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21 pages, 9225 KiB

Open AccessArticle

Train vs. Play: Evaluating the Effects of Gamified and Non-Gamified Wheelchair Skills Training Using Virtual Reality

by Chantal Zorzi, Luma Tabbaa, Alexandra Covaci, Konstantinos Sirlantzis and Gianluca Marcelli

Bioengineering 2023, 10(11), 1269; https://doi.org/10.3390/bioengineering10111269 - 31 Oct 2023

Cited by 1 | Viewed by 1918

Abstract

This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered [...] Read more.

This study compares the influence of a gamified and a non-gamified virtual reality (VR) environment on wheelchair skills training. In specific, the study explores the integration of gamification elements and their influence on wheelchair driving performance in VR-based training. Twenty-two non-disabled participants volunteered for the study, of whom eleven undertook the gamified VR training, and eleven engaged in the non-gamified VR training. To measure the efficacy of the VR-based wheelchair skills training, we captured the heart rate (HR), number of joystick movements, completion time, and number of collisions. In addition, an adapted version of the Wheelchair Skills Training Program Questionnaire (WSTP-Q), the Igroup Presence Questionnaire (IPQ), and the Simulator Sickness Questionnaire (SSQ) questionnaires were administered after the VR training. The results showed no differences in wheelchair driving performance, the level of involvement, or the ratings of presence between the two environments. In contrast, the perceived cybersickness was statistically higher for the group of participants who trained in the non-gamified VR environment. Remarkably, heightened cybersickness symptoms aligned with increased HR, suggesting physiological connections. As such, while direct gamification effects on the efficacy of VR-based wheelchair skills training were not statistically significant, its potential to amplify user engagement and reduce cybersickness is evident. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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23 pages, 5036 KiB

Open AccessArticle

The Translation of Mobile-Exoneuromusculoskeleton-Assisted Wrist–Hand Poststroke Telerehabilitation from Laboratory to Clinical Service

by Wanyi Qing, Ching-Yi Nam, Harvey Man-Hok Shum, Marko Ka-Leung Chan, King-Pong Yu, Serena Sin-Wah Ng, Bibo Yang and Xiaoling Hu

Bioengineering 2023, 10(8), 976; https://doi.org/10.3390/bioengineering10080976 - 18 Aug 2023

Cited by 3 | Viewed by 1563

Abstract

Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist/hand exoneuromusculoskeleton (WH-ENMS) [...] Read more.

Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist/hand exoneuromusculoskeleton (WH-ENMS) into routine clinical services and to compare the rehabilitative effects achieved in the hospital-service-based group (n = 12, clinic group) with the laboratory-research-based group (n = 12, lab group). Both groups showed significant improvements (p ≤ 0.05) in clinical assessments of behavioral motor functions and in muscular coordination and kinematic evaluations after the training and at the 3-month follow-up, with the lab group demonstrating better motor gains than the clinic group (p ≤ 0.05). The results indicated that the WH-ENMS-assisted tele-program was feasible and effective for upper limb rehabilitation when integrated into routine practice, and the quality of patient–operator interactions physically and remotely affected the rehabilitative outcomes. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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16 pages, 3791 KiB

Open AccessArticle

Development of an Integrated Powered Hip and Microprocessor-Controlled Knee for a Hip–Knee–Ankle–Foot Prosthesis

by Yousef Bader, David Langlois, Natalie Baddour and Edward D. Lemaire

Bioengineering 2023, 10(5), 614; https://doi.org/10.3390/bioengineering10050614 - 19 May 2023

Viewed by 2222

Abstract

Hip–knee–ankle–foot prostheses (HKAF) are full lower-limb devices for people with hip amputations that enable individuals to regain their mobility and move freely within their chosen environment. HKAFs typically have high rejection rates among users, as well as gait asymmetry, increased trunk anterior–posterior lean, [...] Read more.

