Search Results (38)

Upper-limb motor dysfunction resulting from neurological disorders severely limits patients’ activities of daily living and social participation. Pneumatic upper-limb rehabilitation robots have emerged as a promising intervention owing to their inherent compliance, lightweight design, and high power-to-weight ratio, which facilitate safe, repetitive, and home-based training. Despite these advantages, extensive clinical translation remains hindered by challenges including actuator hysteresis, nonlinear dynamics, limited accuracy in intention recognition, and inconsistent clinical evaluation metrics. This review systematically examines recent advancements in pneumatic upper-limb rehabilitation robots across four critical dimensions: structural design, human–robot interaction, control strategies, and clinical translation. We comparatively analyze rigid exoskeletons, soft wearable devices, and rigid–soft hybrid configurations based on output capability, motion accuracy, comfort, and clinical applicability. The findings suggest that while rigid systems offer high precision and soft systems maximize safety, rigid–soft hybrid architectures represent a critical developmental trend for balancing motion accuracy with interaction compliance. Furthermore, the review evaluates multimodal sensing techniques (e.g., EMG, EEG, and IMUs) for motion intention decoding and training state monitoring, alongside conventional, adaptive, and artificial intelligence-driven control methods aimed at compensating for pneumatic nonlinearity and improving real-time response. Current clinical evidence indicates that these systems effectively enhance upper-limb function and muscle strength, particularly in post-stroke rehabilitation; however, existing trials are frequently constrained by small sample sizes, short interventions, and heterogeneous protocols. Future research must prioritize rigid–soft hybrid architectures, robust multimodal sensor fusion, digital twin-assisted assessment, adaptive intelligent control, and standardized home-based rehabilitation platforms. Ultimately, this comprehensive review provides a concise reference for the design optimization and clinical deployment of next-generation pneumatic rehabilitation systems. Full article

Introduction: Adult-onset Alexander disease (AOAD) is a rare astrocytopathy linked to the glial fibrillary acidic protein (GFAP) gene, which is known for its clinical heterogeneity and common misdiagnosis. In adults, it may present with bulbar dysfunction, pyramidal signs, ataxia, dysautonomia, cognitive decline, or parkinsonism, which often mimics atypical parkinsonian syndromes like multiple system atrophy (MSA). The purpose of this case series was to define practical clinical, radiological, and genetic cues for suspecting AOAD in adults with atypical parkinsonism, autonomic dysfunction, or paroxysmal focal symptoms, particularly when genetic findings are inconclusive. Case Presentation: Four patients, aged 40 to 59 years, had progressive and varied neurological symptoms, like gait disturbance, lower limb weakness, dysarthria, dysphagia, autonomic dysfunction, parkinsonism, cognitive decline, and paroxysmal focal deficits. Initial diagnoses were parkinsonian syndrome, stroke, transient ischemic attack (TIA), and MSA. Diagnostic Assessment and Intervention: Brain magnetic resonance imaging (MRI) in all patients showed characteristic lower brainstem abnormalities, particularly atrophy of the medulla oblongata and upper cervical spinal cord, consistent with the “tadpole sign.” GFAP sequencing identified one likely pathogenic variant (p.Arg70Trp) and three variants of uncertain significance: p.Glu122_Arg124del, p.Met415Ile, and p.Glu195Val. Management was mainly symptomatic; one patient showed significant motor improvement after repetitive transcranial magnetic stimulation (rTMS). Conclusions: AOAD should be considered in adults with parkinsonism-plus syndromes or unexplained combinations of bulbar symptoms, pyramidal signs, autonomic dysfunction, and cognitive decline. Recognizing the tadpole sign on MRI may improve diagnostic accuracy, particularly when genetic results are inconclusive. Full article

Combat sports are characterized by sport-specific asymmetrical movement patterns that may influence neuromuscular control, functional stability, and injury risk. Although lower-limb asymmetry has been widely investigated in taekwon-do experienced ITF taekwon-do practitioners, upper-limb functional symmetry remains insufficiently explored. Sixteen experienced male ITF taekwon-do practitioners underwent assessment of hand grip strength and upper-limb dynamic stability using the Upper Quarter Y-Balance Test (UQYBT). Reach distances in anterior (AP), posteromedial (PM), and posterolateral (PL) directions were analyzed together with composite symmetry indices. Inter-limb differences were evaluated using paired Student’s t-tests, and associations between strength and dynamic stability variables were examined using Pearson’s correlations. Significant inter-limb asymmetry was observed only in the posteromedial (PM) UQYBT direction, with higher values for the left upper limb (p < 0.001; dz = 1.34). No significant inter-limb differences were observed for hand grip strength, anterior reach distance, posterolateral reach distance, or composite index values. Correlation analyses demonstrated weak-to-moderate and statistically non-significant relationships between hand grip strength and dynamic stability variables. Experienced taekwon-do athletes demonstrate movement-specific upper-limb asymmetry while maintaining relatively symmetrical overall dynamic stability and grip strength. The findings further suggest that upper-limb dynamic stability may depend more strongly on neuromuscular coordination and sport-specific motor control than on maximal grip strength alone. These findings suggest that asymmetry in taekwon-do may reflect a potential sport-specific adaptation rather than generalized neuromuscular dysfunction. Full article

