Search Results (107)

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

Ensuring mathematics education for all learners, including students with blindness learning in mainstream classrooms, is crucial. This exploratory research aims to clarify the characteristics of geometric learning among students with blindness and to identify the factors contributing to the challenges faced by this population. The Van Hiele theory of geometric thought served as a reference framework. Qualitative data were gathered through group interviews with specialists in the field of education for students with blindness and analyzed using inductive analysis. Participants affirmed that students with blindness progress through Van Hiele levels of geometric thought in a manner similar to sighted students, suggesting that much of the learning can take place alongside sighted peers in mainstream classrooms. However, they also highlighted the unique challenges these students face in reaching level 0, a level where students recognize shapes without a formal understanding of their properties or attributes. Among the reasons for these challenges were that for these particular students, subskills, such as bimanual exploration, hand coordination, and cognitive integration, are required to reach level 0. The study also identified the necessity for specialists in visual impairment education to guide students using appropriate tasks and learning materials that reflect the characteristics of haptic perception. Since level 0 serves as a gateway to both basic and advanced geometry, the findings underscore the importance of providing differentiated support that targets these subskills early in students’ schooling. To ensure meaningful geometry instruction, mainstream teachers are encouraged to collaborate with specialists in visual impairment education, who can guide the selection of appropriate learning tools and support the development of the subskills. Full article

Background/Objectives: To compare the surgical outcomes of 25-gauge (G) vitrectomy to those of 27G vitrectomy for proliferative diabetic retinopathy (PDR) with a tractional retinal detachment (TRD). Methods: Eighty-three consecutive eyes of 71 patients with PDR and TRD that underwent initial vitrectomy at the Kyorin Eye Center from June 2021 to August 2023 and were followed for ≥3 months were studied retrospectively. The surgical outcomes of the 10,000 cut/min (cpm) 25G vitrectomy (25G group, 25 eyes) to that of the 20,000 cpm 27G vitrectomy (27G group, 58 eyes) were compared. Results: The preoperative PDR status, surgical procedures, and postoperative outcomes were assessed relative to the surgical success. The 25G group had significantly more eyes with severe PDR (p = 0.010), no prior laser photocoagulation (p = 0.027), macular detachment (p = 0.006), and the use of bimanual technique (p = 0.005). However, the operative times and incidence of iatrogenic breaks were not significantly different. The visual acuity improved significantly in both groups at 3 months postoperatively. The primary anatomical success was 88% in the 25G and 97% in the 27G groups (p > 0.05). The risk factors for a postoperative retinal detachment were significantly associated with the grade (p = 0.042) and type of PDR (p = 0.041), the use of perfluorocarbon liquid (p = 0.028), and bimanual techniques (p = 0.017). Conclusions: The high anatomical success for both groups for TRD secondary to PDR indicates that both can be used to treat eyes with PDR. The 27G vitrectomy may reduce the need for bimanual techniques. Full article

Background/Objectives: The steady increase in the global older adult population highlights critical challenges, including the development of preventive strategies to extend healthy life expectancy and support independence in activities of daily living. Although there is an aging-related reduction in manual dexterity, the difference in bimanual coordination performance between young and older adults remains unclear. We aimed to elucidate the characteristics of bimanual coordination among young, young-old, and old-old adult participants. Methods: The participants performed in-phase (tapping the thumb and index finger together as fast as possible) and anti-phase (alternating movement between the left and right fingers) bimanual coordination tasks, and intergroup comparison of the task parameters was performed. The receiver operating characteristic curve was also conducted to calculate age cut-off points for bimanual coordination. Results: The number and frequency of taps significantly decreased sequentially in young, young-old, and old-old adults, whereas the average of tap interval significantly increased in this order (p < 0.05). There was no significant difference between the young-old and old-old groups in the average local maximum distance (p > 0.05). These findings indicate that bimanual coordination task performance varies depending on specific parameters. Furthermore, the age cut-off points for bimanual coordination were determined as 68.5 years for the right-hand number of taps (AUC = 0.73) in the anti-phase task, 73.5 years for the right-hand average of tapping interval (AUC = 0.72) in the anti-phase task, and 65.5 years for the left-hand frequency of taps (AUC = 0.72) of the anti-phase task. Conclusions: the number of taps, average of tapping interval, and frequency of taps are potential indicators of aging-related changes in bimanual coordination. Full article