Hip–knee–ankle–foot prostheses (HKAF) are full lower-limb devices for people with hip amputations that enable individuals to regain their mobility and move freely within their chosen environment. HKAFs typically have high rejection rates among users, as well as gait asymmetry, increased trunk anterior–posterior lean, and increased pelvic tilt. A novel integrated hip–knee (IHK) unit was designed and evaluated to address the limitations of existing solutions. This IHK combines powered hip and microprocessor-controlled knee joints into one structure, with shared electronics, sensors, and batteries. The unit is also adjustable to user leg length and alignment. ISO-10328:2016 standard mechanical proof load testing demonstrated acceptable structural safety and rigidity. Successful functional testing involved three able-bodied participants walking with the IHK in a hip prosthesis simulator. Hip, knee, and pelvic tilt angles were recorded and stride parameters were analyzed from video recordings. Participants were able to walk independently using the IHK and data showed that participants used different walking strategies. Future development of the thigh unit should include completion of a synergistic gait control system, improved battery-holding mechanism, and amputee user testing. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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13 pages, 974 KiB

Open AccessArticle

Assessment of Dorsiflexion Ability across Tasks in Persons with Subacute SCI after Combined Locomotor Training and Transcutaneous Spinal Stimulation

by Jasmine M. Hope and Edelle C. Field-Fote

Bioengineering 2023, 10(5), 528; https://doi.org/10.3390/bioengineering10050528 - 26 Apr 2023

Viewed by 1501

Abstract

In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity [...] Read more.

In people with spinal cord injury (SCI), transcutaneous spinal stimulation (TSS) has an immediate effect on the ability to dorsiflex the ankle, but persistent effects are not known. Furthermore, TSS has been associated with improved walking, increased volitional muscle activation, and decreased spasticity when combined with locomotor training (LT). In this study, the persistent impact of combined LT and TSS on dorsiflexion during the swing phase of walking and a volitional task in participants with SCI is determined. Ten participants with subacute motor-incomplete SCI received 2 weeks of LT alone (wash-in phase), followed by 2 weeks of either LT + TSS (TSS at 50 Hz) or LT + TSS_Sham (intervention phase). There was no persistent effect of TSS on dorsiflexion during walking and inconsistent effects on the volitional task. There was a strong positive correlation between the dorsiflexor ability for both tasks. There was a moderate effect of 4 weeks of LT on increased dorsiflexion during the task (d = 0.33) and walking (d = 0.34) and a small effect on spasticity (d = −0.2). Combined LT + TSS did not show persistent effects on dorsiflexion ability in people with SCI. Four weeks of locomotor training was associated with increased dorsiflexion across tasks. Improvements in walking observed with TSS may be due to factors other than improved ankle dorsiflexion. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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12 pages, 1511 KiB

Open AccessArticle

Effects of Lumbar Stabilization Exercises on Isokinetic Strength and Muscle Tension in Sedentary Men

by Seunghyeok Yeom, Hyeongdo Jeong, Hyungwoo Lee and Kyoungkyu Jeon

Bioengineering 2023, 10(3), 342; https://doi.org/10.3390/bioengineering10030342 - 8 Mar 2023

Viewed by 2563

Abstract

Lumbar stabilization exercises (LSE) lead to high levels of erector spinae muscle (ESM) activation, which has a positive effect on improving physical function. The purpose of this study is to identify factors explaining changes in muscle strength after 7 weeks of LSE and [...] Read more.

Lumbar stabilization exercises (LSE) lead to high levels of erector spinae muscle (ESM) activation, which has a positive effect on improving physical function. The purpose of this study is to identify factors explaining changes in muscle strength after 7 weeks of LSE and to evaluate changes in stiffness and contraction of the ESM. All participants (male: n = 42, age = 28.26 ± 10.97) were assessed for 60°/s isokinetic extensor muscle strength and tension using a tensiomyography (TMG) and isokinetic device before and after LSE. Maximum displacement (Dm) and average velocity up to 90% Dm (Vc 90) were significantly different before and after LSE. Additionally, participants’ 60°/s isokinetic extensor strength was significantly higher after exercise. A regression analysis was conducted to test the explanatory power of the variables, and positive results were obtained in the increase in extensor strength before and after Vc 90 and LSE. Furthermore, statistical significance was set at p < 0.05. After LSE, the increase in 60°/s isokinetic extensor strength and ESM’s Dm and Vc 90 can be interpreted as positive changes post-exercise in endurance muscles with a higher percentage of type I fibers. Our results can contribute to predicting the long-term exercise effect in sedentary workers and developing an individualized strategic exercise program. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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20 pages, 3527 KiB