Background/Objectives: Upper-limb motor dysfunction is common after stroke, and patients often have limited recovery during rehabilitation. In this study, we aimed to investigate the relationship between contralesional neurophysiological parameters and the effects of rehabilitation on upper-limb motor function in stroke patients with corticospinal tract damage. Methods: Forty patients with subacute stroke with an absent MEP response on the ipsilesional side before admission were included. Contralesional neurophysiological parameters, including resting motor threshold, contralesional MEP, contralesional short-interval intracortical inhibition (short-ICI), and contralesional long-interval intracortical inhibition (long-ICI), were assessed via transcranial magnetic stimulation (TMS) pre-admission. The coefficients of variation for MEP, short-ICI, and long-ICI were calculated to assess cortical stability. Rehabilitation effect was measured using changes in the Fugl–Meyer assessment score after 21 days of rehabilitation. Results: No single contralesional parameter significantly predicted rehabilitation effect. Further exploratory analysis revealed that a model combining contralesional neurophysiological parameters was associated with proximal limb motor function recovery. Short-ICI played a prominent role in this exploratory model. Conclusions: Contralesional neurophysiological markers demonstrated limited predictive value in patients with stroke with moderate-to-severe motor dysfunction and damaged corticospinal tract function on the ipsilesional side. However, a model combining multimodal contralesional TMS measures, particularly short-ICI, may offer incremental value in predicting proximal limb motor improvement following 21-day rehabilitation. Although this mechanism was not directly measured, the findings suggest a compensatory role of the cortico-reticulo-spinal pathway. These exploratory results should be interpreted with caution regarding their clinical applicability and are premature as a predictive tool, pending rigorous external validation. Full article

Upper limb motor dysfunction resulting from stroke requires effective rehabilitation solutions; however, current exoskeletons are limited by single-input control, inadequate adaptation to various rehabilitation stages, and restriction to one limb. This study presents the development of a three-degree-of-freedom upper limb rehabilitation exoskeleton with three core innovations: (1) a neuro-fuzzy adaptive admittance control architecture that integrates human–robot interaction force and joint angular velocity as dual inputs for real-time damping adjustment, enabling accurate capture of dynamic movement intentions; (2) a Brunnstrom stage-specific fuzzy rule base that directly links clinical rehabilitation needs to adaptive control parameters; (3) a bilateral adaptable mechanical structure, allowing dual-upper limb training to enhance practical application. By combining radial basis function (RBF) neural network-based adaptive proportional–integral–derivative (PID) control with fuzzy variable-parameter admittance control, the system achieves a maximum trajectory tracking error of less than 1.2° and a root mean square (RMS) error of ≤0.13°. Trajectory tracing experiments confirm an RMS error of 2.99 mm for a circular trajectory at Bd = 2. The proposed strategy, validated through position tracking, admittance interaction, and trajectory tracing experiments, effectively balances tracking accuracy and human–machine compliance, providing valuable technical support for robot-assisted upper limb rehabilitation. Full article

HTLV-1 and HTLV-2 infections are associated with various neurological manifestations, particularly HTLV-1-associated myelopathy (HAM). This descriptive, cross-sectional observational study aimed to investigate and analyze the neurological manifestations in patients treated at the Service for the Care of People Living with HTLV (Serviço de Atendimento à Pessoa Vivendo com HTLV-SAPEVH) at the Federal University of Pará. A cohort of 957 individuals underwent screening for HTLV-1/2 infection using enzyme-linked immunosorbent assay (ELISA), with seropositive samples subsequently confirmed via Western blotting or quantitative polymerase chain reaction (qPCR). HTLV-1/2 infection was confirmed in 69 individuals. Of these, fifteen individuals—diagnosed with HTLV-1 (n = 11) or HTLV-2 (n = 4) infection—who presented with neurological complaints at the first nursing consultation, were referred to a neurologist for clinical evaluation of neurological signs and symptoms. Most of the patients were female (13), ranging from 33 to 80 years of age. Neurological symptoms were present in 86.7%, and included spasticity, paraparesis, chronic pain, both motor and sensory deficits, as well as urinary disorders, predominantly affecting the thoracic spinal cord and lower limbs. Urinary symptoms were observed in 77% of symptomatic patients, often preceding other neurological signs that suggest a role as “sentinel symptoms” in the clinical screening of HTLV carriers. The results demonstrated the presence of neurological impairment in patients infected with both HTLV-1 and HTLV-2, with motor symptoms ranging from moderate to advanced. In addition, cases of cranial nerve and upper limb involvement were reported, a finding that is rarely described in the literature. The study highlights the importance of neurological assessment as early as possible in patients infected with either HTLV-1 or HTLV-2 and suggests that sphincter dysfunctions can serve as early clinical markers of future neurological impairment. Full article

