Search Results (407)

Integrating neural and muscular signals into wearable robotics enables adaptive assistance during real-world tasks. This study proposes a multimodal neural interface for passive exoskeletons that combines electroencephalography (EEG) and electromyography (EMG) signals to classify motor gestures and estimate real-time cognitive and muscular effort, supported by finite-element-based biomechanical modeling. The system was implemented on the Ottobock Shoulder X passive exoskeleton© and validated using synchronous EEG–EMG acquisition via the LiveAmp platform©, a commercially available platform that was not developed specifically for this study. A hybrid CNN–LSTM architecture with deep fusion was employed to enhance robustness and responsiveness under realistic operating conditions. This study proposes a multimodal neural interface for the software-level adaptive assistance of passive upper-limb exoskeletons. While the physical device maintains a static mechanical profile, the proposed digital framework achieves adaptation by interpreting the user’s physiological and motor states. Ten healthy participants performed three functional tasks (screwing, moving the box, and lifting the box) under five assistive conditions. Finite element modeling (FEM) was used to characterize the torque–angle relationship of the passive exoskeleton and to support the interpretation of experimentally observed assistive torque profiles. The FEM model, used as an offline biomechanical analysis tool to aid in the interpretation of experimental results, has not been integrated into the real-time control loop. Results showed an average classification accuracy of 90%, an F1-score of 0.85, and inference latency below 180 ms, confirming real-time applicability. Cognitive indices such as the Cognitive Load Index (CLI) and Frontal Asymmetry Index (FAI) enabled adaptive modulation of assistance strategies without requiring active actuation, thereby preserving the device’s intrinsic passive nature. Comparative torque analysis highlighted the ergonomic benefits of passive systems in mid-range postures, while Finite Element Method (FEM) supported analysis clarified their limitations under highly dynamic loads compared to active solutions. These findings advance multimodal brain–machine interfaces for wearable robotics by integrating physiological sensing, deep learning, and biomechanical modeling, offering a safe, energy-efficient, and adaptive approach with potential rehabilitation, occupational ergonomics, and human–robot applications. Full article

Background/Objectives: Penile rehabilitation (PR) techniques are claimed to counteract chronic degenerative processes of cavernous tissue, such as penile hypoxia, neurovascular damage, and cavernous fibrosis. The objective of this umbrella review is to synthesize findings from existing meta-analyses to evaluate the efficacy of traditional and emerging PR strategies, providing an evidence-based roadmap for clinical management after surgery for prostate cancer. Methods: Conducted in accordance with PRIOR guidelines, a comprehensive literature search of PubMed, the Cochrane Library, and Scopus was performed through April 2026. The review included primarily systematic reviews and meta-analyses investigating pharmacological, physical, surgical, and regenerative interventions for post-prostatectomy erectile dysfunction (ED). Methodological quality was independently assessed using standardized tools. Results: PDE5 inhibitors (PDE5-is) significantly improve erectile function during active treatment, yet evidence supporting their role in promoting spontaneous, “unassisted” recovery remains limited. Vacuum erectile devices demonstrate high efficacy for assisted intercourse but show minimal impact on returning to baseline function compared to placebo. Penile prosthesis (PP) implantation maintains robust efficacy with exceptionally high satisfaction rates (83–85%), proving independent of prior pelvic surgery. Although early-phase trials suggest clinical potential for regenerative therapies like low-intensity extracorporeal shockwave therapy, platelet-rich plasma, and stem cell interventions, the evidence is currently undermined by substantial heterogeneity in study protocols and concerns regarding methodological quality. Conclusions: PR following radical prostatectomy remains a complex challenge characterized by poor evidence. While PDE5-Is are established first-line therapy for assisted function, PP remains the most reliable definitive treatment for refractory ED cases. Regenerative approaches show promise but remain investigational until standardized protocols and large-scale trials are established. Full article

Background/Objectives: Advanced heart failure is associated with reduced functional capacity and impaired quality of life. Left ventricular assist devices (LVADs) are increasingly used as a long-term treatment option in patients with end-stage heart failure. Despite improvements in hemodynamic function after LVAD implantation, many patients continue to experience limitations in daily functioning. The aim of this study was to evaluate the relationship between physical activity and functional status in patients with LVAD support. Methods: This study included 262 adult participants divided into four groups according to LVAD support and declared physical activity. Functional status and quality of life were assessed using the Short Form-36 Health Survey (SF-36) and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results: Significant differences were observed between the analyzed groups in both SF-36 and MLHFQ scores. Physically active patients with LVAD achieved the most favorable results, indicating a better functional status and lower symptom burden, whereas inactive individuals demonstrated poorer outcomes. Significant correlations were found between physical activity and selected aspects of daily functioning, including walking, climbing stairs, performing household activities, and carrying groceries. Higher levels of physical activity were associated with better quality of life and fewer functional limitations. Conclusions: Physical activity may positively influence functional status and quality of life in patients with LVAD support. The findings suggest that regular physical activity should be considered an important component of rehabilitation and long-term management in patients with advanced heart failure treated with LVAD therapy. Full article