Open AccessArticle

Using Wearable Sensors to Assess Freezing of Gait in the Real World

by David S. May, Lauren E. Tueth, Gammon M. Earhart and Pietro Mazzoni

Bioengineering 2023, 10(3), 289; https://doi.org/10.3390/bioengineering10030289 - 23 Feb 2023

Cited by 6 | Viewed by 2085

Abstract

Freezing of gait (FOG) is a debilitating symptom of Parkinson’s disease (PD) that remains difficult to assess. Wearable movement sensors and associated algorithms can be used to quantify FOG in laboratory settings, but the utility of such methods for real world use is [...] Read more.

Freezing of gait (FOG) is a debilitating symptom of Parkinson’s disease (PD) that remains difficult to assess. Wearable movement sensors and associated algorithms can be used to quantify FOG in laboratory settings, but the utility of such methods for real world use is unclear. We aimed to determine the suitability of our wearable sensor-based FOG assessment method for real world use by assessing its performance during in-clinic simulated real world activities. Accuracy of the sensor-based method during simulated real-world tasks was calculated using expert rated video as the gold standard. To determine feasibility for unsupervised home use, we also determined correlations between the percent of active time spent freezing (%ATSF) during unsupervised home use and in-clinic activities. Nineteen people with PD and FOG participated in this study. Results from our sensor-based method demonstrated an accuracy above 90% compared to gold-standard expert review during simulated real-world tasks. Additionally, %ATSF from our sensor-based method during unsupervised home use correlated strongly with %ATSF from our sensor-based method during in-clinic simulated real-world activities (ρ = 0.73). Accuracy values and correlation patterns suggest our method may be useful for FOG assessment in the real world. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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13 pages, 1234 KiB

Open AccessArticle

Rehabilitation Practitioners’ Perceptions of Optimal Sitting and Standing Posture in Men with Normal Weight and Obesity

by Jiling Ye, Ziang Jiang, Shijie Chen, Rongshan Cheng, Lili Xu and Tsung-Yuan Tsai

Bioengineering 2023, 10(2), 210; https://doi.org/10.3390/bioengineering10020210 - 6 Feb 2023

Cited by 2 | Viewed by 5957

Abstract

The concepts of “optimal posture (OP)” and “harmful posture (HP)” are commonly used, and specific spinal postures can contribute to back pain. However, quantitative descriptions of optimal and harmful standing (StP) and sitting (SP) postures are currently lacking, particularly for different body mass [...] Read more.

The concepts of “optimal posture (OP)” and “harmful posture (HP)” are commonly used, and specific spinal postures can contribute to back pain. However, quantitative descriptions of optimal and harmful standing (StP) and sitting (SP) postures are currently lacking, particularly for different body mass indices (BMIs). Therefore, this study aimed to identify and quantify the OPs and HPs of StP and SP at different BMIs and investigate the attitudes and beliefs of rehabilitation practitioners toward OPs and HPs. Overall, 552 rehabilitation practitioners were recruited to participate in a questionnaire survey to select the optimal position from seven sitting and five standing postures for each BMI healthy volunteer. The segmental relationships of each posture were qualified using the Vicon software. For normal BMI, the physiotherapists chose two SPs (48.19% and 49.64%) and one StP (80.42%) as the OP. One sitting SP (83.7%) and two standing StPs (43.48% and 48.19%) were selected as optimal for obese BMI. All the most commonly selected OPs had an upright lordotic posture, while the postures with slouched spinal curves or forward head postures were almost all selected as HP. Additionally, 96.74% of participants considered education about optimal SP and StP to be “quite” or “very” important. The OP of the StP and SP postures was mostly based on the vertical alignment of gravity lines and sagittal balance. For obese people, the rehabilitation practitioners’ observations may be erroneous, and further physical examination is necessary. Rehabilitation practitioners generally believe that postural education is essential in clinical practice. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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17 pages, 5773 KiB

Open AccessArticle

Smart Work Injury Management (SWIM) System: A Machine Learning Approach for the Prediction of Sick Leave and Rehabilitation Plan

by Peter H. F. Ng, Peter Q. Chen, Zackary P. T. Sin, Sun H. S. Lai and Andy S. K. Cheng

Bioengineering 2023, 10(2), 172; https://doi.org/10.3390/bioengineering10020172 - 28 Jan 2023

Cited by 4 | Viewed by 2163

Abstract

As occupational rehabilitation services are part of the public medical and health services in Hong Kong, work-injured workers are treated along with other patients and are not considered a high priority for occupational rehabilitation services. The idea of a work trial arrangement in [...] Read more.