Background: Traditional common spatial pattern (CSP) algorithms for upper limb neural rehabilitation face inherent challenges of overlapping cortical representations and frequency sensitivity, which hinder the decoding performance of motor imagery (MI) electroencephalogram (EEG) signals. Objective: To address these issues, this study adopts an improved discriminative filter bank CSP (DFBCSP) framework and applies it to the decoding of upper limb MI-EEG signals, achieving remarkable classification performance. Methods: EEG data were acquired from sixteen participants performing two-class (left upper limb flexion-extension vs. relaxing) and three-class (left upper limb flexion vs. right upper limb extension vs. relaxing) MI tasks. The acquired EEG data were then decomposed into nine distinct sub-bands, followed by the adoption of a mutual information-based feature selection strategy to optimize the feature sets. These optimized feature sets were subsequently input into three classification models, namely multilayer perceptron (MLP), support vector machine (SVM), and linear discriminant analysis (LDA), for MI task classification. Results: Experimental results demonstrate that the DFBCSP + MLP method significantly outperforms the traditional CSP approach. Specifically, it achieves an accuracy of 94.83% (Kappa coefficient: 0.890) in two-class MI tasks and 86.20% (Kappa coefficient: 0.775) in three-class MI tasks. Conclusion: The DFBCSP + MLP framework exhibits high robustness and provides a potential technical framework and theoretical basis for future research on the rehabilitation of patients with upper limb motor dysfunction. Full article

Stroke frequently results in persistent upper limb impairments, which are often accompanied by compensatory movement strategies that are not fully captured by conventional clinical assessment scales. Quantitative kinematic analyses may provide more objective and sensitive measures of motor dysfunction. In this study, we propose a probabilistic, distribution-based analysis of upper limb kinematics to quantify motor disability in post-stroke patients. We analyzed reaching movement data acquired with a markerless Kinect V2 system from 36 post-stroke patients and age-matched healthy controls. Wrist velocity profiles were characterized using distribution metrics, including variance, skewness, kurtosis, and entropy, and divergence measures (Hellinger distance, Kullback–Leibler divergence, and Jensen–Shannon divergence). Group differences between patients and controls, as well as across impairment levels stratified by the Fugl-Meyer (FM) score, were evaluated. Several distribution metrics significantly discriminated patients from controls and scaled with motor impairment severity. In particular, divergence-based measures showed a strong association with FM scores, indicating increasing deviation from normative movement patterns with greater impairment. These findings demonstrate that distribution-based metrics focusing on kinematic analysis provide a clinically meaningful, objective descriptor of motor dysfunction and complement conventional biomechanical assessments, offering a sensitive framework for quantifying motor disability after stroke. Full article

Objective: This study investigated the efficacy and neural mechanisms of robot-assisted mirror therapy (RMT) for post-stroke upper limb rehabilitation. RMT integrates the multimodal feedback of mirror therapy with robotic precision and repetition to enhance cortical activation and neuroplasticity. Methods: Seventy-eight stroke patients were randomly assigned to control, mirror therapy (MT), or RMT groups. All received conventional rehabilitation; the MT group additionally underwent mirror therapy, and the RMT group received robot-assisted mirror therapy combined with functional electrical stimulation. The primary outcome was the Fugl–Meyer Assessment for Upper Extremity (FMA-UE), with secondary measures including spasticity, dexterity, daily living, and quality of life. Functional near-infrared spectroscopy (fNIRS) was applied to assess cortical activation and connectivity at baseline, post-intervention, and one-month follow-up. Results: All groups showed significant time effects, though between-group differences were limited. Subgroup analysis revealed that patients at Brunnstrom stages I–II in the MT group achieved greater improvements in upper limb function, dexterity, and daily living ability. fNIRS findings showed enhanced activation in the right sensory association cortex and increased prefrontal–sensory connectivity. Conclusions: While all interventions improved motor outcomes, MT yielded slightly superior recovery associated with neuroplastic changes. RMT demonstrated high safety, compliance, and potential benefit for patients with severe motor deficits. Full article

