Search Results (209)

This study aimed to evaluate the feasibility of using serious games for the (tele)rehabilitation of children with disabilities affected by the Ukrainian war. Additionally, it provides requirements for technologies that can be used in war-affected areas. Structured interviews and Likert scale assessments were conducted on-site and remotely with patients of the tertiary care facility in Ukraine. All participants used the telerehabilitation platform for motor and cognitive training. Nine serious games were employed, involving trunk tilts, upper limb movements, and head control. By mid-September 2023, 186 positive user experiences were evident, with 89% expressing interest in continued engagement. The platform’s accessibility, affordability, and therapeutic benefits were highlighted. The recommendations from user feedback informed potential enhancements, showcasing the platform’s potential to provide uninterrupted rehabilitation care amid conflict-related challenges. This study suggests that serious games solutions that suit the sociopolitical and economic context offer a promising solution to rehabilitation challenges in conflict zones. The positive user experiences towards using the platform with serious games indicate its potential in emergency healthcare provision. The findings emphasize the role of technology, particularly serious gaming, in mitigating the impact of armed conflicts on children’s well-being, thereby contributing valuable insights to healthcare strategies in conflict-affected regions. Requirements for technologies tailored to the context of challenging settings were defined. Full article

Background: Upper-limb impairment is a major cause of post-stroke disability, limiting participation in meaningful activities. Robotic rehabilitation may address this by delivering high-dosage, task-oriented training while reducing clinician workload. However, limited clinical translation of robotic interventions may be partly due to poor reporting in the literature. This systematic review evaluated the intervention-reporting quality (completeness and consistency) of randomized controlled trials (RCTs) comparing robotic and conventional upper-limb stroke rehabilitation. Methods: Four databases were searched for RCTs investigating robotic upper-limb interventions compared with dose-matched conventional interventions for people with stroke. Intervention reporting was assessed using the TIDieR-Rehab checklist. Trained reviewers independently extracted and evaluated data, resolving discrepancies through consensus. Completeness and consistency were analyzed descriptively. Results: Among 25 RCTs, the overall reporting completeness was low (43%). Robotic interventions were better described (50%) than conventional interventions (36%). While timing and total dose were commonly reported, critical details on provider expertise, active dose, progressive challenge, personalization, and harms were often omitted. Reporting consistency was moderate (68%), with key information dispersed across article sections. Conclusions: Inadequate reporting limits the transparency, replication, and implementation of robotic upper-limb interventions. Adopting structured reporting frameworks like TIDieR-Rehab is essential for advancing the field. Full article

Background and Clinical Significance: Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. Case Presentation: A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. Conclusions: Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. Full article

Complex regional pain syndrome (CRPS) is a disabling pain condition, which is distinct from other pain syndromes by the presence of autonomic dysfunction and regional inflammatory changes. Objectives: To explore the impact of pharmacological treatment strategies, specifically scheduled, on-demand dosing regimens versus lack of medical treatment, on pain-related and functional outcomes in rehabilitation for individuals with CRPS. Methods: A total of 32 participants with CRPS were assigned to three treatment groups depending on analgesic treatment during the course of complex rehabilitation. Pre- and post-rehabilitation assessments were conducted using validated measures, including the Numerical Rating Scale (NRS) for pain, the Short-Form McGill Pain Questionnaire (SF-MPQ), PainDETECT, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the Lower Extremity Functional Scale (LEFS). Results: Significant improvements in pain and upper limb function (DASH scores) were observed across all groups (p < 0.05). No statistically significant changes were found in lower limb function (LEFS). Between-group comparisons revealed significant differences in post-treatment pain scores (SFMPQ-B), particularly between groups with a constant treatment regimen and those without treatment. Conclusions: There were no statistically significant changes compared to different treatment regimen groups. The constant treatment group showed slightly better average improvements in pain and disability compared to other groups. Statistically significant improvements in all CRPS patients were observed in pain-related and functional measures. Full article

