Search Results (122)

This present paper proposes the development and validation of a low-cost, portable system for the acquisition, processing, and classification of four-channel surface electromyography (i.e., sEMG) signals recorded from the forearm. The hardware platform integrates an STM32F4 family microcontroller and BioAmp EXG Pill module. The software component was developed in Python to implement an adaptive filtering method. To evaluate gesture classification performance, three machine learning classifiers (SVM, Random Forest, kNN) were compared against a classical adaptive threshold-based detection method (75th percentile of the RMS distribution). To reveal the inter-subject variability across 10 subjects, a data augmentation procedure using a Deep Convolutional Conditional Generative Adversarial Network (i.e., DCGAN) was used. The results demonstrate the superiority of machine learning (i.e., ML) classifiers (SVM: 99.86% accuracy, 5-fold CV) over the threshold-based method (33.00%) in classifying seven gestures, confirming the necessity of pattern recognition approaches for gesture discrimination in neuromotor rehabilitation applications. Full article

Postural control is a multilevel adaptive system that stabilizes the body in space through dynamic sensory rebalancing and predictive neuromotor regulation. This review synthesizes current data on the neural mechanisms of balance maintenance, individual strategies for integrating multisensory information, and the role of immersive virtual reality as a controlled experimental and neuromodulation platform, synthesising evidence from 73 studies across neuroscience, cognitive psychology, and VR-based rehabilitation. Particular attention is paid to the cognitive style of “field dependence/independence”, which reflects stable preferences for the dominance of visual or vestibular-proprioceptive signals and consistently predicts the selection of postural strategies. We show that traditional averaged models ignore interpersonal variability, whereas immersive VR allows for the parametric induction of sensory conflicts, quantitative assessment of sensory dependence profiles, and facilitates the study of adaptive reorganization at the cortical, brainstem, and spinal levels. The review substantiates the need to move from standardized protocols to personalized approaches in diagnostics and neurorehabilitation that consider individual patterns of input rebalancing. The integration of behavioural metrics with neurophysiological markers in a VR environment provides a foundation for developing predictive balance models and targeted training interventions. However, the translational application of VR-based approaches requires careful consideration of methodological limitations, including cybersickness, hardware latency, and ecological validity, to ensure robust and generalisable outcomes. Full article

Background/Objectives. This study examined whether exposure to white noise improves reading and writing performance in children with Specific Learning Disorder (SLD), with and without comorbid Attention-Deficit/Hyperactivity Disorder (ADHD). Methods. Thirty children aged 8–13 years (mean age = 9.4) with SLD, 12 of whom also had ADHD, were recruited from the Centro di Riabilitazione San Raffaele Pisana (Rome). Each child completed two standardized reading and writing assessments, four weeks apart, under two auditory conditions (with vs. without white noise) in randomized order. The primary outcomes were reading speed and accuracy, while the secondary outcome was writing accuracy. Results. Among the 26 completers, white noise significantly improved nonword reading speed and accuracy, showed a trend toward improved passage-reading accuracy, and reduced accuracy in nonword writing. Benefits were different in children with SLD + ADHD compared to those with SLD only. Conclusions. These findings indicate task-specific effects of white noise and suggest potential applications for targeted educational interventions. Full article

Background and Objectives: Post-stroke spasticity is a frequent complication that contributes to impaired mobility, reduced functional independence, and decreased exercise tolerance. While botulinum toxin A (BoNT-A) is widely used to improve muscle tone, its effects on cardiopulmonary exercise capacity remain insufficiently characterized. This study aimed to evaluate the impact of BoNT-A treatment on cardiopulmonary performance and functional outcomes in patients with post-stroke spasticity. Materials and Methods: A prospective before–after study was conducted including 50 patients with post-stroke spasticity. Cardiopulmonary exercise testing was performed before and after BoNT-A administration. The primary outcome was peak oxygen consumption (VO₂ peak), while secondary outcomes included anaerobic threshold (AT), exercise duration, maximal workload, 10 m walk test time, Barthel Index, and modified Rankin Scale (mRS). Paired comparisons and multivariable linear regression analyses were performed to assess changes and associated factors. Results: VO₂ peak increased significantly following treatment (12.96 ± 2.70 vs. 13.55 ± 2.85 mL/kg/min; mean change 0.59 mL/kg/min, 95% CI 0.36–0.82; p < 0.001). Similar improvements were observed for AT (10.47 ± 2.77 vs. 10.97 ± 2.97 mL/kg/min; p < 0.001), exercise duration (6.70 ± 1.48 vs. 7.11 ± 1.55 min; p < 0.001), and maximal workload (44.70 ± 10.97 vs. 48.06 ± 12.60 W; p < 0.001). Functional performance improved, as indicated by reduced 10 m walk time (18.33 ± 4.67 vs. 17.36 ± 4.82 s; p < 0.001) and increased Barthel Index (57.62 ± 19.18 vs. 61.92 ± 21.10; p < 0.001). A modest but significant reduction in disability was observed on the mRS (p = 0.003). Baseline values were the strongest predictors of post-treatment outcomes, while smoking status was associated with worse walking performance. Conclusions: BoNT-A treatment was associated with modest but consistent improvements in cardiopulmonary exercise capacity and functional performance in patients with post-stroke spasticity. These findings suggest that spasticity management may be associated with functional and exercise-related benefits extending beyond local neuromuscular effects, although causal relationships cannot be established based on the present study design. Further controlled studies are needed to confirm these findings and evaluate their long-term clinical significance. Full article

