Search Results (1,685)

Background/Objectives: Traumatic brain injury (TBI) is a major global cause of death and disability, with long-term cognitive, behavioral, and functional consequences. Despite its high burden, management is complicated by heterogeneous presentations and limited evidence. This review summarizes recent advances in monitoring, therapeutic strategies, neuroprotection, and rehabilitation, while highlighting future directions toward individualized and globalized care. Methods: This paper is a narrative review of clinical trials, systematic reviews, and observational studies, focusing on invasive and non-invasive monitoring, pharmacologic and non-pharmacologic interventions, neuroprotective agents, stem cell therapy, and advanced rehabilitation modalities. Results/Findings: Our review focuses on emerging monitoring techniques, including brain tissue oxygenation, cerebral microdialysis, and multimodal strategies, that provide detailed insights but lack standardized application. Interventions such as anti-inflammatory agents, hypothermia, hyperosmolar therapies, and metabolic suppression show mixed efficacy, with few therapies supported by high-level evidence. Novel agents like erythropoietin and progesterone demonstrate neuroprotective potential in preclinical models but remain inconclusive in clinical trials. Stem cell therapies and extracellular vesicle approaches are promising in early studies. Rehabilitation is expanding with virtual reality, robotics, and neurostimulation to promote neuroplasticity. Personalized medicine approaches incorporating biomarkers and machine learning may refine prognostication and guide therapy. Global inequities persist, particularly in low-resource settings. Conclusions: TBI care is shifting toward individualized, multimodal, and technology-driven strategies. While emerging therapies show promise, high-quality randomized trials and global implementation strategies are needed to improve outcomes and reduce disparities. Full article

Telerehabilitation is an effective, accessible addition or alternative to conventional rehabilitation for fracture management, especially in older adults after hip fractures, leveraging video visits, mHealth apps, virtual reality (VR), and wearable sensors to deliver exercise, education, and monitoring at home with high satisfaction and adherence. Across non-surgical and surgical contexts, telemedicine shows feasibility and cost benefits, with mixed superiority but consistent non-inferiority for functional outcomes versus in-person care. In hip fracture populations, randomized and non-randomized studies indicate improvements in functional independence measure (FIM), Timed Up and Go test (TUG), Activities of Daily Living/Instrumental Activities of Daily Living (ADLs/IADLs), and quality of life, with some evidence for reduced anxiety and depression, while effects on mobility, pain, and adverse events remain uncertain overall. In patients with upper-limb fractures, telerehabilitation appears to improve function and pain, though strength gains may lag compared with in-person therapy in some trials; adjuncts like motor imagery and virtual reality may enhance outcomes and motivation. Application is facilitated by user-friendly platforms, caregiver involvement, and simple modalities such as structured phone follow-up. Limitations include small samples, heterogeneous protocols, scarce long-term data, and a predominance of non-inferiority or complementary designs, warranting larger, definitive trials. This technology can lead to improved patient management at home, effortlessly verifying treatment compliance, efficacy, and safety, while simultaneously reducing the need for hospitalization, promoting a more peaceful recovery. Here, we have undertaken a narrative review of the medical–scientific literature in this field. Full article

Background and Objectives: Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. Materials and Methods: A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), Myoton^®PRO, Gross Motor Function Measures (GMFM)-88, Pedalo^® Sensamove Balance Test (Pedalo^® SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. Results: At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728–0.931, p < 0.05). Myoton^®PRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, p < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, p < 0.05) and gastrocnemius-soleus (ES: 0.766–0.865, p < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771–0.886, p < 0.05). Additionally, Pedalo^® SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599–0.602, p < 0.05). Conclusions: HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy. Full article

