Search Results (116)

Background: Deprivation of sleep (DS) might affect mood and cognitive abilities, including psychomotor functions (PF). Molecular mechanisms underlying these effects remain unclear, though studies suggest that the circadian rhythm plays a role. Methods: Seventy participants underwent polysomnography (PSG) and DS. PF was evaluated using Bimanual Eye–Hand Coordination Test (BEHCT). Mood, PF, and clock gene expression (Circadian Locomotor Output Cycles Kaput (CLOCK), Brain and Muscle ARNT-Like 1 (BMAL1), Period Circadian Regulator 1 (PER1), Cryptochrome Circadian Regulator 1 (CRY1), Nuclear Receptor Subfamily 1 Group D Member 1 (NR1D1), and Neuronal PAS Domain Protein 2 (NPAS2)) were analyzed post-PSG and post-DS. Mood changes after DS classified participants as responders (RE) or non-responders (NR). Results: In NRs, but not REs, the BEHCT error count positively correlated with the expression of BMAL1, CRY1, PER1, NR1D1 (R = 0.60, p = 0.002; R = 0.49, p = 0.018; R = 0.57, p = 0.023; and R = 0.53, p = 0.011, respectively), with PER1 explaining its variability in 57.8% (b = 0.174, R² = 0.578, F = 20.144, and p < 0.001). Conclusions: Obtained results suggest that altered clock gene expression may contribute to individual differences in mood and PF following DS. Full article

This work proposes a general methodology for the design and experimental validation of dual-arm robotic platforms intended for intelligent manipulation tasks in real-world environments. The proposed framework formalizes the complete engineering process, from the definition of functional requirements to the structural validation of the final prototype, ensuring reproducibility and adaptability across different applications. The methodology is organized into five main stages: (i) requirement analysis and context characterization; (ii) conceptual architecture definition; (iii) detailed mechanical design and structural analysis; (iv) prototype construction and integration; and (v) experimental validation and iterative refinement. Each stage defines its expected deliverables, evaluation metrics, and decision criteria to support systematic design progression. The approach is demonstrated through its implementation within the European project MANiBOT, where the framework guided the development of a modular bimanual robotic platform capable of integrating collaborative manipulators and conveyor subsystems for dual-arm manipulation. Structural testing, deflection measurements, and stability analyses confirmed the robustness and safety of the resulting design. Beyond this specific case, the proposed methodology provides a replicable and extensible design reference for research and industrial teams developing modular robotic structures, supporting the standardization of engineering practices in bimanual mobile robotics. Full article

Background: Simulation-based laparoscopic training increasingly relies on portable, low-cost platforms that support home-based practice, but detailed descriptions of reproducible, do-it-yourself (DIY) trainers and their educational potential remain limited. Methods: We updated a low-budget laparoscopic simulator constructed from an inexpensive plastic container, wood components, a low-cost webcam, and plywood task pads modeled on Fundamentals of Laparoscopic Surgery (FLS) exercises. We then conducted informal qualitative usability testing in which 10 residents and 5 fellows from general surgery, gynecology, and urology used the simulator at home for one week and completed an eight-item feedback form plus free-text comments on assembly, ergonomics, realism, and educational value. Results: All participants successfully assembled and used the simulator; most described set-up as easy or intuitive, reported adequate image quality and lighting, and considered the platform useful for practicing depth perception, bimanual coordination, and cutting and suturing tasks. Feedback emphasized low cost, portability, and cross-specialty applicability, with only minor suggestions such as adjustable camera height or increased base weight. Conclusions: This DIY laparoscopic simulator could be assembled and used in a home-based setting, and trainees reported favorable usability and perceived educational value. More structured validation studies addressing face, content, and construct validity are needed to define its potential role within contemporary surgical curricula. Full article