Background: technology can significantly improve quality of life for individuals with motor and cognitive disabilities, especially during the transition from rehabilitation to home. However, the success of assistive solutions depends on understanding patients’ functional status, needs, and attitudes toward technology. Methods: we investigated these factors using a multimodal assessment protocol, including the USASS questionnaire and ADL/IADL scales, among 69 participants admitted to intensive neuromotor rehabilitation, most of whom had caregivers (83.6%). Participants were grouped into three sample-derived ordinal categories (Low, Medium, High) based on ADL/IADL scores and age. Results: functional autonomy strongly predicts technology adoption and perceived benefits, surpassing age as a determinant. Individuals in the group with higher sample-derived functional levels reported greater independence in technology use and higher Quality Tech Impact scores. Correlation analysis confirmed moderate-to-strong positive associations between ADL/IADL scores and Quality of Life Index, with the strongest association observed for IADL (ρ = 0.703, 95% CI: 0.559–0.806, p < 0.001). These findings suggest that interventions should prioritise improving functional skills rather than focusing solely on age-related factors to enhance technology adoption and its positive impact. A proactive attitude toward technology is essential to avoid ineffective investments in assistive solutions. Ultimately, functional autonomy emerges as an important contributor of both technological engagement and overall well-being. Full article

Background: Music listening is increasingly applied in medical and healthcare settings as a non-pharmacological intervention to modulate psychophysical outcomes such as anxiety, pain, stress, mood, and physiological parameters. Despite a rapidly expanding evidence base, receptive music-based interventions remain highly heterogeneous with respect to theoretical rationale, music design, and methodological rigor. Objective: The primary aim of this review was to critically examine methodological and conceptual limitations of music listening approaches (based on pre-recorded music listening, without the presence of the music therapist during the listening phase) and to map the range of such interventions across clinical domains. Methods: A systematic search of PubMed was independently conducted by two reviewers for randomized controlled trials published between January 2020 and December 2025. Eligible studies investigated psychophysical outcomes of pre-recorded music listening in clinical or medical populations. Studies involving music listening in relational settings, live music, multimodal interventions, or neuromotor rehabilitation were excluded. Results: Of 280 records initially identified, 63 studies met the inclusion criteria. Most studies employed conventional familiar music, frequently self-selected by participants. Fewer than half reported explicit musical parameters, and only five studies documented the involvement of a certified music therapist. Substantial heterogeneity was observed in music listening experiences, potentially confounding outcome interpretation. Conclusions: Although music listening interventions appear feasible and potentially beneficial across diverse clinical contexts, major methodological and conceptual limitations persist. Greater involvement of music therapy professionals, standardized reporting of musical parameters, clearer theoretical rationales linking musical structure to clinical outcomes, and improved control group design are required to enhance reproducibility, interpretability, and clinical translation. Full article