Background: Mobility assessment is a crucial aspect of rehabilitation for individuals with lower limb amputation, as it directly influences their independence and quality of life. The objective of this study was to translate and cross-culturally adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility grades questionnaire in the Persian language and to investigate its psychometric properties. Methods: The SIGAM mobility scale was translated into Persian according to international guidelines for cross-cultural adaptation of self-reported measures and was administered to forty Persian-speaking people with lower limb amputations. Measurement properties were evaluated following COSMIN (COnsensus-based Standards for the Selection of Health Measurement INstruments) recommendations and included internal consistency, test–retest reliability, and hypotheses testing for construct validity by comparing SIGAM mobility grades to the Locomotor Capabilities Index-5 (LCI-5), Houghton scale, Activities-specific Balance Confidence (ABC) scale, the 2-Minute Walk Test (2-MWT), and the Timed Up and Go (TUG). Results: SIGAM mobility scale demonstrated acceptable internal consistency (Kuder-Richardson 20 coefficient = 0.72) and excellent test–retest reliability (Cohen Kappa coefficient = 0.85). Hypothesis testing for construct validity confirmed the good to very good correlations of the Persian SIGAM mobility scale with the LCI-5 (r = 0.63, 0.55, and 0.63 for the general, basic, and advanced activities components, respectively), Houghton scale (r = 0.63), ABC scale (r = 0.73), 2-MWT (r = 0.50), and TUG test (r = −0.51). Conclusion: The Persian version of the SIGAM mobility scale demonstrated preliminary evidence of acceptable psychometric properties, supporting its clinical applicability. Full article

Stroke is a leading cause of long-term disability worldwide, with survivors often facing significant challenges in regaining upper-limb functionality. In response, robotic rehabilitation systems have emerged as promising tools to enhance post-stroke recovery by delivering precise, adaptable, and patient-specific therapy. This paper presents a review of robotic interfaces developed specifically for upper-limb rehabilitation. It analyses existing exoskeleton- and end-effector-based systems, with respect to three core design pillars: assistance types, control philosophies, and actuation methods. The review highlights that most solutions favor electrically actuated exoskeletons, which use impedance- or electromyography-driven control, with active assistance being the predominant rehabilitation mode. Resistance-providing systems remain underutilized. Furthermore, no hybrid approaches featuring the combination of robotic manipulators with actuated interfaces were found. This paper also identifies a recent trend towards lightweight, modular, and portable solutions and discusses the challenges in bridging research prototypes with clinical adoption. By focusing exclusively on upper-limb applications, this work provides a targeted reference for researchers and engineers developing next-generation rehabilitation technologies. Full article

Spinal cord injury (SCI) often results in long-term locomotor impairments, and strategies to enhance functional recovery remain limited. While epidural electrical stimulation (EES) has shown clinical promise, our understanding of the mechanisms by which it improves function remains incomplete. Here, we use genetic tools in an animal model to perform neuromodulation and treadmill rehabilitation in a manner similar to EES, but with the benefit of the genetic tools and animal model allowing for targeted manipulation, precise quantification of the cells and circuits that were manipulated, and the gathering of extensive kinematic data. We used a viral construct that selectively transduces large diameter afferent fibers (LDAFs) with a designer receptor exclusively activated by a designer drug (hM3Dq DREADD; a chemogenetic construct) to increase the excitability of large fibers specifically, in the rat contusion SCI model. As changes in locomotion with afferent stimulation can be subtle, we carried out a detailed characterization of the kinematics of locomotor recovery over time. Adult Long-Evans rats received contusion injuries and direct intraganglionic injections containing AAV2-hSyn-hM3Dq-mCherry, a viral vector that has been shown to preferentially transduce LDAFs, or a control with tracer only (AAV2-hSyn-mCherry). These neurons then had their activity increased by application of the designer drug Clozapine-N-oxide (CNO), inducing tonic excitation during treadmill training in the recovery phase. Kinematic data were collected during treadmill locomotion across a range of speeds over nine weeks post-injury. Data were analyzed using a mixed effects model chosen from amongst several models using information criteria. That model included fixed effects for treatment (DREADDs vs. control injection), time (weeks post injury), and speed, with random intercepts for rat and time point nested within rat. Significant effects of treatment and treatment interactions were found in many parameters, with a sometimes complicated dependence on speed. Generally, DREADDs activation resulted in shorter stance duration, but less reduction in swing duration with speed, yielding lower duty factors. Interestingly, our finding of shorter stance durations with DREADDs activation mimics a past study in the hemi-section injury model, but other changes, including the variability of anterior superior iliac spine (ASIS) height, showed an opposite trend. These may reflect differences in injury severity and laterality (i.e., in the hemi-section injury the contralateral limb is expected to be largely functional). Furthermore, as with that study, withdrawal of DREADDs activation in week seven did not cause significant changes in kinematics, suggesting that activation may have dwindling effects at this later stage. This study highlights the utility of high-resolution kinematics for detecting subtle changes during recovery, and will enable the refinement of neuromechanical models that predict how locomotion changes with afferent neuromodulation, injury, and recovery, suggesting new directions for treatment of SCI. Full article