Background: Wearable movement sensors can measure upper limb (UL) activity, but single variables may not capture the full picture. This study aimed to replicate prior work identifying five multivariate categories of UL activity performance in people with stroke and controls and expand those findings to other UL conditions. Methods: Demographic, self-report, and wearable sensor-based UL activity performance variables were collected from 324 participants (stroke n = 49, multiple sclerosis n = 19, distal UL fracture n = 40, proximal UL pain n = 55, post-breast cancer n = 23, control n = 138). Principal component (PC) analyses (12, 9, 7, or 5 accelerometry input variables) were followed by cluster analyses and numerous assessments of model fit across multiple subsets of the total sample. Results: Two PCs explained 70–90% variance: PC1 (overall UL activity performance) and PC2 (preferred-limb use). A five-variable, five-cluster model was optimal across samples. In comparison to clusters, two PCs and individual accelerometry variables showed higher convergent validity with self-report outcomes of UL activity performance and disability. Conclusions: A five-variable, five-cluster model was replicable and generalizable. Convergent validity data suggest that UL activity performance in daily life may be better conceptualized on a continuum, rather than categorically. These findings highlight a unified, data-driven approach to tracking functional changes across UL conditions and severity of functional deficits. Full article

Assistive technologies, particularly multi-fingered robotic hands (MFRHs), are critical for enhancing the quality of life for individuals with upper-limb disabilities. However, achieving precise and stable control of such systems remains a significant challenge. This study proposes an Improved Grey Wolf Optimization (IGWO)-tuned Linear Quadratic Regulator (LQR) to enhance the control performance of an MFRH. The MFRH was modeled using Denavit–Hartenberg kinematics and Euler–Lagrange dynamics, with micro-DC motors selected based on computed torque requirements. The LQR controller, optimized via IGWO to systematically determine weighting matrices, was benchmarked against PID and PID-PSO controllers under diverse input scenarios. For step input, the IGWO-LQR achieved a settling time of 0.018 s with zero overshoot for Joint 1, outperforming PID (settling time: 0.0721 s; overshoot: 6.58%) and PID-PSO (settling time: 0.042 s; overshoot: 2.1%). Similar improvements were observed across all joints, with Joint 3 recording an IAE of 0.001334 for IGWO-LQR versus 0.004695 for PID. Evaluations under square-wave, sine, and sigmoid inputs further validated the controller’s robustness, with IGWO-LQR consistently delivering minimal tracking errors and rapid stabilization. These results demonstrate that the IGWO-LQR framework significantly enhances precision and dynamic response. Full article

Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen–Taylor Hand Function Test (JTHFT) (SMD = −0.62; 95% CI = (−1.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = −0.38; 95% CI = (−1;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = −0.42; 95% CI = (−0.78–0.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed. Full article

Background: Music therapy and music-based interventions are increasingly recognized as valuable adjuncts in pediatric neurorehabilitation, leveraging rhythm, singing, instrument playing, and improvisation to support children with neurological disabilities. Objective/Method: This narrative review synthesizes evidence from studies published between 2000 and 2025, focusing on children aged 3 to 18 years receiving neurorehabilitation. Results: The literature demonstrates that music therapy and music-based interventions can improve motor function—particularly gait and upper limb coordination—as well as speech production, while also reducing anxiety and enhancing participation. Techniques such as rhythmic auditory stimulation and melodic intonation therapy have shown promise in targeting movement and communication deficits. Music therapy is further associated with positive effects on vital signs and emotional well-being, supporting its role in holistic care. Neurobiological findings suggest that music-based interventions may promote neuroplasticity and strengthen brain connectivity, though high-quality mechanistic studies remain limited. Conclusions: Despite methodological heterogeneity and small sample sizes in the current literature, the overall evidence supports music therapy and music-based interventions as accessible, cost-effective, and child-centered complements to standard neurorehabilitation. Future research should prioritize rigorous clinical trials and neurobiological investigations to clarify mechanisms and optimize therapeutic protocols. Full article

