Search Results (42)

Multiple Sclerosis (MS) is a chronic neurological disorder affecting the central nervous system that significantly impairs postural control and functional abilities. Robotic-assisted gait training mitigates this functional deterioration. This preliminary study aims to investigate the effects of a four-week gait training with the ExoAtlet II exoskeleton on static balance control and functional mobility in five individuals with MS (Expanded Disability Status Scale ≤ 2.5). Before and after the training, they were assessed in quiet standing under Eyes Open (EO) and Eyes Closed (EC) conditions and with the Timed Up and Go (TUG) test. Center of Pressure (CoP) Sway Area, Antero–Posterior (AP) and Medio–Lateral (ML) CoP displacement, Stay Time, and Total Instability Duration were computed. TUG test Total Duration, sit-to-stand, stand-to-sit, and linear walking phase duration were analyzed. To establish target reference values for rehabilitation advancement, the same evaluations were performed on a matched healthy cohort. After the training, an improvement in static balance with EO was observed towards HS values (reduced Sway Area, AP and ML CoP displacement, and Total Instability Duration and increased Stay Time). Enhancements under EC condition were less marked. TUG test performance improved, particularly in the stand-to-sit phase. These preliminary findings suggest functional benefits of exoskeleton gait training for individuals with MS. 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

Assistive devices, such as Exoskeletons (EXOs) can enhance endurance, but could inadvertently alter body mechanics, compromise balance, and elevate fall risk, particularly under fatigue. We evaluated effects of an EXO on postural stability during standing still and sustained trunk flexion tasks as users become fatigued during intermittently performed tasks. As trunk bending is common across many occupational/routine tasks, a repetitive 45° trunk flexion task was selected. In this controlled laboratory study, symmetric and asymmetric trunk flexion tasks were performed by twelve participants with a Back-support EXO until medium-high fatigue level (7/10 on Borg CR10 scale). Outcomes showed that the device increased trunk flexion durations (~16~25%), and upper-body movement beyond intended position. EXO-use improved stability by reducing maximum deviation (~22%) and mean velocity (~57%) of Center of Pressure (COP) co-ordinates. Asymmetric trunk flexion without assistance led to highest mean velocity of COP during fatigued state, but the same remained lower (~67%) with EXO-use, even with fatigue. The device decreased variance of COP during in medial/lateral direction (~44%), but increased the same in anterior/posterior direction by the same amount. Efforts in this study contribute towards understanding implications of using assistive devices for improving human performance across diverse applications. Full article

Pomegranate seed oil (PSO), a by-product of juice production, is rich in bioactive compounds, especially punicic acid, and has significant potential for health and industrial applications. The present study aimed to optimize an ultrasound-assisted extraction (UAE) of PSO and compare its effectiveness with conventional methods such as cold pressing and Soxhlet extraction. A Box–Behnken design was used to determine the optimal UAE parameters (amplitude 46%, 12 min, L/S ratio 19 mL/g), yielding 12.67% oil with the highest oxidative stability (τ_max = 5.44 min). Compared to Soxhlet and cold-pressed methods, UAE gave the highest yield, but slightly lower levels of total polyphenols and antioxidant activity. Cold-pressed oil retained the most bioactive compounds, but showed reduced oxidative stability and higher susceptibility to degradation. Soxhlet extraction provided moderate antioxidant capacity and the highest punicic acid content, but exceeded the recommended limits for acid value. Overall, the UAE offers an effective balance between yield, quality, and sustainability, with minimal thermal degradation and reduced solvent consumption. The results confirm that UAE is a promising alternative for high-quality PSO extraction, although cold pressing remains superior in preserving sensitive bioactive components. Ultimately, this study underscores that the extraction method plays a decisive role in determining the functional quality and oxidative stability of PSO, with UAE standing out as the most efficient and environmentally favorable approach. Full article

