Search Results (39)

Background: Manual dexterity (MD) impairment is a frequent and disabling feature in patients with Parkinson’s disease (PD) and paranoid schizophrenia (PS), significantly affecting functional independence and activities of daily living. However, rehabilitation strategies specifically targeting fine motor control remain insufficiently integrated into routine physiotherapy (PT). Objective: This study investigated the effects of a structured, progressive PT program incorporating targeted MD training on upper limb function in patients with PD and PS. Methods: A prospective, exploratory, interventional study was conducted in 30 patients, allocated to either an experimental group (EG, n = 20) or a control group (CG, n = 10). Participants had PD (Hoehn and Yahr stages II–III) or chronic, clinically stable PS. MD was assessed using the Purdue Pegboard Test, Coin Rotation Task, and Kapandji opposition score. The EG completed a four-phase, 40-week dexterity-oriented rehabilitation program, while the CG received standard disease-specific PT. Between-group differences in change scores were analyzed using one-way ANOVA. Results: The EG showed significantly greater improvements than the CG in thumb opposition, psychomotor processing speed, and unilateral and bilateral fine motor performance (p < 0.001 for all), with large to very large effect sizes (η² = 0.45–0.76). No significant between-group differences were observed for complex sequential assembly tasks. Conclusions: Integrating targeted MD training into structured PT programs significantly improves fine motor performance in patients with PD and PS, supporting its inclusion in rehabilitation protocols for residential and outpatient care settings. Full article

Stroke-induced motor impairment necessitates objective and quantitative assessment tools for rehabilitation planning. In this study, a gesture-specific framework based on high-density surface electromyography (HD-sEMG) was developed to characterize neuromuscular dysfunction using eight macroscopic features and two microscopic motor unit decomposition features. HD-sEMG recordings were collected from stroke patients (n = 11; affected and unaffected sides) and healthy controls (n = 8; dominant side) during seven standardized hand gestures. Feature-level comparisons revealed hierarchical abnormalities, with the affected side showing significantly reduced activation/coordination relative to healthy controls, while the unaffected side exhibited intermediate deviations. For each gesture, dedicated K-nearest neighbors (KNN) models were constructed for clinical validation. For Brunnstrom stage classification, wrist extension yielded the best performance, achieving 92.08% accuracy and effectively discriminating severe (Stage 4), moderate (Stage 5), and mild (Stage 6) impairment as well as healthy controls. For fine motor recovery prediction, the thumb–index–middle finger pinch provided the optimal regression performance, predicting Upper Extremity Fugl–Meyer Assessment (UE-FMA) scores with R = 0.86 and RMSE = 3.24. These results indicate that gesture selection should be aligned with the clinical endpoint: wrist extension is most informative for gross recovery staging, whereas pinch gestures better capture fine motor control. Overall, the proposed HD-sEMG framework provides an objective approach for monitoring post-stroke recovery and supporting personalized rehabilitation assessment. Full article

Background: Secretan’s syndrome is a rare and under-recognized condition characterized by chronic, indurated, non-pitting edema of the dorsal hand with thumb sparing. Twelve studies reporting 17 patients have been published worldwide, mostly as isolated case reports, and its pathogenesis remains debated between traumatic, inflammatory, and factitious mechanisms. This article presents a surgically managed hyperplastic case and a literature review, highlighting how precision medicine principles can guide diagnosis and treatment. Materials and Methods: A 36-year-old healthcare worker developed progressive dorsal swelling of the left hand following minor trauma, with marked restriction of metacarpophalangeal flexion. Laboratory tests and radiographs were normal. MRI demonstrated peritendinous fibrosis encasing the extensor tendons. Psychiatric evaluation excluded factitious behavior. Due to functional limitation and MRI evidence of fibrosis, selective fasciotomies and tenolysis were performed. A systematic literature review was conducted, in accordance with the PRISMA 2020 guidelines, to summarize epidemiology, clinical and imaging features, histopathology, and management options. Results: Histology revealed fibro-adipose tissue with chronic inflammatory changes and CD68+ histiocytic aggregates; microbiological cultures were negative. Postoperative rehabilitation enabled significant functional recovery. The literature review confirmed the scarcity of published cases and the absence of standardized guidelines. MRI proved the most informative imaging tool, while surgery was described only in refractory forms. Conclusions: This case and review illustrate how a precision medicine approach can optimize management of rare disorders. Early MRI-based diagnosis, multidisciplinary assessment, and phenotype-driven surgical intervention allowed tailored treatment and favorable outcome. Personalized care that integrates clinical features, imaging findings, and patient-specific factors may improve results despite the limited evidence base. Full article

