professionals in Speech and Language Therapy (SLT) for children with communication disorders. However, despite a positive public perception, therapists face difficulties when integrating these technologies into practice due to technical challenges and a lack of user-friendly interfaces. To address this gap, a design-based research approach has been employed to streamline the integration of SARs, VR and ConvAI in SLT, and a new software platform called “ATLog” has been developed for designing interactive and playful learning scenarios with ATs. ATLog’s main features include visual-based programming with graphical interface, enabling therapists to intuitively create personalized interactive scenarios without advanced programming skills. The platform follows a subprocess-oriented design, breaking down SAR skills and VR scenarios into microskills represented by pre-programmed graphical blocks, tailored to specific treatment domains, therapy goals, and language skill levels. The ATLog platform was evaluated by 27 SLT experts using the Technology Acceptance Model (TAM) and System Usability Scale (SUS) questionnaires, extended with additional questions specifically focused on ATLog structure and functionalities. According to the SUS results, most of the experts (74%) evaluated ATLog with grades over 70, indicating high acceptance of its usability. Over half (52%) of the experts rated the additional questions focused on ATLog’s structure and functionalities in the A range (90–100), while 26% rated them in the B range (80–89), showing strong acceptance of the platform for creating and running personalized interactive scenarios with ATs. According to the TAM results, experts gave high grades for both perceived usefulness (44% in the A range) and perceived ease of use (63% in the A range). Full article

Cerebral palsy is the leading cause of motor disability in early childhood, with no curative treatment currently available. To mitigate its effects and promote motor rehabilitation, robotic-assisted therapies have emerged as a complement to conventional physiotherapy. In particular, cable-driven exoskeletons offer notable advantages, providing patients with additional mobility and interaction with their environment while preserving motion assistance. Within this context, the Discover2Walk project introduces a modular cable-driven robotic platform designed for early-stage gait rehabilitation. This article presents a novel ankle control module capable of actuating 3 degrees of freedom: 2 translational (in the x and z directions) and 1 rotational (dorsiflexion/plantarflexion). Experimental results confirm the technical feasibility of the approach and its effectiveness in guiding motion within the targeted degrees of freedom. Full article

Lung cancer remains one of the main causes of cancer-related death globally and a significant global health concern. There is an urgent need for safer and more effective therapeutic alternatives despite notable progress in therapy; issues such as drug resistance, side effects, metastasis, and recurrence still affect patient outcome and quality of life. The aim of this review is to examine recent developments in the application of herbal-drug-loaded nanoparticles as a new strategy for treating lung cancer. A thorough examination of different drug delivery systems based on nanoparticles is provided, highlighting their function in improving the solubility, bioavailability, and targeted delivery of herbal compounds. In addition, the review evaluates the biomarkers used for targeted therapy and examines how new personalised treatment approaches like wearable electronic patches, robotics-assisted interventions, smartphone-enabled therapies, AI-driven diagnostics, and lung-on-a-chip technologies can be integrated to improve the accuracy and effectiveness of lung cancer treatment. In conclusion, the combination of personalised medicine and nanotechnology may lead to revolutionary changes in lung cancer treatment in the future. Full article

Background/Objectives: Prostate cancer ranks as the second-most prevalent cancer globally, and is the fifth-ranking cause of cancer-related mortality. Radical prostatectomy presents a significant risk of postoperative sequelae, including erectile dysfunction. Postoperative erectile dysfunction adversely affects the patient’s quality of life and can severely impact total treatment satisfaction. Nomograms have demonstrated efficacy in forecasting diverse outcomes in urology. We sought to create a nomogram to facilitate a more precise, evidence-based, and individualized prediction of erectile function outcomes following radical prostatectomy. Between January 2018 and January 2022, one hundred and eleven prostate cancer patients had robot-assisted radical prostatectomy, excluding those who had undergone prior transurethral prostatectomy, radiotherapy, or hormone therapy. Demographics, medical records, preoperative and postoperative erectile function statuses, and IIEF scores (≥17 indicating retained erections, <17 indicating full erectile dysfunction) were evaluated. Outcomes: Patients’ ages ranged from 45 to 76 years, with an average of 61.18 ± 6.72 years. Patients in the emergency department were considerably older (p = 0.004; p < 0.01) and exhibited elevated Charlson Comorbidity Indices (3.63 ± 0.85; p = 0.004; p < 0.01). Preoperative IIEF scores in ED patients were lower (14.29 ± 5.34), although obturator internus thickness (20.61 ± 2.91) and intraprostatic urethra length (36.48 ± 9.3) were considerably elevated. Altered surgical techniques were linked to maintained erections (p = 0.002; p < 0.01), but traditional approaches were connected with erectile dysfunction (p = 0.007; p < 0.01). Bilateral nerve-sparing procedures were more prevalent among patients preserving erectile function (p = 0.003; p < 0.01). Conclusions: The nomogram, which includes age, Charlson Comorbidity Index, preoperative IIEF, obturator internus thickness, intraprostatic urethra length, surgical technique, and degree of nerve preservation, provides clinicians with a pragmatic instrument for forecasting postoperative erectile dysfunction in prostate cancer patients. Full article