Background/Objectives: Laparoscopic surgery has become the pre-eminent surgical approach for performing general surgical and gynecological operations, but it can lead to musculoskeletal disorder in surgeons. This study aimed to investigate the musculoskeletal demands of completing four core laparoscopic skills tasks amongst Obstetrics and Gynecology (O&G) and General Surgery (GS) trainees, recognizing that differences between specialties may create different ergonomic and muscular demands. Methods: Ten O&G and ten GS trainees both performed the same four tasks to evaluate their core laparoscopic skills whilst using electromyography (EMG) to assess the physical demand of each task in the trainee groups as a percent of maximum voluntary contraction. Results: O&G trainees had significantly higher muscle activity when completing a hand–eye coordination (HEC) task (167.9 ± 63.8 vs. 92.5 ± 31.3%, p = 0.019), bimanual coordination (BMC) task (205.6 ± 80.7 vs. 106.9 ± 47.0%, p = 0.017), and suturing (267.7 ± 121.6 vs. 122.2 ± 33.0%, p = 0.016) task in the right trapezius and deltoid muscle groups compared to GS trainees. No difference was observed between trainee groups in the laparoscopic camera navigation (LCN) task (p = 0.438). Conclusions: There appears to be increased muscular activity in O&G compared to GS trainees during the same simulated laparoscopic tasks. The findings should inform training policy around the optimization of ergonomics to minimize the risk of musculoskeletal disorder. Full article

Background/Objectives: We studied the feasibility of incorporating a play-based bimanual ride-on-toy navigation training (RNT) program into an intensive hybrid training camp based on principles of modified constraint induced movement therapy and bimanual training for children with unilateral cerebral palsy (UCP). The bimanual RNT sessions included theme-based play involving navigational exploration and object-based tasks. Methods: We employed a pretest-posttest, mixed methods design. Ten children between 3 and 11 years participated. Camp was 6 h/day and 5 days/week for 3 weeks. Researchers trained camp staff to provide RNT every day. The feasibility of clinician delivery of RNT was assessed using training logs and staff exit questionnaires. The combined effects of the camp programming, inclusive of bimanual RNT, was measured through a combination of standardized tests (Quality of Upper Extremity Skills Test (QUEST), Shriner’s Hospital Upper Extremity Evaluation (SHUEE), and Box and Blocks Test) and video-coding measures. We report on means (M), standard errors (SE), and effect sizes (ES) with 95% confidence intervals for outcome measures. Results: The average session adherence was 90.7%, and staff were able to successfully deliver RNT, despite initial logistical challenges. In combination with camp programming, RNT led to improvements in the total QUEST score (pretest M (SE): 77.54 (5.11), posttest M (SE): 81.46 (5.22)) and SHUEE spontaneous functional analysis score (pretest M (SE): 41.33 (7.48), posttest M (SE): 50.22 (7.88)). Children increased the use of their affected upper extremity (UE) during late RNT sessions and improved in their navigational abilities. Conclusions: RNT is a fun and easily adaptable therapy adjunct that can complement traditional therapies to incentivize spontaneous use of the affected UE in children with UCP. Full article

Cataracts are one of the leading causes of vision loss in dogs, significantly impairing their quality of life and visual behavior. Phacoemulsification, followed by intraocular lens (IOL) implantation, is currently the gold standard for visual rehabilitation. This non-randomized clinical study included 60 dogs (120 eyes)of various breeds, ages, and sizes, diagnosed with cataracts of different etiologies and degrees of evolution (incipient, mature, hypermature, and intumescent). Postoperative visual function was assessed using conventional neuro-ophthalmologic tests (menace response, cotton ball test, maze navigation) and a custom-designed visual scoring scale developed by the authors to objectively quantify functional recovery. The bimanual technique (Phaco 2) showed slightly shorter surgical times than the monomanual approach (Phaco 1), with significant differences during the capsulorhexis (T1) and IOL implantation (T4) phases (p < 0.05). Postoperative inflammation was mild and transient, with no IOL decentration or posterior capsule opacification observed over 60 days. Visual function improved progressively, with 79.2% (95/120 eyes) reaching functional vision by two months and mean recovery exceeding 90%of normal by day 30. Both techniques provided favorable short-term outcomes for canine cataract extraction, with outcomes mainly influenced by cataract type and lens consistency. The proposed visual scoring system represents a preliminary clinical tool that may support standardized evaluation of postoperative vision in dogs. The results highlight the importance of ongoing refinement in surgical training and the standardization of phacoemulsification protocols to improve reproducibility and long-term outcomes in veterinary ophthalmology. Full article