Background/Objectives: Assisted verticalization and supported upright activity are relevant components of rehabilitation in adults with severe acquired brain injury (sABI), although patient selection and implementation remain challenging. This retrospective observational study aimed primarily to describe the implementation feasibility and documented safety of GRILLO-based training in routine inpatient multidisciplinary rehabilitation, and secondarily to report exploratory pre–post functional changes. Methods: We reviewed clinical records of 34 adults screened or considered for GRILLO-based training at Centro Cardinal Ferrari KOS, Italy, between June 2022 and December 2024. GRILLO training was delivered as part of standard care and not as an experimental intervention. Functional outcomes included the Barthel Index (BI), Trunk Control Test (TCT), Tinetti Balance Scale, and Tinetti Gait subscale, extracted from routine documentation. Non-parametric descriptive analyses were used. Results: Of 34 screened patients, 4 did not meet diagnostic criteria for ABI, 5 interrupted training because of pain or poor tolerance to prolonged upright positioning, and 3 were not included because of poor compliance/motivation or an incomplete clinical pathway. The paired functional-analysis cohort comprised 22 patients: 20 (91%) completed 15 sessions and 2 (9%) completed 10 sessions. No serious device-related adverse events were documented in available clinical records, although minor adverse events were not systematically monitored. Among patients with paired observations, median BI increased from 16 to 22.5 (median change, +3; p = 0.008; n = 20), median TCT from 72 to 74 (median change, +12; p < 0.001; n = 21), and median Tinetti Balance Scale from 1 to 2 (median change, +1; p = 0.006; n = 22). Individual responses were heterogeneous and floor effects were evident, especially for balance and gait-related measures. Conclusions: In this retrospective real-world cohort, GRILLO-based training could be implemented in selected severely impaired inpatients, but feasibility may be overestimated if interrupted and non-completing cases are not considered. The non-completion cases may suggest that feasibility depends not only on initial clinical indication, but also on the appropriate timing of introduction, tolerance to prolonged upright physical effort, pain/discomfort, motivation, and behavioral engagement. The retrospective design, survivorship bias, non-systematic adverse-event monitoring, concurrent multidisciplinary rehabilitation, and absence of a comparator group preclude conclusions regarding device-specific safety or efficacy. Nevertheless, these preliminary findings support further prospective controlled studies. Full article

People living with neurological disorders frequently experience gait impairments that substantially reduce mobility, independence, and quality of life. This pilot study aimed to evaluate the feasibility, safety, and preliminary functional outcomes of integrating the EksoNR robotic exoskeleton (Ekso Bionics, San Rafael, CA, USA) into outpatient neurorehabilitation practice in individuals with chronic neurological impairments. Over an eight-month period, five participants with heterogeneous neurological conditions (two spinal cord injuries, one cerebellar ataxia, one ischemic stroke, and one spastic paraparesis) completed a four-week robotic gait training program consisting of 15 intervention sessions. Functional outcomes were assessed before and after the intervention using standardized clinical tests. Cardiovascular endurance was evaluated using the 6-Minute Walk Test (6MWT), while physical and psychological well-being were assessed with the Functional Independence Measure (FIM) and the Barthel Index, in addition to the WHO Quality of Life (WHOQOL) and EQ-5D-5L questionnaires. Mobility and balance were evaluated using the Timed Up and Go (TUG), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA), and Walking Index for Spinal Cord Injury II (WISCI II), where applicable. In addition, device-recorded gait parameters, including step count, step length, walking distance, and walking duration, were analyzed. Significant improvements were observed in several device-derived gait parameters, including the number of steps performed with the exoskeleton (p < 0.001), step length (p = 0.003), walking distance (p = 0.002), and walking duration (p < 0.05). Significant improvements were also identified in balance performance (BBS: p = 0.006; Tinetti POMA: p = 0.001), cardiovascular endurance (6MWT: p = 0.017), and EQ-5D-5L scores (p = 0.038). Functional independence measures (FIM and BI), TUG performance, and WHOQOL domains did not demonstrate statistically significant changes. No serious adverse events or device-related injuries occurred during the intervention period. Due to the small and clinically heterogeneous sample, these findings should be interpreted as preliminary exploratory results. Nevertheless, the study supports the feasibility and potential clinical utility of EksoNR-assisted gait rehabilitation and provides a basis for larger controlled investigations. Full article