This paper introduces the Gesture-Based Physical Stability Classification and Rehabilitation System (GPSCRS), a low-cost, non-invasive solution for evaluating physical stability using an Arduino microcontroller and the DFRobot Gesture and Touch sensor. The system quantifies movement smoothness, consistency, and speed by analyzing “up” and “down” hand gestures over a fixed period, generating a Physical Stability Index (PSI) as a single metric to represent an individual’s stability. The system focuses on a temporal analysis of gesture patterns while incorporating placeholders for speed scores to demonstrate its potential for a comprehensive stability assessment. The performance of various machine learning and deep learning models for gesture-based classification is evaluated, with neural network architectures such as Transformer, CNN, and KAN achieving perfect scores in recall, accuracy, precision, and F1-score. Traditional machine learning models such as XGBoost show strong results, offering a balance between computational efficiency and accuracy. The choice of model depends on specific application requirements, including real-time constraints and available resources. The preliminary experimental results indicate that the proposed GPSCRS can effectively detect changes in stability under real-time conditions, highlighting its potential for use in remote health monitoring, fall prevention, and rehabilitation scenarios. By providing a quantitative measure of stability, the system enables early risk identification and supports tailored interventions for improved mobility and quality of life. Full article

This study presents the design, development, and experimental validation of a novel cable-driven shoulder exosuit (CDSE) for upper limb rehabilitation and assistance. Unlike existing exoskeletons, which are often bulky, limited in degrees of freedom (DOFs), or impractical for home use, the proposed DSE offers a lightweight (≈2 kg), portable, and wearable solution capable of supporting three shoulder movements: abduction, flexion, and horizontal adduction. The system employs a bioinspired tendon-driven mechanism using Bowden cables, transferring actuation forces from a backpack to the arm, thereby reducing user load and improving comfort. Mathematical models and inverse kinematics were derived to determine cable length variations for targeted motions, while control strategies were implemented using a PID-based approach in MATLAB Simscape-Multibody simulations. The prototype was fabricated in three iterations using PLA, aluminum, and carbon fiber—culminating in a durable and ergonomic final version. Experimental evaluations on a healthy subject demonstrated high accuracy in position tracking (<5% error) and torque profiles consistent with simulation outcomes, validating system robustness. The CDSE successfully supported loads up to 4 kg during rehabilitation tasks, highlighting its potential for clinical and at-home applications. This research contributes to advancing wearable robotics by addressing portability, biomechanical alignment, and multi-DOF functionality in upper limb exosuits. Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries continue to present significant clinical and rehabilitative challenges. Despite advances in surgical techniques and rehabilitation protocols, persistent reinjury rates and increased pressure for early return to sport require a critical reassessment of current practices. This narrative review provides a comprehensive overview of the evolution, current standards, and future directions of ACL surgery and rehabilitation. Content: The literature search was conducted primarily in PubMed/MEDLINE and Web of Science using ACLRelated keywords, with emphasis on systematic reviews, randomized controlled trials, registry data, and consensus guidelines published within the past two decades. The evolution of ACL treatment is shaped by the transition from open to arthroscopic and anatomic reconstructions, as well as the refinement of fixation and augmentation techniques. In parallel, rehabilitation concepts shifted from rigid, time-based schedules to criteria-driven, individualized approaches. Key aspects include early mobilization, prehabilitation, and the integration of innovative tools such as anti-gravity treadmill and blood flow restriction training. Evidence on bracing suggests no routine benefit, while structured prevention programs have proven effective. Return-to-play strategies now emphasize objective functional criteria and psychological readiness. Conclusions: ACL therapy has evolved toward personalized, function-oriented rehabilitation. Future developments—including markerless motion analysis, AI-supported rehabilitation, and digital health applications promise for further individualization of care and optimization of long-term outcomes. Full article