Background: Carpometacarpal (CMC-I) arthritis is a frequent and disabling condition. Standard surgical options include trapeziectomy and prosthetic arthroplasty. While quantitative outcomes have been widely studied, little is known about patient perspectives regarding function, aesthetics, and rehabilitation. Methods: We conducted semi-structured interviews with ten patients who had undergone trapeziectomy on one side and prosthesis implantation on the contralateral side. Interviews were performed ≥6 months postoperatively, audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Researcher triangulation and member checking were applied to enhance trustworthiness. Results: Four overarching themes were identified. (1) Strength: Most patients reported greater strength and endurance on the prosthetic side, though both hands were generally adequate for daily activities. (2) Rehabilitation: Recovery after prosthesis implantation was described as markedly faster and less burdensome, with reduced need for therapy compared to trapeziectomy. (3) Aesthetics: Trapeziectomy was often associated with dissatisfaction due to thumb shortening and collapse, while prostheses were perceived as restoring a more natural appearance. (4) Surgical preference: When asked which procedure they would hypothetically choose again, all participants favored prosthesis implantation, citing superior function, faster recovery, and more favorable aesthetics. Conclusions: Patients who experienced both procedures consistently preferred prosthesis implantation. Their narratives highlight dimensions beyond standard clinical scores, including rehabilitation burden, appearance, and psychosocial impact. Incorporating patient-reported outcomes into surgical counseling is essential to align treatment of CMC-I arthritis with patient priorities and to support shared decision-making. Full article

This work introduces two complementary surface electromyography (sEMG) datasets for hand gesture recognition. Signals were collected from 40 healthy subjects aged 18 to 40 years, divided into two independent groups of 20 participants each. In both datasets, subjects performed five hand gestures. Most of the gestures are the same, although the exact set and the order differ slightly between datasets. For example, Dataset 2 (DS2) includes the simultaneous flexion of the thumb and index finger, which is not present in Dataset 1 (DS1). Data were recorded with three bipolar sEMG sensors placed on the dominant forearm (flexor digitorum superficialis, extensor digitorum, and flexor pollicis longus). A battery-powered acquisition system was used, with sampling rates of 1000 Hz for DS1 and 1500 Hz for DS2. DS1 contains recordings performed at a constant moderate force, while DS2 includes three force levels (low, medium, and high). Both datasets provide raw signals and pre-processed versions segmented into overlapping windows, with clear file structures and annotations, enabling feature extraction for machine learning applications. Together, they constitute a large-scale standardized sEMG resource that supports the development and benchmarking of gesture and force recognition algorithms for rehabilitation, assistive technologies, and prosthetic control. Full article

Background: Grip control is a critical determinant of fencing performance, requiring both stability and precision. Traditional measures of hand strength, such as dynamometry, provide only a global estimate and cannot capture finger-specific load distribution. Yet, upper-extremity overuse syndromes, tendinopathies of the wrist and digital flexors are common in fencers, underscoring the need for more granular assessments that may inform clinical practice, especially in prehension contexts. Methods: This pilot study included eight elite épée fencers from the Polish National Team (age: 23.9 ± 4.9 years; training experience: >10 years) tested using a novel épée handle instrumented with five force-sensitive resistors (FSRs) embedded beneath each finger. Participants performed two 5-s maximal voluntary contractions (MVCs) for each of the three conditions—Pinch (thumb + index), Trio (middle + ring + small), and Whole (all digits). Standard handheld dynamometry was also performed to provide a global reference measure. Results: Maximal grip strength measured with a dynamometer (65.3 ± 11.7 kgf) was substantially higher than finger-specific forces captured with the FSR handle (14.4 ± 4.4 kgf). Isolated Pinch contractions (83.0 ± 29.2 N) were significantly stronger than their integrated contribution within the Whole-hand condition (54.7 ± 16.3 N; Z = 2.52, p = 0.012), whereas Trio forces did not differ significantly (p = 0.263). On average, radial digits (thumb + index) contributed ~39% and ulnar digits (middle, ring, small) ~61% of Whole output, with the thumb and middle finger producing the largest forces. Conclusions: This pilot study demonstrates the feasibility of using an FSR-instrumented épée handle to capture finger-specific grip contributions in elite fencers. Despite limited statistical power (n = 8), the observed effects provide initial quantitative evidence for sport-specific, digit-level assessment, showing potential clinical utility in detecting maladaptive load-transfer mechanisms and informing rehabilitation and injury-prevention programs. Full article