Background and Objectives: Overt perioperative stroke remains a feared complication of adult cardiac surgery. Diffusion-weighted magnetic resonance imaging (DWI-MRI) has revealed a more prevalent form of cerebral injury, termed silent stroke or silent brain injury (SBI). Covert ischemic lesions occur without focal neurological deficits but are increasingly associated with postoperative delirium, cognitive decline, and elevated long-term cerebrovascular risk. Despite growing recognition, the true burden, mechanisms, and clinical relevance of SBI remain incompletely integrated into perioperative practice. Materials and Methods: We performed a narrative review of the literature published between January 2000 and December 2025, identified through PubMed/MEDLINE and Scopus. Eligible studies included prospective and retrospective cohorts, randomized trials, systematic reviews, and meta-analyses involving adult patients undergoing coronary artery bypass grafting, valve surgery, or minimally invasive cardiac procedures, with or without cardiopulmonary bypass, and reporting MRI-detected ischemic lesions or validated surrogate markers of cerebral injury. Pediatric studies, transcatheter interventions, case reports, and non-English publications were excluded. Sixty studies met the inclusion criteria. Results: Silent stroke occurred more frequently than clinically apparent stroke, with new DWI-MRI lesions detected in approximately 20–60% of patients following cardiac surgery. Lesions were typically small, multifocal, and embolic in distribution, predominantly affecting cortical and watershed regions. Cardiopulmonary bypass-related factors, including aortic manipulation, cerebral microembolization, hemodilution, hypoperfusion, and impaired oxygen delivery, emerged as key contributors. Several studies demonstrated associations between SBI burden and postoperative delirium, early cognitive dysfunction, and functional decline. Perfusion-based neuroprotective strategies showed mechanistic benefit, although no single intervention conclusively prevented SBI. Conclusions: Silent stroke represents the most frequent form of neurological injury in adult cardiac surgery. Evidence suggests that these covert lesions reflect clinically meaningful cerebral injury, with potential short- and long-term consequences. Recognition of silent stroke as a relevant neurological endpoint supports a shift toward multimodal, perfusion-driven neuroprotective strategies and the routine incorporation of MRI-based outcomes in future cardiac surgical research. Full article

Background/Objectives: Diabetic neuropathy (DN), a common complication of type 2 diabetes mellitus, manifests as peripheral nerve dysfunction with symptoms such as fatigue. Although exercise effectively reduces fatigue in neuropathy patients, precise detection methods are crucial to elucidate the role of rehabilitation. Accordingly, this study aimed to evaluate fatigue in DN patients using a multimodal approach (clinical and instrumental) and to compare the efficacy of aerobic versus resistance training on fatigue parameters. Methods: Eligible DN inpatients admitted for rehabilitation at the Neuromotor Rehabilitation Unit of the IRCCS ICS Maugeri Institute of Montescano (PV) were enrolled. Inclusion criteria included age between 65 and 85 years and confirmation via the Michigan Neuropathy Screening Instrument (anamnestic section: ≥7; clinical section: ≥2.5). Patients with confounding orthopedic, neurologic, or unstable cardiopulmonary/diabetic conditions were excluded. Overall, 36 participants were randomized into two groups: 17 underwent aerobic training (treadmill), while 19 received resistance training (elastic bands), both as supplements to a standard rehabilitation program. Assessments at baseline and post-training comprised clinical measures (Borg CR10 scale, Functional Independence Measure (FIM) total and subitems, Six-Minute Walk Test (6MWT), fasting blood glucose) and instrumental evaluations (sEMG of the tibialis anterior muscle to analyze conduction velocity intercept, slope, and changes). Results: All patients completed the protocol without dropout or adverse events. Both groups demonstrated significant improvements in FIM scores and post-exercise perceived exertion over time. Instrumental sEMG analysis confirmed a physiological fatigue trend manifested as conduction velocity reduction, yet revealed no significant differences between groups. Conclusions: Multimodal assessment provides an effective means to characterize fatigue in DN patients. Both aerobic and resistance modalities enhance functional independence and fatigue perception. Its early identification enables clinicians to tailor rehabilitation strategies to overcome exercise barriers. Full article

Post-stroke rehabilitation integrates technological feedback systems to enhance motor relearning and autonomic regulation. Among these, physiological biofeedback—based on electromyography (EMG), heart rate variability (HRV) and electrocardiography (ECG)—represents a multimodal approach for restoring neuromotor control and autonomic balance. EMG biofeedback enables patients to visualize and voluntarily modulate muscle activation, supporting cortical reorganization and improving movement precision through real-time feedback. Recent meta-analyses confirm that EMG biofeedback significantly improves upper- and lower-limb function in stroke survivors, particularly when combined with task-oriented physiotherapy. EMG biofeedback demonstrates improvements in swallowing function, motor control, and patient motivation. Beyond the motor domain, HRV biofeedback has shown substantial benefits lately, especially in regulating the autonomic nervous system (ANS) activity, improving vagal tone, and reducing sympathetic overdrive: a major contributor to fatigue and cardiovascular instability post-stroke. By targeting the sympathetic–parasympathetic balance, HRV biofeedback not only enhances autonomic flexibility but also supports emotional and cognitive recovery. Together, these modalities integrate neuromuscular and autonomic rehabilitation, offering a path toward individualized, feedback-driven recovery protocols. This narrative review synthesizes recent evidence on the mechanisms, the clinical outcomes, and translational potential of EMG- and HRV-based biofeedback in stroke rehabilitation, highlighting their role in advancing physiotherapy toward an adaptive, data-driven, and neuroplastic paradigm, as from now on, the emerging directions will include integrating physiological biofeedback with immersive or AI-driven platforms for enhanced personalization and motivation. Full article