Reaction time and hand–eye coordination are critical neuromotor skills in school-aged children, influencing academic, cognitive, and motor development. The objective of this study was to evaluate schoolchildren’s performance on reaction time tests using Neural Trainer device sensors and wearable technology, establishing baseline metrics and identifying lateral performance asymmetries. Fifty-nine schoolchildren performed six sensor-based motor tests involving bimanual and unimanual interaction: P1 (10 timed repetitions, bimanual), P2 (10 timed repetitions, left hand), P3 (10 timed repetitions, right hand), P4 (hits, bimanual), P5 (hits, left hand), and P6 (hits, right hand). Neural Trainer devices with four light nodes were used for activity monitoring. Data was analyzed using statistical methods to assess time, accuracy, and variability. The results showed that the average times were P1 = 8.69 ± 1.44 s, P2 = 8.90 ± 1.30 s, and P3 = 8.83 ± 1.29 s. The average successes were P4 = 22.90 ± 3.10, P5 = 22.00 ± 3.40, and P6 = 24.42 ± 2.72 hits. Significant differences were found between hands in successes (p < 0.001) but not in times (p = 0.716). The ANOVA for the hit trials revealed significant differences between conditions, F(2, 174) = 9.30, p < 0.001. The conclusions indicate that sensor-based systems such as the Neural Trainer device demonstrated the potential to provide objective and consistent measurements of reaction time in schoolchildren; however, further studies comparing its performance with established clinical assessment tools are necessary to confirm its validity and diagnostic accuracy. Full article

Dexterous bimanual manipulation remains a challenging task in reinforcement learning (RL) due to the vast state–action space and the complex interdependence between the hands. Conventional end-to-end learning struggles to handle this complexity, and multi-agent RL often faces limitations in stably acquiring cooperative movements. To address these issues, this study proposes a hierarchical progressive policy learning framework for dexterous bimanual manipulation. In the proposed method, one hand’s policy is first trained to stably grasp the object, and, while maintaining this grasp, the other hand’s manipulation policy is progressively learned. This hierarchical decomposition reduces the search space for each policy and enhances both the connectivity and the stability of learning by training the subsequent policy on the stable states generated by the preceding policy. Simulation results show that the proposed framework outperforms conventional end-to-end and multi-agent RL approaches. The proposed method was demonstrated via sim-to-real transfer on a physical dual-arm platform and empirically validated on a bimanual cube manipulation task. Full article

(1) Background: Hand and Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) is a high-dose evidence-based neurorehabilitation. This study aims to develop and validate a protocol using three inertial measurement units (IMUs) to objectively document upper and lower extremities’ (UE; LE) motor activity during a HABIT-ILE intervention in chronic stroke adults. (2) Method: Thirteen adults (57.1 y ± 11.3) who completed 65 h of HABIT-ILE (2 weeks, 6.5 h/d) were included. Daily motor activity was recorded with IMUs placed on both wrists and one thigh with nine IMU-derived variables extracted to evaluate motor activity and posture. Each variable was correlated with baseline abilities and day-to-day patterns were observed with subgroup analyses based on baseline dexterity and walking endurance. Day-to-day patterns were highlighted based on mean values and effect size analyses. (3) Results: Only the Magnitude and Use ratios showed high correlations with baseline abilities, with a day-to-day specific pattern highlighted for participants with moderate to good dexterity at baseline. (4) Conclusions: All participants reported a high level of engagement during HABIT-ILE independently of their baseline abilities. Although we could not detect a global trend to document the content of a HABIT-ILE intervention, these exploratory results suggest IMU monitoring to be relevant to characterize therapeutic content. Full article