As stroke is becoming more frequent nowadays, cutting edge rehabilitation approaches are required to recover upper limb functionalities and to support patients during daily activities. Recently, focus has moved to robotic rehabilitation; however, therapeutic devices are still highly expensive, making rehabilitation not easily affordable. Moreover, devices are not easily accepted by patients, who can refuse to use them due to not feeling comfortable. The presented work proposes the exploitation of a virtual prototype of the human–robot ecosystem for the study and analysis of patient–robot interactions, enabling their simulation-based investigation in multiple scenarios. For the accomplishment of this task, the Dynamics of Multi-physical Systems platform, previously presented by the authors, is further developed to enable the integration of biomechanical models of the human body with mechatronics models of robotic devices for motion assistance, as well as with PID-based control strategies. The work begins with (1) a description of the background; hence, the current state of the art and purpose of the study; (2) the platform is then presented and the system is formalized, first from a general side and then (3) in the application-specific scenario. (4) The use case is described, presenting a controlled gym weightlifting exercise supported by an exoskeleton and the results are analyzed in a final paragraph (5). Full article

The sustainable development of society requires the incorporation of environmental, social, and governance (ESG) principles. While ESG assessments are widely used in corporate settings, their application in healthcare settings, such as hospitals, remains underexplored. This study aimed to develop a comprehensive evaluation framework integrating ESG and digital transformation (DX) with traditional hospital efficiency and effectiveness assessments. Using open data, financial reports, and hospital website scraping, we applied a slack-based model (SBM) of data envelopment analysis (DEA) and super-efficiency SBM-DEA to calculate sustainability scores across four dimensions: overall sustainability, efficiency, effectiveness, and ESG/DX performance. Results showed that all three components—efficiency, effectiveness, and ESG/DX—were positively associated with overall sustainability. However, ESG/DX performance negatively impacted profitability in smaller hospitals, and improved effectiveness in rehabilitation hospitals was linked to higher operational costs. These findings suggest that while ESG and DX contribute to long-term sustainability, their short-term financial burden may challenge certain hospital types. The proposed index provides valuable insights for hospital management and policy development, aiming to advance ESG and DX initiatives in healthcare. Full article

Flexible and wearable sensors have emerged as transformative technologies in the field of real-time health monitoring, offering non-invasive, continuous, and personalized healthcare solutions. These devices are designed to conform intimately to the human body, enabling seamless detection of vital physiological and biochemical signals under dynamic conditions. Recent advancements in material science and device engineering have led to the development of sensors with enhanced sensitivity, biocompatibility, and wearability, addressing the growing demand for preventive healthcare and remote patient monitoring. This review provides a comprehensive overview of the progress in flexible wearable sensors, including novel materials, sensor designs, and system integration strategies. It begins by surveying the latest advances in substrate and functional materials and hybrid structures that enable mechanical flexibility, skin conformability, and high sensitivity. The review then examines various sensor mechanisms and their implementation in monitoring vital signs, physical activity, and chronic diseases. Real-world applications are explored in depth, covering scenarios from cardiovascular and respiratory monitoring to motion tracking and rehabilitation support. Despite the significant strides made, challenges related to material robustness, sensor accuracy, and multi-modal integration remain, and this review discusses these challenges alongside potential future directions for enhancing the functionality and adoption of flexible wearable sensor systems. Full article