Background/Objectives: Responsiveness and minimal important change (MIC) are key metrics that vary across conditions and should be determined for specific populations. However, these metrics have not yet been established for the Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest in people with subacute traumatic incomplete cervical spinal cord injury (iCSCI). In this study, we aimed to determine the responsiveness and MIC of the Mini-BESTest and Brief-BESTest in people with subacute iCSCI. Methods: This study included people with iCSCI who could maintain the standing position for 30 s without assistance within 7 days of injury at the university hospital’s advanced critical care center. Responsiveness was assessed by correlating Mini-BESTest and Brief-BESTest change scores with the Berg Balance Scale (BBS). MIC values were determined using the global rating of change scale as an anchor, employing receiver operating characteristic curve methods (MIC_ROC) and predictive modeling methods adjusted for the proportion of improved participants (MIC_adjusted). Results: Fifty people with iCSCI were included in the analysis. Changes in BBS scores were moderately positively correlated with changes in Mini-BESTest and Brief-BESTest scores. MIC_adjusted values were 3.7 for the Mini-BESTest and 2.2 for the Brief-BESTest. The MIC_ROC, based on an improvement rate of 64%, was deemed less appropriate for interpreting meaningful changes due to the high proportion of improved participants. Conclusions: MIC_adjusted benchmarks can help clinicians measure significant improvements in dynamic balance, design effective interventions, and evaluate rehabilitation outcomes in people with iCSCI. Full article

Prostate cancer presents a substantial challenge, necessitating a delicate balance between effective treatment and preserving the overall quality of life for men, while robot-assisted radical prostatectomy (RARP) stands as the premier surgical approach, with a negligible rate of patients who remained incontinent. This review explores various technical modifications employed in RARP to improve early continence recovery, offering a summary of their implementation and potential benefits. Techniques like bladder neck preservation, subapical urethral dissection, and nerve-sparing approaches are critically discussed, highlighting their role in minimizing continence issues and ensuring a better post-operative experience for patients with prostate cancer. Full article

Background: The objective of this study was to compare the outcomes between patients undergoing mechanically aligned conventional total knee arthroplasty (MA-CTKA) and functionally aligned robotic-arm-assisted TKA (FA-RTKA). Methods: We reviewed a prospectively collected database of consecutive patients who underwent primary total knee arthroplasty (TKA) for knee osteoarthritis between June 2022 and May 2023. Patients were divided into two groups—MA-CTKA (n = 50) and FA-RTKA (n = 50)—based on the introduction of a robotic-arm-assisted system during the study period. The hip–knee–ankle (HKA) angle, joint line orientation angle (JLOA) relative to the floor, and weight-bearing line (WBL) ratio were evaluated using full-length standing hip-to-calcaneus radiographs to compare the conventional mechanical axis (MA) and the ground mechanical axis (GA) passing through the knee joint between the groups. Clinical outcomes were also compared between the two groups. Results: There were no significant differences in the postoperative HKA angle between the groups, due to discrepancies in the targeted alignment strategies (FA-RTKA: 2.0° vs. MA-CTKA: 0.5°; p = 0.001). The postoperative JLOA in the FA-RTKA group was more parallel to the floor, whereas the MA-CTKA group showed a downward angulation toward the lateral side (0.6° vs. −2.7°; p < 0.001). In the FA-RTKA group, the GA passed through a neutral position when accounting for the calcaneus, while the MA-CTKA group showed a more lateral GA position (48.8% vs. 53.8%; p = 0.001). No significant differences in clinical outcomes were shown between the FA-RTKA and MA-CTKA groups, with the FA-RTKA group demonstrating higher Forgotten Joint Scores and a greater range of motion (all p < 0.05). Conclusions: Functionally aligned TKA demonstrated improved joint line parallelism to the floor and more neutral weight-bearing alignment in the GA compared to mechanically aligned TKA. These findings indicate a more balanced load distribution across the knee, which may contribute to the superior clinical outcomes observed in the functionally aligned group. Full article