Stroke remains a significant global health challenge, particularly in low- and middle-income Countries (LMICs), where two-thirds of stroke-related deaths occur, and disability-adjusted life years are seven times higher compared to high-income Countries (HICs). The majority of stroke survivors suffer from upper limb impairment, severely limiting their daily activities and significantly diminishing their overall quality of life. Rehabilitation plays a critical role in restoring function and independence, but it faces challenges such as low engagement, limited customization, difficulty tracking progress, and accessibility barriers, particularly in LMICs. Immersive virtual reality (imVR) has shown promise in addressing these challenges, but most commercial imVR systems lack therapeutic design and cultural adaptation. This study aimed to develop culturally adaptable imVR games for upper limb stroke rehabilitation (ULSR) in the context of LMICs, with a particular focus on Ethiopia. The AdaptRehab VR system was developed including six imVR games (Basket Bloom, Strike Zone, TapQuest, FruitFall Frenzy, Precision Pitch, and Bean Picker Pro) through co-creation approaches involving Ethiopian and Belgian physiotherapists, stakeholders, and patients, incorporating game development mechanics in rehabilitation, such as therapeutic aims, cultural factors, feedback, automatic progression recording, task variety, and personalized rehabilitation. It was designed with the Unity 3D engine and Oculus Quest headsets, supporting controllers and hand tracking. This culturally tailored imVR platform has demonstrated significant potential to enhance ULSR accessibility, patient motivation, and outcomes in resource-constrained settings, addressing critical gaps in stroke rehabilitation solutions. In conclusion, the AdaptRehab VR system was successfully developed as a culturally contextualized imVR platform tailored to tackle ULSR challenges in LMICs, with a specific focus on Ethiopia. Full article

Background/Objective: Fatigue is one of the most recurrent and most disabling symptoms of long COVID (LC) and is associated with a worse quality of life. Reducing body fat in these patients could be important to mitigate fatigue and post-exertional worsening. Aerobic exercise may not be indicated in LC patients who have orthostatic tachycardia and post-exertional worsening. The aim of this study was to evaluate the effects of a personalized supine therapeutic motor control exercise program on fatigue and fat tissue in women with LC. Methods: A single-arm exploratory case study, with a pre–post format, was conducted on 17 women with LC to test the effects of a plank-based strengthening exercise program on fatigue, which was evaluated by the Modified Fatigue Impact Scale and fat tissue assessed by bioimpedance. The twelve-week program included two weekly sessions. The exercise program was personalized, considering the symptoms and characteristics of the patients. Results: Participants with overweight or obesity (n = 12) comprised 70% of the entire sample. After completing the exercise program this value decreased by 5.9 percentage points. Significant differences were found in the total [(MD  = −1.72, 95% CI −2.57 to −0.86), r = 0.73], trunk, upper and inner limbs body fat percentages (p < 0.05). The overall fatigue decreased at 12 weeks [(MD  =  −14.00, 95% CI −21.69 to −6.31), r = 0.69] as well as the physical and psychosocial fatigue sub-scale (p  <  0.001); no differences were observed in the cognitive sub-scale. Conclusions: The plank-based personalized strengthening exercise program showed rapid improvements in fatigue and fat percentages. It could be an effective strategy to achieve improvements for LC patients. Full article

Clinical research has demonstrated that stroke patients benefit from active participation during robot-assisted training. However, the weight of the arm impedes the execution of tasks and movements due to the functional disability. The purpose of this paper is to develop a gravity compensation strategy for an end-effector upper limb rehabilitation robot based on an arm dynamics model to reduce the arm’s muscle activation level. This control strategy enables real-time evaluation of arm gravity torques based on feedback from upper limb kinematic parameters. The performance of the proposed strategy in movement tracking is then compared to that of other types of weight compensation strategies. Experimental results demonstrate that compared to movements without compensation, the mean activation levels of arm muscles with the proposed strategy showed a significant reduction (p < 0.05), except for activation of the triceps. Furthermore, the proposed strategy provides superior performance in reducing the arm muscle’s effort compared to the position-varying weight compensation strategy. Therefore, with the proposed strategy, the end-effector rehabilitation robot might improve participation in robot-assisted rehabilitation training, as well as the usability and feasibility of the rehabilitation or assistive robot. Full article

Background: Cervical radiculopathy is one of the frequent musculoskeletal problems prevalent in the general population, characterized by neck pain radiating to the upper limb. This study investigated the effects of the myokinetic stretching technique versus post-isometric relaxation (PIR) exercises with mechanical traction in patients with cervical radiculopathy. Methods: A single-blinded, randomized clinical trial was conducted from March 2023 to June 2023. Sixty-six patients with cervical radiculopathy were randomly assigned to two groups: Group A (n = 33) received myokinetic stretching exercises and Group B (n = 33) received isometric relaxation exercises, while mechanical cervical traction was applied to both groups as the baseline treatment. The treatment frequency was two sessions per week for eight weeks. Outcome measures were pain, range of motion, and neck disability measured through the Numerical Pain Rating Scale, a goniometer, and the Urdu version of the Neck Disability Index. Assessments were performed at the baseline and the 4th and 8th weeks of the treatment. Results: The between-group analysis showed a non-significant difference (p > 0.05). The within-group analysis showed (p < 0.001) significant improvement in both groups. Conclusion: This study concluded that the myokinetic stretching technique and post-isometric relaxation exercises combined with mechanical traction are effective in improving pain, range of motion, and neck disability in patients with cervical radiculopathy. Full article