Wearable sensing technologies are increasingly used to assess neuromuscular function during daily-life activities. This study presents and evaluates a multisensor wearable system integrating a textile-based surface Electromyography (sEMG) sleeve and a pressure-sensing insole for monitoring Tibialis Anterior (TA) and Gastrocnemius Lateralis (GL) activation during gait. Eleven healthy adults performed overground walking trials while synchronised sEMG and plantar pressure signals were collected and processed using a dedicated algorithm for detecting activation intervals across gait cycles. All participants completed the walking protocol without discomfort, and the system provided stable recordings suitable for further analysis. The detected activation patterns showed one to four bursts per gait cycle, with consistent TA activity in terminal swing and GL activity in mid- to terminal stance. Additional short bursts were observed in early stance, pre-swing, and mid-stance depending on the pattern. The area under the sEMG envelope and the temporal features of each burst exhibited both inter- and intra-subject variability, consistent with known physiological modulation of gait-related muscle activity. The results demonstrate the feasibility of the proposed multisensor system for characterising muscle activation during walking. Its comfort, signal quality, and ease of integration encourage further applications in clinical gait assessment and remote monitoring. Future work will focus on system optimisation, simplified donning procedures, and validation in larger cohorts and populations with gait impairments. Full article

Analyzing the dynamics of muscle activation patterns and joint range of motion is essential to understanding human movement during complex tasks such as tooth brushing Activities of Daily Living (ADLs). In individuals with neuromotor impairments, accurate assessment of upper limb motor patterns plays a critical role in rehabilitation, supporting the identification of compensatory strategies and informing clinical interventions. This study presents the validation of a previously developed novel, low-cost, wearable, and portable multimodal prototype that integrates inertial measurement units (IMU) and surface electromyography (sEMG) sensors into a single device. The system enables bilateral monitoring of arm segment kinematics and muscle activation amplitudes from six major agonist muscles during ADLs. Eleven healthy participants performed a functional task, tooth brushing, while wearing the prototype. The recorded data were compared with two established gold-standard systems, Qualisys^® motion capture system and Biosignalsplux^®, for validation of kinematic and electrophysiological measurements, respectively. This study provides technical insights into the device’s architecture. The developed system demonstrates potential for clinical and research applications, particularly for monitoring upper limb function and evaluating rehabilitation outcomes in populations with neurological disorders. Full article

Background/Objectives: Post-traumatic epileptogenesis is a frequent and clinically relevant consequence of traumatic brain injury (TBI), often contributing to worsened neurological and functional outcomes. In patients experiencing early post-injury seizures, rehabilitative strategies that support recovery while considering increased epileptogenic risk are needed. This case study explores the potential benefits of combining neurofeedback (NFB) with motor therapy on cognitive and motor recovery. Methods: A patient hospitalized for severe TBI who experienced an acute symptomatic seizure in the early post-injury phase underwent baseline quantitative EEG (qEEG), neuromotor, functional, and neuropsychological assessments. The patient then completed a three-week rehabilitation program (five days/week) including 30 sensorimotor rhythm (SMR) NFB sessions (35 min each) combined with daily one-hour motor therapy. qEEG and clinical assessments were repeated post-intervention and at 6-month follow-up. Results: Post-intervention qEEG showed significant reductions in Delta and Theta power, reflecting decreased cortical slowing and enhanced neural activation. Relative power analysis indicated reduced Theta activity and Alpha normalization, suggesting improved cortical stability. Increases were observed in Beta and High-beta activity, alongside significant reductions in the Theta/Beta ratio, consistent with improved attentional regulation. Neuropsychological outcomes revealed reliable improvements in global cognition, memory, and visuospatial abilities, mostly maintained or enhanced at follow-up. Depressive and anxiety symptoms decreased markedly. Motor and functional assessments demonstrated meaningful improvements in motor performance, coordination, and functional independence. Conclusions: Findings suggest that integrating NFB with motor therapy may support recovery processes and be associated with sustained neuroplastic changes in the early post-injury phase after TBI, a condition associated with elevated risk for post-traumatic epilepsy. Full article