Background/Objectives: The maintenance of peri-implant soft tissue health is critical for the long-term success of implant therapy, particularly in edentulous patients rehabilitated with mandibular overdentures. Leukocyte- and platelet-rich fibrin (L-PRF) has been proposed as an autologous biomaterial to enhance peri-implant tissue quality. This randomized controlled clinical trial evaluated the effect of L-PRF on peri-implant mucosal thickness in edentulous patients treated with mandibular implant-retained overdentures. Methods: Edentulous patients received two interforaminal implants to retain a mandibular overdenture and were randomly assigned to a test group (L-PRF applied during surgery) or a control group (standard protocol without L-PRF). Clinical measurements of keratinized mucosal thickness and width were recorded at baseline, 12 weeks, and 24 weeks. Volumetric analyses of soft and hard tissue changes were performed using digital superimposition of STL models. The trial was conducted in accordance with the Declaration of Helsinki and approved by the Scientific Ethics Committee of the Aconcagua Health Service. All participants provided written informed consent. Results: A significant increase in keratinized mucosal thickness was observed in the L-PRF group at 12 and 24 weeks compared with baseline (p < 0.01). No significant differences were detected between the groups in soft tissue volume (p = 0.12) or bone volume (p = 0.45). Mucosal width remained stable in both groups throughout follow-up. Conclusions: The application of L-PRF at implant placement resulted in a significant gain in peri-implant mucosal thickness, suggesting a soft tissue modulating effect. Enhancing keratinized mucosal thickness during implant surgery may improve peri-implant tissue quality and support long-term stability of mandibular overdentures. Full article

The advancement of sports science has heightened demands for precise monitoring of athletes’ technical movements, physiological status, and performance. Optical fiber sensing (OFS) technology, with its unique advantages including high sensitivity, immunity to electromagnetic interference, capability for distributed sensing, and strong biocompatibility, demonstrates significant application potential in sports science. This review systematically examines the technical principles, innovative breakthroughs, and practical application cases of optical fiber sensors in various domains: monitoring key human physiological parameters such as respiration, heart rate, and body temperature; capturing motion and analyzing movement covering muscle activity, joint angles, and gait; integrating within smart sports equipment and protective gear; and monitoring sports apparatus and environments. The value of OFS technology is further analyzed in areas including sports biomechanics analysis, training load monitoring, injury prevention, and rehabilitation optimization. Concurrently, current technical bottlenecks such as the need for enhanced sensitivity, advancements in flexible packaging technologies, cost control, system integration, and miniaturization are discussed. Future development trends involving the integration of OFS with artificial intelligence, the Internet of Things, and new materials are explored, aiming to provide a theoretical foundation for sports medicine and training optimization. Full article

Virtual communication, involving the transmission of all human senses, is the next step in the development of telecommunications. Achieving this vision requires real-time data exchange with low latency, which in turn necessitates the implementation of the Tactile Internet (TI). TI will ensure the transmission of high-quality tactile data, especially when combined with audio and video signals, thus enabling more realistic interactions in virtual environments. In this context, advances in realism increasingly depend on the accurate simulation of the grasping process and hand–object interactions. To address this, in this paper, we methodically present the challenges of human–object interaction in virtual environments, together with a detailed review of the datasets used in grasping modeling and the integration of physics-based and machine learning approaches. Based on this review, we propose a multi-step framework that simulates grasping as a series of biomechanical, perceptual, and control processes. The proposed model aims to support realistic human interaction with virtual objects in immersive settings and to enable integration into applications such as remote manipulation, rehabilitation, and virtual learning. Full article