As occupational rehabilitation services are part of the public medical and health services in Hong Kong, work-injured workers are treated along with other patients and are not considered a high priority for occupational rehabilitation services. The idea of a work trial arrangement in the private market occurred to meet the need for a more coordinated occupational rehabilitation practice. However, there is no clear service standard in private occupational rehabilitation services nor concrete suggestions on how to offer rehabilitation plans to injured workers. Electronic Health Records (EHRs) data can provide a foundation for developing a model to improve this situation. This project aims at using a machine-learning-based approach to enhance the traditional prediction of disability duration and rehabilitation plans for work-related injury and illness. To help patients and therapists to understand the machine learning result, we also developed an interactive dashboard to visualize machine learning results. The outcome is promising. Using the variational autoencoder, our system performed better in predicting disability duration. We have around 30% improvement compared with the human prediction error. We also proposed further development to construct a better system to manage the work injury case. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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20 pages, 2177 KiB

Open AccessArticle

SARN: Shifted Attention Regression Network for 3D Hand Pose Estimation

by Chenfei Zhu, Boce Hu, Jiawei Chen, Xupeng Ai and Sunil K. Agrawal

Bioengineering 2023, 10(2), 126; https://doi.org/10.3390/bioengineering10020126 - 17 Jan 2023

Cited by 1 | Viewed by 2333

Abstract

Hand pose estimation (HPE) plays an important role during the functional assessment of the hand and in potential rehabilitation. It is a challenge to predict the pose of the hand conveniently and accurately during functional tasks, and this limits the application of HPE. [...] Read more.

Hand pose estimation (HPE) plays an important role during the functional assessment of the hand and in potential rehabilitation. It is a challenge to predict the pose of the hand conveniently and accurately during functional tasks, and this limits the application of HPE. In this paper, we propose a novel architecture of a shifted attention regression network (SARN) to perform HPE. Given a depth image, SARN first predicts the spatial relationships between points in the depth image and a group of hand keypoints that determine the pose of the hand. Then, SARN uses these spatial relationships to infer the 3D position of each hand keypoint. To verify the effectiveness of the proposed method, we conducted experiments on three open-source datasets of 3D hand poses: NYU, ICVL, and MSRA. The proposed method achieved state-of-the-art performance with 7.32 mm, 5.91 mm, and 7.17 mm of mean error at the hand keypoints, i.e., mean Euclidean distance between the predicted and ground-truth hand keypoint positions. Additionally, to test the feasibility of SARN in hand movement recognition, a hand movement dataset of 26K depth images from 17 healthy subjects was constructed based on the finger tapping test, an important component of neurological exams administered to Parkinson’s patients. Each image was annotated with the tips of the index finger and the thumb. For this dataset, the proposed method achieved a mean error of 2.99 mm at the hand keypoints and comparable performance on three task-specific metrics: the distance, velocity, and acceleration of the relative movement of the two fingertips. Results on the open-source datasets demonstrated the effectiveness of the proposed method, and results on our finger tapping dataset validated its potential for applications in functional task characterization. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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20 pages, 9373 KiB

Open AccessArticle

Development and Validation of a System for the Assessment and Recovery of Grip Force Control

by Martina Lapresa, Clemente Lauretti, Francesco Scotto di Luzio, Federica Bressi, Fabio Santacaterina, Marco Bravi, Eugenio Guglielmelli, Loredana Zollo and Francesca Cordella

Bioengineering 2023, 10(1), 63; https://doi.org/10.3390/bioengineering10010063 - 4 Jan 2023

Cited by 6 | Viewed by 2505

Abstract

The ability to finely control hand grip forces can be compromised by neuromuscular or musculoskeletal disorders. Therefore, it is recommended to include the training and assessment of grip force control in rehabilitation therapy. The benefits of robot-mediated therapy have been widely reported in [...] Read more.