Forest development forms the foundation for the advancement of sustainable forest management that integrates the knowledge of natural and anthropogenic processes with ecological and biological insights. This study aims to emphasize the role of assisted natural regeneration and balanced forest development phases in fostering closer-to-nature management approaches, contributing to resilient forest ecosystems capable of self-regulation and biodiversity support in the face of anthropogenic and climatic challenges. This study focuses on forest development in Lithuania based on five National Forest Inventories (NFIs) from 2002 to 2022. We examine the tree volume structure of the growing stock by stand type and forest type series from the point of view of stand age and forest development phases. This is performed by applying the standardized methodologies of the Lithuanian National Forest Inventory. Our analysis focuses on broader patterns derived from the selected NFI data rather than stand-level details. Our findings demonstrate that long-term observation of dynamic National Forest Inventories can aid in the development of closer-to-nature forest management methods for different forest type series. In order to implement the European Union’s strategy and policy for closer-to-nature forest management, we call for the use of “assisted succession” methods in commercial forests, promoting the formation of mixed-species forest stands with multi-cohort age profiles, including old-growth all-aged forest patches of >121 years. Full article

Research into new solutions for wearable assistive devices for the visually impaired is an important area of assistive technology (AT). This plays a crucial role in improving the functionality and independence of the visually impaired, helping them to participate fully in their daily lives and in various community activities. This study presents a bibliometric analysis of the literature published over the last decade on wearable assistive devices for the visually impaired, retrieved from the Web of Science Core Collection (WoSCC) using CiteSpace, to provide an overview of the current state of research, trends, and hotspots in the field. The narrative focuses on prominent innovations in recent years related to wearable assistive devices for the visually impaired based on sensory substitution technology, describing the latest achievements in haptic and auditory feedback devices, the application of smart materials, and the growing concern about the conflicting interests of individuals and societal needs. It also summarises the current opportunities and challenges facing the field and discusses the following insights and trends: (1) optimization of the transmission of haptic and auditory information while multitasking; (2) advance research on smart materials and foster cross-disciplinary collaboration among experts; and (3) balance the interests of individuals and society. Given the two essential directions, the low-cost, stand-alone pursuit of efficiency and the high-cost pursuit of high-quality services that are closely integrated with accessible infrastructure, the latest advances will gradually allow more freedom for ambient assisted living by using robotics and automated machines, while using sensor and human–machine interaction as bridges to promote the synchronization of machine intelligence and human cognition. Full article

Driven by the increasing care needs of residents in long-term care facilities, Ambient Assisted Living paradigms have become very popular, offering new solutions to alleviate this burden. This work proposes an efficient edge-cloud system for indoor activity monitoring in long-term care institutions. Action recognition from video streams is implemented via Deep Learning networks running at edge nodes. Edge Computing stands out for its power efficiency, reduction in data transmission bandwidth, and inherent protection of residents’ sensitive data. To implement Artificial Intelligence models on these resource-limited edge nodes, complex Deep Learning networks are first distilled. Knowledge distillation allows for more accurate and efficient neural networks, boosting recognition performance of the solution by up to 8% without impacting resource usage. Finally, the central server runs a Quality and Resource Management (QRM) tool that monitors hardware qualities and recognition performance. This QRM tool performs runtime resource load balancing among the local processing devices ensuring real-time operation and optimized energy consumption. Also, the QRM module conducts runtime reconfiguration switching the running neural network to optimize the use of resources at the node and to improve the overall recognition, especially for critical situations such as falls. As part of our contributions, we also release the manually curated Indoor Action Dataset. Full article

Parkinson’s disease (PD) is a neurodegenerative disorder and always results in balance loss. Although studies in lower-extremity exoskeleton robots are ample, applications with a lower-extremity exoskeleton robot for PD patients are still challenging. This paper aims to develop an effective assistive control for PD patients with a lower-extremity exoskeleton robot to maintain standing balance while being subjected to external disturbances. When an external force is applied to participants to force them to lose balance, the hip strategy for balance recovery based on the zero moment point (ZMP) metrics is used to generate a reference trajectory of the hip joint, and then, a model-free linear extended state observer (LESO)-based fuzzy sliding mode control (FSMC) is synthesized to regulate the human body to recover balance. Balance recovery trials for healthy individuals and PD patients with and without exoskeleton assistance were conducted to evaluate the performance of the proposed exoskeleton robot and balance recovery strategy. Our experiments demonstrated the potential effectiveness of the proposed exoskeleton robot and controller for standing balance recovery control in PD patients. Full article