Trapeziometacarpal osteoarthritis is the second most frequent degenerative hand disease, and it presents in 66% of women over the age of 55. Post-surgery immobilization results in functional losses that could be attenuated by motor imagery training. Objectives: The aim of this study is to evaluate the efficacy of motor imagery training during the post-surgical immobilization period in women who underwent surgery for trapeziometacarpal osteoarthritis. Methods: A randomized controlled trial was performed. A total of 40 patients satisfied the eligibility criteria, agreed to participate, and were randomized into an experimental group (n = 20) or control group (n = 20). Motor imagery was applied to the experimental group during the 3 weeks of post-surgical immobilization and to the control group with the conventional protocol. Measurement outcomes were assessed four times throughout the study using the Disabilities of the Arm, Shoulder, and Hand questionnaire, the Cochin Hand Function Scale questionnaire, the Visual Analogue Scale, goniometry, a baseline pinch gauge, circumferential measurement, and the modified Kapandji Index. Results: There were significant improvements in the motor imagery group compared with the control group in post-motor imagery, pre- and post-rehabilitation measurements, functional pain (p < 0.001), rest pain (p < 0.01), hand mobility (p < 0.001), range of motion (p < 0.05), and wrist edema (p < 0.04); there were also improvements in pre- and post-rehabilitation measurements, quality of life in relation to upper limb function problems (p < 0.04), the post-rehabilitation measurement of hand functionality (p = 0.02), and post-motor imaging in finger-to-finger pinch strength. There were no statistically significant differences in the rest of the variables. Conclusions: Early intervention with motor imagery could be effective for resting and functional pain, quality of life in relation to upper limb problems, functional capacity, mobility, range of motion, strength, and edema. Full article

The global aging trend is becoming increasingly severe, and the demand for life assistance and medical rehabilitation for frail and disabled elderly people is growing. As the best solution for assisting limb movement, guiding limb rehabilitation, and enhancing limb strength, exoskeleton robots are becoming the focus of attention from all walks of life. This paper reviews the progress of research on upper limb exoskeleton robots, sEMG technology, and intention recognition technology. It analyzes the literature using keyword clustering analysis and comprehensively discusses the application of sEMG technology, deep learning methods, and machine learning methods in the process of human movement intention recognition by exoskeleton robots. It is proposed that the focus of current research is to find algorithms with strong adaptability and high classification accuracy. Finally, traditional machine learning and deep learning algorithms are discussed, and future research directions are proposed, such as using a deep learning algorithm based on multi-information fusion to fuse EEG signals, electromyographic signals, and basic reference signals. A model with stronger generalization ability is obtained after training, thereby improving the accuracy of human movement intention recognition based on sEMG technology, which provides important support for the realization of human–machine fusion-embodied intelligence of exoskeleton robots. Full article

Objectives: The aim of this study was to analyze differences in affected upper limb functionality (grip strength, digital pinch, sensitivity, and manual dexterity) in women with breast cancer and to determine whether these factors can predict perceived disability. This study highlights the motor and sensory deficits resulting from breast cancer treatments and underscores the need for a comprehensive approach to addressing them. Methods: A descriptive cross-sectional study was conducted with 42 women diagnosed with breast cancer who underwent surgery and received chemotherapy, radiotherapy, or hormonal therapy. Strength, sensitivity, and manual dexterity were assessed, along with pain and disability questionnaires. Results: Significant differences were found in affected upper limb functionality according to age, employment status, and time since surgery. Grip strength, pinch strength, manual dexterity, and sensitivity were identified as predictors of perceived disability, explaining 92.15% of the variance in SPADI scores. Conclusions: Women with breast cancer experience functional deficits in the upper limb, particularly in strength, sensitivity, and manual dexterity. Age, employment status, and time since surgery influence the perceived disability. These findings emphasize the need for comprehensive upper limb evaluations to identify functional deficits and guide personalized rehabilitation strategies. Full article