Background: Children with diplegic Cerebral Palsy often exhibit upper-limb (UL) motor impairments compounded by deficits in visuospatial, sensory, and executive functions. Despite this, research has primarily focused on lower-limb rehabilitation, leaving the treatment of UL function in diplegic Cerebral Palsy underexplored. Action Observation Therapy (AOT), based on Mirror Neuron System activation, has shown promise in promoting motor recovery, but evidence specific to this population is limited. This exploratory randomized controlled trial (RCT) aims to assess the feasibility and effectiveness of a home-based AOT program—ACT ON DIP—for improving upper-limb function in children and adolescents with diplegic Cerebral Palsy. Methods: Fifty-four participants with spastic diplegic Cerebral Palsy (MACS and GMFCS levels I–III, aged 5–16 years) will be randomly assigned to an experimental group (receiving an 8-week home-based AOT program) or a control group (receiving standard care). The ACT ON DIP system includes an ad hoc software, kits of objects for daily tasks, and wearable sensors. The system allows for delivering structured uni- and bimanual AOT activities tailored to the child’s profile. Primary outcome is the Both Hands Assessment (BoHA); secondary outcomes include motor (MA-2, BBT, ABILHAND), neuropsychological (NEPSY-II, Corsi Test, BRIEF), and participation measures (COPM, PEM-CY, CP-QOL). A subgroup will undergo fMRI to explore neural correlates of training-related changes. Results: Feasibility, compliance, and user experience with the home-based system will be assessed. This study will evaluate short-, medium-, and long-term changes in UL performance and related neuropsychological functions. Conclusions: ACT ON DIP represents a novel, personalized, and accessible tele-rehabilitation intervention for children with diplegic Cerebral Palsy. If effective, it could expand treatment opportunities for UL rehabilitation in this population and support broader implementation of home-based AOT. Full article

Purpose: This study investigates the test–retest reliability of maximal voluntary contraction (MVC) and integrated object positioning during bimanual box lifting tasks in children with unilateral spastic cerebral palsy (USCP), using the Activities of Daily Living Test and Training Device (ADL-TTD). Materials and Methods: Utilizing an explorative cross-sectional design, the study recruited 47 children with USCP. The ADL-TTD, equipped with an Inertial Measurement Unit (IMU) for precise object positioning, measured MVC, and object position in 3D space in a cross-sectional measurement containing two measurements in a fixed time period. Results: The findings demonstrated good test–retest reliability for MVC, with an ICC_agreement of 0.95 for the mean MVC value. Additionally, good reliability was observed for object positioning in different directions measured with an IMU, with ICC_agreement ranging from 0.82 to 0.86 degrees. Regarding the standard error of measurement (SEM), the SEM_agreement for the mean MVC value was 5.94 kg, while the SEM_agreement for object positioning was 1.48, 5.39, and 3.43 degrees, respectively. Conclusions: These results indicate that the ADL-TTD demonstrates good test–retest reliability for both MVC and object positioning, making it a valuable tool for analyzing this population in cross-sectional research by providing reliable measures of task-oriented strength and object manipulation. However, the relatively high SEM_agreement, particularly in MVC, suggests that caution is needed when using this tool for repeated testing over time. This pioneering approach could significantly contribute to tailored assessment and training for children with USCP, highlighting the importance of integrating task-specific strength and positional accuracy into therapeutic interventions. Full article