This review provides a comprehensive analysis of recent advancements in lower limb exoskeleton systems, focusing on applications, control strategies, hardware architecture, sensing modalities, human-robot interaction, evaluation methods, and technical innovations. The study spans systems developed for gait rehabilitation, mobility assistance, terrain adaptation, pediatric use, and industrial support. Applications range from sit-to-stand transitions and post-stroke therapy to balance support and real-world navigation. Control approaches vary from traditional impedance and fuzzy logic models to advanced data-driven frameworks, including reinforcement learning, recurrent neural networks, and digital twin-based optimization. These controllers support personalized and adaptive interaction, enabling real-time intent recognition, torque modulation, and gait phase synchronization across different users and tasks. Hardware platforms include powered multi-degree-of-freedom exoskeletons, passive assistive devices, compliant joint systems, and pediatric-specific configurations. Innovations in actuator design, modular architecture, and lightweight materials support increased usability and energy efficiency. Sensor systems integrate EMG, EEG, IMU, vision, and force feedback, supporting multimodal perception for motion prediction, terrain classification, and user monitoring. Human–robot interaction strategies emphasize safe, intuitive, and cooperative engagement. Controllers are increasingly user-specific, leveraging biosignals and gait metrics to tailor assistance. Evaluation methodologies include simulation, phantom testing, and human–subject trials across clinical and real-world environments, with performance measured through joint tracking accuracy, stability indices, and functional mobility scores. Overall, the review highlights the field’s evolution toward intelligent, adaptable, and user-centered systems, offering promising solutions for rehabilitation, mobility enhancement, and assistive autonomy in diverse populations. Following a detailed review of current developments, strategic recommendations are made to enhance and evolve existing exoskeleton technologies. Full article

Robotic-assisted therapy is an increasingly vital approach for upper-limb rehabilitation, offering consistent, high-intensity training critical to neuroplastic recovery. However, current control strategies often lack robustness against uncertainties and external disturbances, limiting their efficacy in dynamic, real-world settings. Addressing this gap, this study proposes a novel control framework for the iTbot—a 2-DoF end-effector rehabilitation robot—by integrating differential flatness theory with a derivative-free Kalman filter (DFK). The objective is to achieve accurate and adaptive trajectory tracking in the presence of unmeasured dynamics and human–robot interaction forces. The control design reformulates the nonlinear joint-space dynamics into a 0-flat canonical form, enabling real-time computation of feedforward control laws based solely on flat outputs and their derivatives. Simultaneously, the DFK-based observer estimates external perturbations and unmeasured states without requiring derivative calculations, allowing for online disturbance compensation. Extensive simulations across nominal and disturbed conditions demonstrate that the proposed controller significantly outperforms conventional flatness-based control in tracking accuracy and robustness, as measured by reduced mean absolute error and standard deviation. Experimental validation under both simple and repetitive physiotherapy tasks confirms the system’s ability to maintain sub-millimeter Cartesian accuracy and sub-degree joint errors even amid dynamic perturbations. These results underscore the controller’s effectiveness in enabling compliant, safe, and disturbance-resilient rehabilitation, paving the way for broader deployment of robotic therapy in clinical and home-based environments. Full article