Background/Objectives: Older people with hip fractures (HF) are highly heterogeneous patients at risk of adverse events, which impacts healthcare and economic systems. Tools for estimating 30-day and 1-year mortality may help optimize patient management decisions. The Nottingham Hip Fracture Score (NHFS) is one of the most reliable tools for assessing 30-day mortality after surgery. The aim is to validate the NHFS in a cohort of Italian patients hospitalized due to HF and enhance its predictive capacity against 30-day and 1-year mortality. Methods: A prospective observational study among older patients with HF who underwent surgery after a comprehensive geriatric assessment (CGA). Data about 30-day and 1-year mortality were gathered from regional registries. Logistic regression analyses were performed to assess the predictive accuracy of the NHFS against 30-day and 1-year mortality. The adapted scores were measured using ROC curves, and a nomogram was developed. Result: Among 1169 patients, 30-day and 1-year mortality rates were 4.3% and 21.3%, respectively. The NHFS was validated and recalibrated in the study sample for 30-day mortality. The recalibrated NHFS showed better predictive capacity for 30-day mortality (AUC 0.693) than the ASA score (AUC 0.547) and remained a significant predictor for 1-year mortality (AUC 0.712). BADL and METs showed an association with mortality, so the modified NHFS was integrated, resulting in a more accurate prediction compared to the original score for 1-year mortality (AUC = 0.747). Conclusions: The NHFS is a reliable tool for estimating 30-day and 1-year mortality in Italian older adults with HF. The revised NHFS, which includes METs and BADL, offers higher predictive power than the original version in our sample, and the nomogram may facilitate its clinical use. Full article

Stroke is a leading cause of disability, often resulting in motor, cognitive, and language deficits, with significant impact on upper-limb function. Robotic therapy (RT) has emerged as an effective strategy, providing intensive, repetitive, and adaptable practice to optimize functional recovery. This pilot study aimed to describe and evaluate the effects of robotic rehabilitation as a complement to conventional therapy, using a biomimetic activities-of-daily-living (ADL)-based protocol, on upper-limb function in post-stroke patients. Three participants (aged 30–80 years) undergoing occupational and/or physiotherapy received individualized robotic training with a lightweight cable-driven upper-limb exoskeleton, m-FLEX™, twice a week for ten weeks (30 min per session). Movements were designed to mimic natural upper-limb actions, including elbow flexion-extension, forearm pronation-supination, tripod pinch, and functional tasks such as grasping a cup. Assessments included the Fugl-Meyer (FM) scale, the Functional Independence Measure (FIM), and device satisfaction, performed at baseline, mid-intervention, and post-intervention. Descriptive analysis of the tabulated data revealed improvements in range of motion and functional outcomes. These findings suggest that biomimetic protocol of robotic rehabilitation, when combined with conventional therapy, can enhance motor and functional recovery in post-stroke patients. Full article

Background: Recovery following incomplete spinal cord injury (iSCI) remains challenging, with conventional rehabilitation often emphasizing compensation over functional restoration. As most new spinal cord injury cases preserve some motor or sensory pathways, there is increasing interest in therapies that harness neuroplasticity. Robotic exoskeletons provide a promising means to deliver task-specific, repetitive gait training that may promote adaptive neural reorganization. This feasibility study investigates the feasibility, safety, and short-term effects of exoskeleton-assisted walking in individuals with degenerative iSCI. Methods: Two cooperative male patients (patients A and B) with degenerative iSCI (AIS C, neurological level L1) participated in a four-week intervention consisting of one hour of neuromotor physiotherapy followed by one hour of exoskeleton-assisted gait training, three times per week. Functional performance was assessed using the 10-Meter Walk Test, while gait quality was examined through spatiotemporal gait analysis. Vendor-generated surface electromyography (sEMG) plots were available only for qualitative description. Results: Patient A demonstrated a clinically meaningful increase in walking speed (+0.15 m/s). Spatiotemporal parameters showed mixed and non-uniform changes, including longer cycle, stance, and swing times, which reflect a slower stepping pattern rather than improved efficiency or coordination. Patient B showed a stable walking speed (+0.03 m/s) and persistent gait asymmetries. Qualitative sEMG plots are presented descriptively but cannot support interpretations of muscle recruitment patterns or neuromuscular changes. Conclusions: In this exploratory study, exoskeleton-assisted gait training was feasible and well tolerated when combined with conventional physiotherapy. However, observed changes were heterogeneous and do not allow causal or mechanistic interpretation related to neuromuscular control, muscle recruitment, or device-specific effects. These findings highlight substantial inter-individual variability and underscore the need for larger controlled studies to identify predictors of response and optimize rehabilitation protocols. Full article