Stroke often leads to persistent upper limb dysfunction that impairs activities of daily living, yet objective biomechanical indicators for precise assessment remain limited. This study aimed to characterize phase-specific impairments in energy output, torque stability, and muscle coordination during the hand-to-mouth (HTM) task and to explore their potential for improving rehabilitation evaluation. Motion data from 20 stroke patients and 20 healthy controls were recorded using wearable surface electromyography and inertial measurement unit systems. A musculoskeletal model was applied to calculate joint torque, mechanical work, torque smoothness, and a novel torque-based co-contraction index across four movement subphases. These phase-specific metrics demonstrated significant correlations with clinical motor impairment scores, confirming their clinical validity. Significant dynamic features were then selected to construct machine learning models for group classification. Stroke patients showed reduced output capacity, increased torque fluctuations, and abnormal co-contraction patterns that varied across subphases. Among the classifiers, the quadratic support vector machine achieved the best performance, with an accuracy of 84.6% and an AUC of 0.853, surpassing models based on whole-task features. These findings demonstrate that phase-specific biomechanical features sensitively capture neuromuscular deficits in stroke survivors and highlight the potential of phase-specific biomechanics to inform future individualized rehabilitation assessment and treatment planning. Full article

Background: Hemiplegic cerebral palsy (HCP) is a motor dysfunction disorder resulting from perinatal developmental brain injury, predominantly impairing upper limb function in children. Nonetheless, there has been insufficient research on the brain activation patterns and inter-brain coordination mechanisms of HCP children when performing motor control tasks, especially in contrast to children with typical development(CD). Objective: This cross-sectional study employed functional near-infrared spectroscopy (fNIRS) to systematically compare the cerebral blood flow dynamics and brain network characteristics of HCP children and CD children while performing upper-limb mirror training tasks. Methods: The study ultimately included 14 HCP children and 28 CD children. fNIRS technology was utilized to record changes in oxygenated hemoglobin (HbO) signals in the bilateral prefrontal cortex (LPFC/RPFC) and motor cortex (LMC/RMC) of the subjects while they performed mirror training tasks. Generalized linear model (GLM) analysis was used to compare differences in activation intensity between HCP children and CD children in the prefrontal cortex and motor cortex. Finally, conditional Granger causality (GC) analysis was applied to construct a directed brain network model, enabling directional analysis of causal interactions between different brain regions. Results: Brain activation: HCP children showed weaker LPFC activation than CD children in the NMR task (t = −2.032, p = 0.049); enhanced LMC activation in the NML task (t = 2.202, p = 0.033); and reduced RMC activation in the MR task (t = −2.234, p = 0.031). Intragroup comparisons revealed significant differences in LMC activation between the NMR and NML tasks (M = −1.128 ± 2.764, t = −1.527, p = 0.025) and increased separation in RMC activation between the MR and ML tasks (M = −1.674 ± 2.584, t = −2.425, p = 0.031). Cortical effective connectivity: HCP group RPFC → RMC connectivity was weaker than that in CD children in the NMR/NML tasks (NMR: t = −2.491, p = 0.018; NML: t = −2.386, p = 0.023); RMC → LMC connectivity was weakened in the NMR task (t = −2.395, p = 0.022). Conclusions: This study reveals that children with HCP exhibit distinct abnormal characteristics in both cortical activation patterns and effective brain network connectivity during upper limb mirror training tasks, compared to children with CD. These characteristic alterations may reflect the neural mechanisms underlying motor control deficits in HCP children, involving deficits in prefrontal regulatory function and compensatory reorganization of the motor cortex. The identified fNIRS indicators provide new insights into understanding brain dysfunction in HCP and may offer objective evidence for research into personalized, precision-based neurorehabilitation intervention strategies. Full article

With the continuous increase in the global aging population, stroke has become one of the major diseases affecting the health of the elderly, and the upper limb motor dysfunction it causes often requires long-term rehabilitation. To improve rehabilitation outcomes for hemiplegic patients and alleviate the shortage of rehabilitation physicians, upper limb rehabilitation robots have shown great potential in enhancing motor function and improving stroke patients’ rehabilitation outcomes in clinical research. This paper first classifies rehabilitation robots based on their driving mechanisms and interaction modes, describing the application of their structural features in various scenarios. It then analyzes the optimization methods used in the trajectory planning process of rehabilitation robots at different stages. Finally, based on existing shortcomings, the paper summarizes the future development directions of upper limb rehabilitation robots, providing prospects for the development of upper limb rehabilitation robots in the areas of artificial intelligence and compliant control, multi-sensory feedback and interactive training, ergonomics and new driving technologies, modular and customizable designs, and multi-modal brain stimulation techniques. Full article