This research addresses the enhancement of operational efficiency in apple-picking robots through the design of a bimanual spatial configuration enabling obstacle avoidance in contemporary orchard environments. A parallel coordinated harvesting paradigm for dual-arm systems was introduced, leading to the construction and validation of a six-degree-of-freedom bimanual apple-harvesting robot. Leveraging the kinematic architecture of the AUBO-i5 manipulator, three spatial layout configurations for dual-arm systems were evaluated, culminating in the adoption of a “workspace-overlapping Type B” arrangement. A functional prototype of the bimanual apple-harvesting system was subsequently fabricated. The study further involved developing control architectures for two end-effector types: a compliant gripper and a vacuum-based suction mechanism, with corresponding operational protocols established. A networked communication framework for parallel arm coordination was implemented via Ethernet switching technology, enabling both independent and synchronized bimanual operation. Additionally, an intersystem communication protocol was formulated to integrate the robotic vision system with the dual-arm control architecture, establishing a modular parallel execution model between visual perception and motion control modules. A coordinated bimanual harvesting strategy was formulated, incorporating real-time trajectory and pose monitoring of the manipulators. Kinematic simulations were executed to validate the feasibility of this strategy. Field evaluations in modern Red Fuji apple orchards assessed multidimensional harvesting performance, revealing 85.6% and 80% success rates for the suction and gripper-based arms, respectively. Single-fruit retrieval averaged 7.5 s per arm, yielding an overall system efficiency of 3.75 s per fruit. These findings advance the technological foundation for intelligent apple-harvesting systems, offering methodologies for the evolution of precision agronomic automation. Full article

Cerebral palsy generates an elevated burden on both patients and health-care systems. Cost-effective therapies such as action observation therapy (AOT), have been proposed to enhance motor performance in these patients. Objective: This systematic review with meta-analysis aimed to evaluate the effectiveness of AOT in children and adolescents with CP and describe its prescription parameters. Results: Fourteen studies involving a total of 393 patients with CP were included. Most studies presented some concerns on risk of bias. Meta-analyses compared AOT to placebo (no motor content) observation and found inconclusive results for the following: unilateral upper limb function (g = 0.565; 95% CI −0.174, 1.305), assisting hand function during bimanual activities (g = 0.200; 95% CI −0.742, 1.143), manual function daily activities (g = −0.022; 95% CI −3.134, 3.090), and hand grip strength (MD (kg) = 1.175; 95% CI −0.280, 2.630). Meta-analysis comparing AOT and physical therapy also yielded inconclusive findings for standing (g = 0.363; 95% CI −5.172, 5.898), as well as the combined dimension of walking, standing, and jumping (g = 0.798; 95% CI −8.821, 10.417) within gross motor function. Conclusions: Current evidence is imprecise and does not support definitive conclusions regarding the effectiveness of AOT over placebo observation, or over physical therapy, on functional outcomes including upper limb, hand, and lower limb functioning parameters. Current findings prevent recommending AOT for its employment in clinical practice. Further evidence is required to draw precise conclusions. 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

Aim: This study explores the effects of core stabilization exercises on balance and upper extremity functions—both unilateral and bilateral—in children with cerebral palsy (CP). Method: Thirty-six children with CP (aged 5–12) were randomly assigned to a study group (n = 18) or control group (n = 18). Both groups received four weeks of physiotherapy and occupational therapy. The study group additionally performed ~45 min of daily core stabilization exercises. Outcome measures included the Box and Block Test (BBT), Assisting Hand Assessment (AHA), Pediatric Berg Balance Scale (PBBS), and Trunk Control Measurement Scale (TCMS). (ClinicalTrials.gov ID: NCT06973213). Results: No significant baseline differences were found between the groups (p > 0.05). Post-intervention, the study group showed significant improvements in PBBS (p = 0.011), TCMS static sitting (p = 0.003), dynamic reaching (p = 0.037), and total score (p = 0.044). Between-group differences remained non-significant for BBT, AHA, and TCMS selective movement control (p > 0.05). Within-group analysis revealed significant gains in BBT (median = 7), PBBS (median = 8), TCMS total (median = 12), static sitting (median = 3.5), and selective movement (median = 6) (all p < 0.001). AHA showed a near-significant trend (median = 6, p = 0.051). Conclusions: Core stabilization exercises significantly enhance balance and unilateral upper extremity function in children with CP. However, they show limited impact on bimanual function. Integration of these exercises into rehabilitation programs may optimize motor outcomes. Full article