Robotic assistive devices, such as exoskeletons, are increasingly employed in walking rehabilitation. Therefore, the measurement of both movement kinematics and cognitive workload is important to understand this human–robot interaction in real-world contexts. To address this need this study presents the validation of a framework integrating inertial motion capture (Xsens) and eye-tracking sensor (Pupil Neon) within a Mixed Reality (Meta Quest 3) architecture. We developed an overground dual-task paradigm in which holographic numbers appear in the user’s peripheral vision. This setup actively stimulates visuospatial attention while quantifying kinematic and cognitive output. To validate the framework, the protocol has been tested on 30 healthy subjects across repeated exoskeleton training sessions. Statistical analyses revealed that the Coefficient of Multiple Correlation (CMC) and Spectral Arc Length (SPARC), calculated on the shank angular velocity, together with the Step Length Variability, exhibited significant time effects (p < 0.01), mapping the transition toward automated gait. Concurrently, pupillometric data demonstrated a measurable reduction in neurocognitive demand; specifically, the Task-Evoked Pupillary Response (TEPR) decreased significantly across progressive training sessions (p < 0.05). With this work, we validated a measurement protocol that aims to provide a novel methodology for objectively evaluating motor and cognitive adaptation in wearable assistive devices. Full article

Disabilities of the lower extremities significantly affect a person’s ability to perform activities of daily living. Many people have been affected by this type of disability due to birth disease or injury from accidents, strokes or even old age. The technical aids used in this type of disability are very basic, and rehabilitation is mainly performed by therapists. Rehabilitation consists of repetitions of exercises with normal movements that must be performed for prolonged periods of time. On the other hand, therapists, having to support the weight of the patient, tend to get injured. This paper introduces the design and modeling a robotic device intended to assist the therapist in the rehabilitation of sit-to-stand (STS) and walking movements, focusing primarily on the technical aspects of the system. The robot is designed to safely support the user’s weight and guide the user with appropriate movements according to the usual biomechanics of STS. This paper presents the solution of the inverse kinematic modeling of both the position and velocity of the robot mechanism, as well as the dynamic analysis. A series of simulations is conducted to evaluate the performance of the proposed mechanical architecture during the STS task, providing quantitative information on the system dynamics and the interaction forces between the user and the robot. The mathematical model was employed in the design of a prototype intended for children aged 8–12 years, capable of supporting up to 50 kg and providing a vertical motion range of 20–90 cm. The main structural elements of the robot, its control architecture, and its operation during the execution of the STS task are described. Finally, the conclusions of this work are discussed, and future work derived from this research is outlined. Full article

Stroke is the second leading cause of death globally and a major contributor to lower-limb disability, affecting gait, balance, and functional independence in elderly populations. While robot-assisted rehabilitation has demonstrated effectiveness in motor recovery, access remains limited due to high costs and geographic barriers, particularly in Latin America. This study presents ExoKnee, a low-cost knee exoskeleton designed through biomimetic principles and 3D-printed fabrication as a proof-of-concept device targeting gait rehabilitation in elderly adults. The system integrates a single-degree-of-freedom pneumatic actuator controlled by electromyography (EMG) signals from the quadriceps muscle, enabling knee flexion and extension (90° to 180°). The design was evaluated through finite element analysis and dynamic simulations in MATLAB/Simulink R2024a under constant, stepwise, and sinusoidal reference inputs in a digital-twin environment. Expert validation using the Content Validity Coefficient yielded a mean score of 0.8747, reflecting preliminary expert agreement on the conceptual design’s coherence and relevance. The prototype demonstrated controlled movements through a 6-bar pneumatic system with EMG-triggered relay activation, validated at the proof-of-concept level through simulation and single-subject threshold calibration. ExoKnee addresses critical gaps by offering an anthropometrically informed, biosignal-driven, and locally manufacturable rehabilitation platform for low- and middle-income countries, pending clinical validation. Future work will focus on clinical trials and adaptive EMG control strategies. Full article