Endometriosis, a prevalent gynecological condition affecting 10–15% of reproductive-age women, involves the growth of endometrial-like tissue outside the uterine cavity. This chronic inflammatory disease can significantly impact fertility by disrupting ovulation, tubal transport, and implantation. Clinical manifestations vary widely, ranging from asymptomatic cases to severe pelvic pain, dysmenorrhea, and dyspareunia. Accurate diagnosis remains challenging, often requiring a combination of patient history, clinical examination, and imaging studies. This paper will discuss the clinical approach to endometriosis during a first-line gynecological appointment, focusing on patient history, including detailed assessment of menstrual, pelvic, and bowel symptoms, and clinical examination; thorough gynecological examination, including abdominal and pelvic palpation, speculum examination, and bimanual examination; imaging evaluation (particularly of the role of ultrasound in identifying and characterizing endometriotic lesions, including the use of the #ENZIAN classification for deep infiltrating endometriosis and evaluation of fertility impact); and discussion of the Endometriosis Fertility Index (EFI) as a tool for assessing fertility potential. This comprehensive approach aims to guide clinicians in identifying and managing endometriosis effectively, improving patient outcomes and optimizing fertility management strategies. Methods: A literature search for suitable articles published from January 1974 to 2024 in the English language was performed using PubMed. Results: Endometriosis is associated with infertility rates ranging from 20% to 68%, with mechanisms including pelvic adhesions, chronic inflammation, and immune dysregulation. The revised American Society for Reproductive Medicine (rASRM) classification and #ENZIAN classification were identified as essential tools for staging and characterizing the disease. Transvaginal ultrasound (TVS) demonstrated high diagnostic accuracy for deep infiltrating endometriosis, with a sensitivity of up to 96% and specificity of 99%. EFI emerged as a valuable predictor of natural conception post-surgery. Additionally, the review underscores the frequent co-occurrence of adenomyosis in women with endometriosis, which may further compromise fertility. Despite advancements in imaging techniques and classification systems, the variability in symptom presentation and disease progression continues to challenge early diagnosis and effective management. Conclusions: Endometriosis is a prevalent gynecological condition affecting women of reproductive age and is associated with infertility. This paper describes the diagnostic approach to endometriosis during a first-line gynecological appointment, focusing on clinical history, physical examination, and the role of imaging, particularly ultrasound, in identifying and characterizing endometriosis lesions. The adoption of standardized classification systems such as #ENZIAN and EFI enhances disease staging and fertility prognosis, allowing for tailored treatment strategies. Despite improvements in non-invasive diagnostic methods, challenges persist in correlating symptom severity with disease extent, necessitating continued research into biomarkers and novel imaging techniques. Additionally, the frequent coexistence of adenomyosis further complicates fertility outcomes, underscoring the need for comprehensive management strategies. Further research is needed to enhance early detection strategies and optimize fertility preservation techniques for affected women. Full article

Children with neurodevelopmental disabilities often struggle with motor control and stability, impacting their ability to perform functional tasks such as lifting and carrying objects. This study explores positional performance during bimanual box-lifting tasks in children aged 9–18 years with neurodevelopmental disabilities. A total of 83 participants, including 62 with unilateral spastic cerebral palsy and 21 with non-unilateral spastic cerebral palsy, performed tasks using the Activity of Daily Living Testing and Training Device. Tasks were conducted at maximal (80–100% force) and submaximal (40–80% force) levels of force control, with positional performance measured in six directions using Inertial Measurement Unit sensors. Statistical analyses included the Wilcoxon signed-rank test for levels of force control comparisons, Kruskal–Wallis tests for group differences, and Spearman correlations to assess relationships between maximal and submaximal performance. The results revealed that four of six positional parameters were worse in the maximal zone than in the submaximal zone ($p<0.05$), highlighting the challenges of higher force demands. Additionally, positive correlations between maximal and submaximal performance suggest consistency across levels of force control. Maximal levels of force control increased variability, with submaximal performance proven to be a reliable predictor of maximal capabilities. This finding offers a safer and more efficient method for assessing motor performance. Overall, these results underscore the importance of targeted rehabilitation strategies focused on improving stability and precision in children with neurodevelopmental disabilities so they can perform daily tasks more independently. Full article

Grasping others’ intentions from their actions is essential for learning, as it enhances the ability to identify collaborative acts and anticipate others’ actions, facilitating effective coordination toward shared goals. From a young age, children seem to recognize when others are working together based on their interactions and use this understanding to inform their own learning. Although much of early learning occurs in joint contexts, little attention has been devoted to understanding how children learn by participating in joint actions and by observing others acting together. Using a puzzle box paradigm, we tested 3–6-year-old children’s imitation of an inefficient performance following individual and joint demonstrations in which the inefficient performance did or did not involve bimanual or joint coordination. This allowed us to test whether the tendency to overimitate extends to joint actions and how action coordination modulates imitative behavior. We found that overimitation extends to joint actions, as indicated by similar rates of inefficient copying following individual and joint action demonstrations. Furthermore, our results suggest that action coordination did not play a significant role in modulating children’s tendency to overimitate. Taken together, the results of the study advance our understanding of how learning occurs in social interactions. Full article

Introduction: Single-port video-assisted techniques, such as one-trocar-assisted pyeloplasty (OTAP) or Round-Traction-Assisted Pyeloplasty (RoTAP), have proven helpful for correcting congenital ureteropelvic junction obstruction (UPJO), especially in infants. Surgical Technique: This manuscript presents a technical variation based on the gloveport system that allows bimanual endocavitary dissection and protects the surgical wound during the procedure without increasing the cost or technical difficulty. Comment: This new technique, called gloveport-assisted retroperitoneal pyeloplasty (GARP), could be a valuable alternative for this pathology. Full article

Background/Objectives: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. Methods: A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (<5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. Results: A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1–22). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family’s needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. Conclusions: Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice. Full article

Individuals with hemiparetic cerebral palsy (CP) exhibit reduced use of their more affected (MA) arm, yet the factors that influence its use during activities of daily living remain elusive. The objectives of this study were to describe the relative use of the MA arm during an ecological task, examine its relationship with the level of impairment, and investigate its association with performance in various unilateral and bilateral tasks. Methods: Participants took part in two sessions comprising robotic assessments and clinical assessments of motor functions, as well as accelerometry measurement during kitchen tasks. Four variables were derived from accelerometry data. Stepwise regression analyses were used to identify the best contributors to the accelerometry variables among robotic and clinical assessments. Results: Nineteen adults with CP (34.3 years old ± 11.5; MACS I = 7, II = 6, III = 6) were included. The Use Ratio measured during the kitchen tasks ranged between 0.10 and 0.63. The best predictors of all accelerometry metrics were two bilateral assessments (r² = 0.23–0.64). Conclusions: The importance of assessing bilateral tasks was reaffirmed by the key role played by two bilateral tasks in determining the relative use of the MA arm. The results support the use of intensity-based accelerometry metrics to measure MA arm use. Full article