Virtual reality (VR) is a promising tool in spinal cord injury (SCI) rehabilitation, particularly through virtual adaptations of functional tests like the Box and Block test (BBT). However, a comprehensive dynamic comparison between real and virtual BBT is lacking. This study investigates the kinematic and electromyographic (EMG) differences between healthy individuals and SCI patients performing both real (RBBT) and virtual (VBBT) versions of the BBT. An electromagnetic motion-tracking system, an instrumented glove, and surface EMG electrodes were used to capture hand trajectories, joint angles, and forearm muscle activation. The analysis included cycle-averaged and temporal kinematic and EMG parameters. Our findings reveal that both groups showed increased trajectory length and velocity peaks during the VBBT, with more pronounced increases in SCI patients. Unlike healthy individuals, SCI patients also showed increased finger and thumb flexion during VBBT. Cycle-averaged EMG values were lower in healthy participants during VBBT, likely due to reduced motor demands and lack of real grasping. Conversely, SCI patients exhibited higher muscle activity, suggesting impaired coordination and compensatory overactivation. Healthy individuals showed consistent temporal kinematic synergies and muscle activation, whereas they were altered in SCI patients, especially during reaching. These findings highlight the need for rehabilitation strategies to improve motor control and feedback integration. Full article

Spasticity often occurs following neurological disorders such as traumatic brain injury, cerebral palsy, and stroke. Botulinum toxin (BTX) injections, especially when paired with rehabilitation, are among the most effective interventions for these patients. Various techniques for administering BTX injections to the upper limb muscles have been described. However, a standardized method for ultrasound-guided injections in the intrinsic muscles of the hand remains quite scant in the literature. The authors suggest a novel dorsal approach to treat the most common abnormal postural patterns in hand spasticity, thumb-in-palm, and intrinsic plus. This approach facilitates access to the muscles while minimizing patient discomfort, as it avoids the need to open forcibly the spastic hand. The adductor pollicis, flexor pollicis brevis, lumbrical, and interosseus muscles have been identified as primary anatomical targets to improve hand posture and function. Standardized sonographic scans are leveled with anatomical illustrations and probe/patient positioning images for interventional procedures. Additionally, tips and techniques for promptly identifying vascular bundles are included to enhance the safety of the procedures. This technical report aims to provide an easy and ready-to-use tool in clinical practice for injecting intrinsic hand muscles in spastic patients, utilizing a novel dorsal approach. Full article

Background: COVID-19 presented many challenges for our health system, one being a suspected change in the epidemiology of severe hand trauma modalities. These complex injuries are traditionally treated at specialized hand trauma centers, but COVID-19 has in many ways disturbed these established pathways and presented new challenges. Methods: We retrospectively analyzed finger amputation injuries treated at the University Hospital of St. Poelten between 2018 and 2022 to examine differences in the management of micro amputation injuries before and during the COVID-19 pandemic. Further challenges in the treatment of hand trauma patients were analyzed and solutions were developed. Results: Overall, the number of occupational finger amputation injuries in Lower Austria declined during the COVID-19 pandemic. Contrarily, more private accidents were treated in the same period, suggesting a lockdown specific change in injury characteristics. Throughout the entire examined period, a total of 130 injured fingers, including 29 thumbs, were treated. In 67 cases, a reconstruction attempt was feasible and successful in 59 cases. Specific challenges were fewer active hand trauma centers, subsequent long transport times, specific COVID-19 prevention measures, and limited postoperative rehabilitation resources. Conclusions: Despite many challenges overall affecting the time to revascularization, good results were achieved by small but meaningful modifications. These included well-established principles such as back table preparation and strengthening novel concepts such as tele-medicine for patient selection. Overall, the reconstruction of severe hand injuries is often challenging, especially during a world-wide health crisis, but with adequate solutions, good results can be readily achieved. Full article