This paper reviews recent advances in assistive devices based on multimodal information fusion control, designed for individuals with motor dysfunction. The prevalence of motor dysfunction is increasingly concerning amidst global population aging. Information fusion technology, widely adopted in rehabilitation, enhances the efficacy and specificity of rehabilitation treatments. This paper introduces the concept of multimodal information fusion control into rehabilitation equipment design. It highlights the advantages and disadvantages of data-level, feature-level, and decision-level fusion, along with commonly employed fusion algorithms. By summarizing and analyzing the current state of research, this paper aims to provide a valuable reference for the further development and optimization of assistive devices for motor dysfunction. Full article

Background/Objectives: This study explored parents’ perspectives regarding digital media use in children and adolescents with neurodevelopmental disorders (NDs) and examined how these views vary according to family and clinical characteristics. Methods: Data were collected from an Italian survey involving 352 families. Items assessed the perceived effects of digital devices on child development and parenting, awareness of screen time guidelines, and use of time- and content-limiting tools. Quantitative analyses were complemented by a reflexive thematic analysis of open-ended responses describing how digital media influenced parenting. Results: Parents expressed divergent attitudes towards digital media, with broadly similar proportions reporting positive, neutral, and negative views regarding both child development and parenting. More favourable views were associated with greater perceived benefits for children and were more frequent among parents of children with more severe functional disabilities. About half had discussed screen use with health professionals, and most were aware of existing guidelines. Thematic analysis identified six themes related to digital parenting: educational means (digital devices as tools for communication, learning, and socialisation), entertainment (screens as a source of leisure or behavioural management), reward (digital media used as reinforcement), screen time as a “necessity” (technology as an integral and sometimes rehabilitative part of daily life), negative effects on the child (concerns about detachment, reduced social interaction, and mood dysregulation), and parental behaviour and attitudes (reflecting the emotional burden of regulation and broader beliefs about digital media). Conclusions: Parents of children with NDs navigate digital media use through a complex balance of perceived risks and benefits. Findings highlight the need for family-centred guidance and assistive technology approaches that promote digital inclusion while addressing parental stress and regulatory challenges. Full article

Background: Sensorineural hearing loss represents a significant global health burden affecting over 1.5 billion individuals worldwide. Modern hearing aids, equipped with digital signal processing and smart connectivity features, constitute a cornerstone of neuro-sensory rehabilitation. However, the psychosocial impact of these assistive smart technologies on patient self-esteem remains incompletely characterized. Methods: A cross-sectional multivariate study was conducted with 245 participants, divided into three groups: normal-hearing controls (NH, n = 73), hearing-impaired patients using smart hearing aid technology (HA users, n = 86), and hearing-impaired patients not using hearing aid technology (HA non-users, n = 86). Self-esteem was measured using the Rosenberg Self-Esteem Scale (SES). Hearing disability and tinnitus severity were assessed with the Hearing Handicap Inventory for Adults (HHIA) and Tinnitus Handicap Inventory (THI), respectively. Data analysis included one-way ANOVA, Tukey’s HSD post hoc tests, Pearson correlations, and multivariate regression. Results: Hearing aid users showed significantly higher SES scores (35.41 ± 5.32) compared to non-users (22.99 ± 4.53; p < 0.001, Cohen’s d = 2.515). One-way ANOVA indicated highly significant differences among groups (F = 299.00, p < 0.001, η² = 0.712). SES was negatively correlated with HHIA (r = −0.573, p < 0.001) and THI (r = −0.443, p < 0.001), while HHIA and THI were strongly positively correlated (r = 0.729, p < 0.001). In multivariate analysis, HA use remained a strong independent predictor of self-esteem (β ≈ 11.9, p < 0.001), even after adjustment for age, sex, HHIA, and THI. Perceived hearing handicap was independently associated with lower self-esteem, whereas tinnitus severity was not a significant predictor in the fully adjusted model. The model explained approximately 65% of the variance in self-esteem scores. Conclusions: Smart hearing-aid use is strongly and independently associated with higher self-esteem in patients with sensorineural hearing loss. These results support the inclusion of modern audiological rehabilitation devices in comprehensive management strategies for long-term conditions and highlight psychosocial benefits that extend beyond hearing restoration. Full article