Background: Modern technologies are being applied to maintain and improve the functional performance of older adults. Fully immersive virtual reality (VR) combined with a scope of dual-task (DT) activities may effectively complement conventional physiotherapy programmes for seniors. The study aimed to compare the effectiveness of a fully immersive virtual reality (VR) environment combined with a scope of dual-task activities regarding balance in older women. Methods: Eighty women were recruited to the study protocol and, following randomisation, allocated to two equally sized groups, one pursuing conventional OTAGO exercises, the other one the VR-solutions-aided exercise programme combined with a scope of DT activities. Physiotherapy sessions spanned 6 weeks, each one lasting 60 min, three times a week, in both groups. Results: Homogeneity analysis of both study groups indicated no statistically significant differences at the first measurement point. After the intervention, both study groups achieved significantly improved scores on all tests. The VR + DT group obtained better results in dual-task gait and single-leg standing, whereas the greatest difference was observed during SLS CL (1.52 s vs. 2.33 s—difference 0.81 s 53.2% change, p = 0.001). The OTAGO group performed better in the TUG single-task gait (11.35 s vs. 12.60 s, p < 0.001) and in the Berg balance scale. Conclusions: The VR + DT training is effective in improving individual balance as well as in reducing fall risks. VR-assisted physiotherapy should complement conventional physiotherapy programmes (e.g., OTAGO). The benefits of applying VR solutions indicate that older women might well use this form of activity regularly under the guidance of a therapist or a family member. Full article

Impaired balance is a key symptom following acute concussion. Unfortunately, the recommended clinical balance assessment lacks sensitivity and discriminative ability, relying on the experience of the clinician for interpretation. The aim of this pilot study is to explore smartphone technology to remotely assess balance impairment in people with acute concussion. A smartphone app was developed to allow the clinician to connect remotely using their personal web browser to the participant’s smartphone and collect motion data while instructing the participant to perform the following balance tests: standing on firm and foam surface with eyes opened and closed (FIRMEO, FIRMEC, FOAMEO, and FOAMEC). Outcome measures were processed from the raw acceleration to calculate the average acceleration magnitude from the mean and the root-mean square, with greater values indicating more sway. Eleven healthy controls (HCs) and 11 people with concussion (CON) participated. In all sway measurements, the CON group had significantly (p < 0.05) greater values when standing on a firm surface. In the FOAMEC condition, the CON group had significantly (p < 0.05) greater sway measures only in the AP direction, while significantly greater sway in all directions were found in the CON group in the FOAMEO condition. This study shows that remote balance assessment using a smartphone can discriminate between healthy controls and people with acute concussion. This technology could play an important role in concussion management to assist with determining recovery from concussions and the optimal timing for return to sport. Full article

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO’s healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson’s Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso^®, HAL^®, Stride Management Assist^®, Honda Walking Assist^®, Lokomat^®, Walkbot^®, Healbot^®, Keeogo Rehab^®, EX1^®, overground wearable exoskeletons, Eksoband^®, powered ankle–foot orthoses, HAL^® lumbar type, Human Body Posturizer^®, Gait Enhancing and Motivation System^®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults. Full article

Background: Falls are common and dangerous for stroke survivors. Current fall risk assessment methods rely on subjective scales. Objective sensor-based methods could improve prediction accuracy. Objective: Develop machine learning models using inertial sensors to objectively classify fall risk in stroke survivors. Determine optimal sensor configurations and clinical test protocols. Methods: 21 stroke survivors performed balance, Timed Up and Go, 10 Meter Walk, and Sit-to-Stand tests with and without dual-tasking. A total of 8 motion sensors captured lower limb and trunk kinematics, and 92 spatiotemporal gait and clinical features were extracted. Supervised models—Support Vector Machine, Logistic Regression, and Random Forest—were implemented to classify high vs. low fall risk. Sensor setups and test combinations were evaluated. Results: The Random Forest model achieved 91% accuracy using dual-task balance sway and Timed Up and Go walk time features. Single thorax sensor models performed similarly to multi-sensor models. Balance and Timed Up and Go best-predicted fall risk. Conclusion: Machine learning models using minimal inertial sensors during clinical assessments can accurately quantify fall risk in stroke survivors. Single thorax sensor setups are effective. Findings demonstrate a feasible objective fall screening approach to assist rehabilitation. Full article