Background: This study reported a case of zone VII multiple neglected extensor tendons reconstruction with a palmaris longus tendon autograft in a 15-year-old boy 3 months after the initial trauma. Case presentations: Preoperative examinations revealed complete damage of the extensor carpi radialis longus (ECRL), extensor carpi radialis brevis (ECRB), abductor pollicis longus (APL), and partial injury of the extensor pollicis brevis (EPB). The extensor tendons were reconstructed with a palmaris longus tendon autograft combined with graft tunnel reconstruction within the scar at the level of the damaged retinaculum. After the surgical treatment, short immobilization and early rehabilitation were applied, providing passive sliding of the reconstructed tendon supplemented with actively mediated extension. Results: Despite the neglectful nature of the injury, surgical treatment and early postoperative rehabilitation resulted in an excellent functional outcome. At the follow-up visit, 6 months postoperative, the patient presented a full range of motion of the radiocarpal joint and thumb without any limitations on hand function. Conclusions: (1) Palmaris longus tendon autograft is a viable option for the treatment of multiple zone VII extensor tendon damage. (2) The combination of early passive motion and actively mediated extension provides tendon gliding and results in good functional outcomes for a hand with zone VII extensor tendon injury. (3) Ultrasound examination can evaluate early results and detect complications, mainly tendon/graft adhesions, after extensor tendon reconstruction surgery. Full article

An accurate assessment of thumb range of motion is crucial for diagnosing musculoskeletal conditions, evaluating functional impairments, and planning effective rehabilitation strategies. In this study, we aimed to enhance the accuracy of estimating thumb range of motion using a combination of MediaPipe, which is an AI-based posture estimation library, and machine learning methods, taking the values obtained using angle sensors to be the true values. Radial abduction, palmar abduction, and pronation angles were estimated using MediaPipe based on coordinates detected from videos of 18 healthy participants (nine males and nine females with an age range of 30–49 years) selected to reflect a balanced distribution of height and other physical characteristics. A conical thumb movement model was constructed, and parameters were generated based on the coordinate data. Five machine learning models were evaluated, with LightGBM achieving the highest accuracy across all metrics. Specifically, for radial abduction, palmar abduction, and supination, the root mean square error (RMSE), mean absolute error (MAE), coefficient of determination (R²), and correlation coefficient were 4.67°, 3.41°, 0.94, and 0.97; 4.63°, 3.41°, 0.95, and 0.98; and 5.69°, 4.17°, 0.88, and 0.94, respectively. These results demonstrate that when estimating thumb range of motion, the AI model trained using angle sensor data and LightGBM achieved accuracy that was high and comparable to that of prior methods involving the use of MediaPipe and a protractor. Full article

Background/Objectives: An Extensor Pollicis Longus (EPL) subcutaneous rupture is a substantial complication in post-traumatic or degenerative wrist and tendinous lesions. The diagnosis is essentially dictated by a clinical evaluation; in fact, it is characterized by the inability to extend the thumb interphalangeal joint and to retropose the thumb while the hand is resting on a surface. The tendinous transposition using the Extensor Indicis Proprius (EIP) as a donor tendon is a well-known surgical technique performed to restore functional activity to the thumb, and it is preferred for the closer cerebellar network with the thumb itself. However, there is a dearth of clinical results and scientific evidence in the literature. The aim of this study is to evaluate the return-to-work eligibility after an inveterate EPL subcutaneous rupture repaired with a transposition of the EIP. Methods: Patients who reported a subcutaneous rupture of the EPL due to rheumatic diseases or who had undergone previous hand or wrist surgery were excluded; however, all patients tested positive for traumatic wrist hypertension. The surgical technique involves three small incisions to achieve tenorrhaphy of the EIP at the distal head of the EPL. Dynamic tests are carried out intraoperatively to verify the tightness and sufficient rigidity of the suture. The objective evaluation involves the range of motion, pinch strength, and power extension of the thumb and the index finger. Patient-reported outcome measures for pain and patient satisfaction include the Numeric Pain Rating Scale and the Disabilities of the Arm, Shoulder, and Hand questionnaire. Results: A total of 12 patients were eligible (7 W, 5 M, mean age 56.3 years) and were followed for at least one year. There were no surgery-related complications. After the cast was removed 3 weeks after surgery, patients could extend their thumbs, put them back, and use their index fingers. An immediate improvement in objective and subjective assessments was reported. At 10 weeks, nine patients (75%) returned to full work with no pain and without the aid of rehabilitation; two patients (17%) returned to full work with no symptoms 2 weeks later; and only one patient (8%) with a neurological disease required physical therapy, achieving pain control and restoration of full mobility approximately six months after surgery. Conclusions: This surgical technique seems to address satisfactory results in terms of skill recovery and rapid return to work. A tailored rehabilitation program should be implemented for selected patients with neurological conditions that may prolong the adaptation process of the transposed tendon, the coordination, and the independent function of the thumb and index finger. Full article