Biomechanics sits at the interface of engineering and medical sciences, offering essential insight into how tissues, organs, and biological systems respond to mechanical loading. This review brings together recent advances in musculoskeletal and cardiovascular biomechanics, illustrating how experimental techniques, computational modeling, and multiscale analysis are used to characterize load transfer, tissue deformation, fatigue, and injury mechanisms. In musculoskeletal applications, predictive simulations, wearable sensing technologies, and neuromechanical assessment tools support improved injury prevention, rehabilitation planning, and assistive device development. In the cardiovascular domain, patient-specific modeling, fluid–structure interaction analyses, and advanced imaging approaches clarify how hemodynamics, vessel wall mechanics, and device–tissue interactions influence disease progression, implant performance, and therapeutic outcomes. Emerging technologies including artificial intelligence, machine learning, digital twin frameworks, biofabrication, soft robotics, and self-powered sensing are enabling data-driven, real-time, and personalized interventions that connect mechanistic understanding with clinical practice. Despite these advances, challenges remain in accounting for individual variability, integrating multiscale data, and translating computational predictions into clinically validated solutions. By emphasizing interdisciplinary strategies that unite biomechanics, computational analytics, and innovative device engineering, this review outlines a pathway toward predictive, patient-centered healthcare and next-generation therapeutic and rehabilitation solutions. Full article

In recent years, hand exoskeleton robots have attracted extensive attention from researchers and practitioners due to their potential to rehabilitate, assist, and enhance hand movements, particularly for stroke patients. With an ageing population increasingly affected by strokes, there is a growing demand for patient-centred interventions which place less demand on clinicians, especially wearable devices that can enhance hand function. Advances in artificial intelligence have opened new avenues for developing more reliable and adaptive assistive systems. This study presents a systematic literature review, following the PRISMA protocol on the design elements of hand exoskeleton robots, acknowledging the emerging perspectives on AI integration and ethical considerations. The study provides a comprehensive foundation for future research and development in rehabilitation technologies by systematically synthesising the current mechanical architecture, actuation, sensors, material, weight, and cost aspects of soft hand exoskeleton robots for rehabilitation. The results show important patterns and trade-offs in various design dimensions, providing useful information to direct the development of more accessible and efficient rehabilitation solutions in the future. Full article

Introduction: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) volumes continue to rise, yet postoperative functional recovery and physical therapy (PT) utilization remain highly variable. Frailty and sarcopenia capture biological vulnerability beyond chronological age and may better explain heterogeneity in rehabilitation needs and recovery trajectories. Methods: We conducted a qualitative narrative review guided by SANRA recommendations. PubMed, Scopus, Web of Science, CINAHL, and Google Scholar were searched for English-language studies (January 2000–December 2025) involving adults undergoing THA/TKA that assessed preoperative frailty and/or sarcopenia and reported postoperative functional or rehabilitation-related outcomes. Data were extracted and synthesized thematically without quantitative pooling. Results: Thirty-four studies met inclusion criteria. Despite heterogeneous definitions and measures, both frailty and sarcopenia were consistently associated with slower early mobility, poorer functional recovery, longer hospital stays, and higher rates of non-home discharge. Frailty showed stronger links to post-acute care use and healthcare costs, whereas sarcopenia was more closely tied to impaired early function, delayed ambulation, and greater reliance on assistive devices. Frailty may improve after arthroplasty in some patients, while sarcopenia often represents a more persistent, muscle-specific limitation. Direct reporting of PT dose was uncommon, with only a minority of included studies explicitly reporting physical therapy frequency, duration, or intensity, limiting the ability to assess dose–response relationships. Conclusions: Preoperative frailty and sarcopenia are clinically meaningful predictors of functional recovery and rehabilitation utilization after THA/TKA and support vulnerability-informed discharge planning and stratified rehabilitation pathways. Future prospective studies should standardize vulnerability assessment and directly quantify PT dose, setting, and patient-centered outcomes to inform and test vulnerability-guided rehabilitation strategies, including prehabilitation. Full article

Artificial intelligence (AI) is reshaping medical rehabilitation by advancing from isolated assistive technologies toward data-driven program management. Beyond established applications in robotics and virtual reality, AI enables multimodal data integration, predictive analytics, adaptive therapy optimization, and real-time monitoring across rehabilitation domains. This review synthesizes 61 peer-reviewed studies to examine how AI supports the management, planning, and evaluation of rehabilitation programs. The evidence indicates strong technical maturity at the device and session levels, particularly in robotic control and wearable monitoring, whereas longitudinal program orchestration and system-level coordination remain at an emerging stage. Machine learning, reinforcement learning, computer vision, and time-series models facilitate patient phenotyping, therapy personalization, and prognostic modeling. However, their scalability is constrained by limited interoperability, heterogeneous outcome measures, and insufficient multicenter validation. A structured six-layer management architecture is proposed to conceptualize AI as an integrated orchestration framework. Advancing toward scalable and trustworthy rehabilitation ecosystems will require interoperable infrastructures, longitudinal validation, and embedded ethical and explainability mechanisms. Full article