Background/Objectives: Robotic-assisted gait training (RAGT) is a promising adjunct to conventional rehabilitation for stroke survivors. However, its additive benefit over standard therapy remains to be fully clarified. This systematic review and meta-analysis evaluated the effectiveness of combining RAGT with conventional rehabilitation in improving gait-related outcomes among individuals with stroke. Methods: We searched PubMed, Embase, CINAHL, and Cochrane CENTRAL through September 2024 for randomized controlled trials (RCTs) comparing combined RAGT and conventional rehabilitation versus conventional rehabilitation alone in adults post-stroke. Data were synthesized using a random-effects model, and subgroup analyses examined effects by intervention duration, stroke chronicity, and robotic system type. Results: Twenty-three RCTs (n = 907) were included. The combined intervention significantly improved gait function (SMD = 0.51, p = 0.001), gait speed (SMD = 0.47, p = 0.010), balance (MD = 4.58, p < 0.001), and ADL performance (SMD = 0.35, p = 0.001). Subgroup analyses revealed that end-effector robotic systems yielded superior outcomes compared to exoskeletons, particularly in subacute stroke patients. The most pronounced benefits were seen in gait velocity and dynamic balance, especially with ≤15 training sessions. Conclusions: Integrating RAGT with conventional rehabilitation enhances motor recovery and functional performance in stroke survivors. End-effector devices appear most effective in subacute phases, supporting individualized RAGT application based on patient and device characteristics. Full article

Children with physical disabilities are increasingly using socially assistive robots (SARs) as part of therapy to enhance motivation, engagement, enjoyment, and adherence. Research on SARs in rehabilitation has primarily focused on verbal and visual interaction, but little is known about tactile interaction (physical touch). The objective of this scoping review was to examine empirical studies published between 2010 and 2024 focusing on tactile interaction between SARs and children with physical disabilities, such as cerebral palsy (CP). Nine studies were identified as being eligible after a rigorous selection process, showing that although touch-based SAR interventions have been used in pediatric rehabilitation, structured methodologies and standardized tools are lacking for measuring tactile engagement. In light of the studies’ findings, it is evident that few studies evaluate the therapeutic effects of touch-sensitive SARs, underscoring the need for validated frameworks to assess their efficacy. In this review, SAR and tactile sensing researchers, rehabilitation specialists, and designers are given critical insights into how tactile interaction can enhance the role of SARs in physical therapy. Full article

Obesity is a major global health challenge associated with significant metabolic and gastrointestinal comorbidities. While metabolic and bariatric surgery remains the gold standard for durable weight loss, the desire for additional options has fueled the development of endoscopic bariatric therapies (EBTs) as another tool for weight loss. This review examines established EBTs, including endoscopic sleeve gastroplasty (ESG), intragastric balloons (IGBs), and transoral outlet reduction (TORe), alongside emerging therapies such as duodenal mucosal resurfacing (DMR), incisionless anastomosis creation, and fully automated endoscopic gastric remodeling systems. ESG has demonstrated durable weight loss, favorable safety, and superior cost-effectiveness compared to pharmacotherapy alone, while combination strategies using EBTs and anti-obesity medications (AOMs), particularly GLP-1 receptor agonists, have resulted in greater total-body weight loss than either modality alone. Genetic variation, particularly within the leptin–melanocortin pathway, may predict response to endoscopic interventions and guide personalized treatment selection. Novel investigational procedures such as DMR, automated or robotic gastric remodeling, and magnetic or ultrasound-assisted gastric bypass show promising early results. Endoscopic therapies are poised to become increasingly central to the personalized, scalable management of obesity and related metabolic diseases. Full article

Rehabilitation robotic systems have been developed to perform therapy with minimal supervision from a specialist. Hence, they require algorithms to assess and support patients’ motions. Artificial intelligence brings an opportunity to implement new exercises based on previously modelled ones. This study focuses on analysing the similarities in upper extremity movements during activities of daily living (ADLs). This research aimed to model ADLs by registering and segmenting real-life movements and dividing them into sub-tasks based on joint motions. The investigation used IMU sensors placed on the body to capture upper extremity motion. Angular measurements were converted into joint variables using Matlab computations. Then, these were divided into segments assigned to the sub-functionalities of the tasks. Further analysis involved calculating mathematical measures to evaluate the similarity between the different movements. This approach allows the system to distinguish between similar motions, which is critical for assessing rehabilitation scenarios and anatomical correctness. Twenty-two ADLs were recorded, and their segments were analysed to build a database of typical motion patterns. The results include a discussion on the ranges of motion for different ADLs and gender-related differences. Moreover, the similarities and general trends for different motions are presented. The system’s control algorithm will use these results to improve the effectiveness of robotic-assisted physiotherapy. Full article