In this paper, we propose a thumb rehabilitation device based on the concept of Repetitive Facilitation Exercise (RFE) therapy. Our device only uses rapid passive stretching to the extensor muscle to induce a stretch reflex as a facilitative stimulation. RFE, a proven rehabilitation method, promotes neural pathway recovery through repetitive voluntary movements facilitated by passive stimulation. We proposed a simple mechanism capable of performing flexion/extension and palmar adduction/abduction RFE training movements using only a single motor and a single link, without a tapping mechanism. Our results demonstrate that the proposed control method can induce a stretch reflex in the desired muscle through rapid adduction/flexion passive stretching and facilitate active abduction/extension motion. Full article

Background: Cardiopulmonary exercise testing is not used routinely. The goal of this study was to determine whether accurate estimates of VO₂ values can be made at the beginning and at the end of a rehabilitation program. Methods: A total of 91 cardiac rehabilitation patients were included. Each participant had to complete cardiopulmonary exercise testing at the beginning and at the end of a rehabilitation program. Measured VO₂ values were compared with estimates based on three different equations. Results: Analyses of the means of the differences in the peak values showed very good agreement between the results obtained with the FRIEND equation or those obtained with a combination of rules of thumb and the results of the measurements. This agreement was confirmed with the ICCs and with the standard errors of the measurements. The ACSM equation performed worse. The same tendency was seen when considering the VO₂ values at percentage-derived work rates. Conclusions: The FRIEND equation and the more easily applicable combination of rules of thumb are suitable for estimating the peak VO₂ and the VO₂ at a percentage-derived work rate in cardiac patients both at the beginning and at the end of a cardiac rehabilitation program. Full article

The finger workspace is crucial for performing various grasping tasks. Thus, various soft rehabilitation gloves have been developed to assist individuals with paralyzed hands in activities of daily living (ADLs) or rehabilitation training. However, most soft robotic glove designs are insufficient to assist with various hand postures because most of them use an underactuated mechanism for design simplicity. Therefore, this paper presents a methodology for optimizing the design of a high-degree-of-freedom soft robotic glove while not increasing the design complexity. We defined the required functional workspace of the index finger based on ten frequently used grasping postures in ADLs. The design optimization was achieved by simulating the proposed finger–robot model to obtain a comparable workspace to the functional workspace. In particular, the moment arm length for extension was optimized to facilitate the grasping of large objects (precision disk and power sphere), whereas a torque-amplifying routing design was implemented to aid the grasping of small objects (lateral pinch and thumb–two-finger pinch). The effectiveness of the optimized design was validated through testing with a stroke survivor and comparing the assistive workspace. The observed workspace demonstrated that the optimized glove design could assist with nine out of the ten targeted grasping posture functional workspaces. Furthermore, the assessment of the grasping speed and force highlighted the glove’s usability for various rehabilitation activities. We also present and discuss a generalized methodology to optimize the design parameters of a soft robotic glove that uses an underactuated mechanism to assist the targeted workspace. Overall, the proposed design optimization methodology serves as a tool for developing advanced hand rehabilitation robots, as it offers insight regarding the importance of routing optimization in terms of the workspace. Full article