The application of exoskeleton robots has demonstrated promising effectiveness in promoting the recovery of motor skills in patients with upper limb dysfunction. However, the joint misalignment caused by rigid exoskeletons usually leads to an uncomfortable experience for users. In this work, an adaptive cable-driven elbow exoskeleton inspired by the structural characteristics of the shrimp shell was developed to facilitate the rehabilitation of the elbow joint and to provide more compliant human-exoskeleton interactions. The exoskeleton was specifically designed for elbow flexion and extension, with a total weight of approximately 0.6 kg. Based on the mechanical design and cable configuration of the exoskeleton, the kinematics and dynamics of driving cables were analyzed. Subsequently, a PID-based control strategy was designed with cable kinematics. To evaluate the practical performance of the proposed exoskeleton in elbow assistance, a prototype was established and experimented with six subjects. According to the experimental results, the measured elbow joint angle trajectory is generally consistent with the desired trajectory, with a mean position tracking accuracy of approximately 0.997, which supports motion stability in rehabilitation scenarios. Meanwhile, the collected sEMG values from biceps brachii and brachioradialis under the exoskeleton condition show a significant reduction in average muscle activation by 37.7% and 28.8%, respectively, compared to the condition without exoskeleton. Full article

Background/Objectives: Huntington’s disease (HD) is a neurodegenerative movement disorder associated with significant disability and impairment of Activities of Daily Living (ADLs). The impact of upper limb disability on quality of life (QoL) and its influence on ADLs is not well known yet. The aim of this study was to describe the manipulative dexterity, strength, and manual eye coordination of patients with manifest and premanifest-HD compared to healthy individuals and to analyze its influence on ADLs and QoL. Methods: We performed an observational, cross-sectional study including 71 ambulatory participants (27 manifest-HD patients, 15 premanifest-HD, and 29 controls). We gathered sociodemographic data, as well as clinical data, including cognition (MMSE), HD motor severity (Unified HD rating scale, UHDRS-TMS), QoL (Neuro-QoL), and ADLs (HD-ADL). Hand dexterity and strength in the dominant and non-dominant hand were assessed with the Nine Hole Peg Test, Ten Neurotest, Nut and Bolt Test, dynamometry, and Late-Life FDI. Analysis of covariance (ANCOVA) models were performed to investigate differences in hand function between manifest-HD, premanifest-HD, and controls. Results: Manifest-HD patients had significantly worse performance in manual and finger dexterity, fine-motor coordination, and poorer handgrip strength than premanifest-HD and controls. Premanifest-HD required more time to complete the test than controls. Significant correlations were found between hand variables and Late-Life FDI, Neuro-QoL, HD-ADL, and UHDRS-TMS. Conclusions: HD affects manipulative dexterity and hand function in premanifest and manifest patients. Therefore, to prevent disability and decreased QoL, evaluating the progression of upper limb dysfunction in HD is important to offer the best possible therapeutic interventions. Full article

In recent years, extended reality (XR) and telerehabilitation (TR) technologies have increasingly been used in the neurorehabilitation of motor dysfunctions in patients with cerebral palsy (CP). The Khymeia Virtual Reality Rehabilitation System (K-VRRS) is a medical device specifically designed for neuromotor rehabilitation, and it can also be used in TR mode. This pilot study aims to evaluate the effectiveness and adherence to a “two-step neuromotor program” (TS-NP) approach using K-VRRS to enhance upper limb motor functions in children with CP. The TS-NP protocol consists of two phases. In the first phase, patients undergo intensive motor training with K-VRRS during a period of hospitalization. In the second phase, initiated after discharge, patients continue K-VRRS treatment at home through TR, building upon the progress made during their hospital stay. A total of seven children with unilateral spastic CP (ages 4–10 years) were assessed at three time points: baseline (T0), after the first phase of in-person hospital treatment (T1), and following the second phase of TR treatment at home (T2). Standardized outcome measures were used, with the primary measure being the Melbourne Assessment 2. Preliminary data support the hypothesis that intensive K-VRRS treatment during hospitalization enhances motor function in the affected upper limb of children with CP. Furthermore, continuing K-VRRS treatment at home through TR appears crucial for maintaining the motor gains achieved during the hospital phase. Full article