The ability to finely control hand grip forces can be compromised by neuromuscular or musculoskeletal disorders. Therefore, it is recommended to include the training and assessment of grip force control in rehabilitation therapy. The benefits of robot-mediated therapy have been widely reported in the literature, and its combination with virtual reality and biofeedback can improve rehabilitation outcomes. However, the existing systems for hand rehabilitation do not allow both monitoring/training forces exerted by single fingers and providing biofeedback. This paper describes the development of a system for the assessment and recovery of grip force control. An exoskeleton for hand rehabilitation was instrumented to sense grip forces at the fingertips, and two operation modalities are proposed: (i) an active-assisted training to assist the user in reaching target force values and (ii) virtual reality games, in the form of tracking tasks, to train and assess the user’s grip force control. For the active-assisted modality, the control of the exoskeleton motors allowed generating additional grip force at the fingertips, confirming the feasibility of this modality. The developed virtual reality games were positively accepted by the volunteers and allowed evaluating the performance of healthy and pathological users. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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12 pages, 1332 KiB

Open AccessArticle

Bilateral Sensorimotor Cortical Communication Modulated by Multiple Hand Training in Stroke Participants: A Single Training Session Pilot Study

by Jian-Jia Huang, Yu-Cheng Pei, Yi-Yu Chen, Shen-Shiou Tseng and Jen-Wen Hung

Bioengineering 2022, 9(12), 727; https://doi.org/10.3390/bioengineering9120727 - 24 Nov 2022

Cited by 1 | Viewed by 2021

Abstract

Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different [...] Read more.

Bi-manual therapy (BT), mirror therapy (MT), and robot-assisted rehabilitation have been conducted in hand training in a wide range of stages in stroke patients; however, the mechanisms of action during training remain unclear. In the present study, participants performed hand tasks under different intervention conditions to study bilateral sensorimotor cortical communication, and EEG was recorded. A multifactorial design of the experiment was used with the factors of manipulating objects (O), robot-assisted bimanual training (RT), and MT. The sum of spectral coherence was applied to analyze the C3 and C4 signals to measure the level of bilateral corticocortical communication. We included stroke patients with onset <6 months (n = 6), between 6 months and 1 year (n = 14), and onset >1 year (n = 20), and their Brunnstrom recovery stage ranged from 2 to 4. The results showed that stroke duration might influence the effects of hand rehabilitation in bilateral cortical corticocortical communication with significant main effects under different conditions in the alpha and beta bands. Therefore, stroke duration may influence the effects of hand rehabilitation on interhemispheric coherence. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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19 pages, 4971 KiB

Open AccessArticle

Two-Dof Upper Limb Rehabilitation Robot Driven by Straight Fibers Pneumatic Muscles

by Francesco Durante, Terenziano Raparelli and Pierluigi Beomonte Zobel

Bioengineering 2022, 9(8), 377; https://doi.org/10.3390/bioengineering9080377 - 9 Aug 2022

Cited by 5 | Viewed by 2416

Abstract

In this paper, the design of a 2-dof (degrees of freedom) rehabilitation robot for upper limbs driven by pneumatic muscle actuators is presented. This paper includes the different aspects of the mechanical design and the control system and the results of the first [...] Read more.

In this paper, the design of a 2-dof (degrees of freedom) rehabilitation robot for upper limbs driven by pneumatic muscle actuators is presented. This paper includes the different aspects of the mechanical design and the control system and the results of the first experimental tests. The robot prototype is constructed and at this preliminary step a position and trajectory control by fuzzy logic is implemented. The pneumatic muscle actuators used in this arm are designed and constructed by the authors’ research group. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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13 pages, 3874 KiB

Open AccessArticle

Actuator and Contact Force Modeling of an Active Soft Brace for Scoliosis

by Athar Ali, Vigilio Fontanari, Werner Schmoelz and Marco Fontana

Bioengineering 2022, 9(7), 303; https://doi.org/10.3390/bioengineering9070303 - 11 Jul 2022

Cited by 3 | Viewed by 4243

Abstract

Scoliosis is an abnormality of the spinal curvature that severely affects the musculoskeletal, respiratory, and nervous systems. Conventionally, it is treated using rigid spinal braces. These braces are static, rigid, and passive in nature, and they (largely) limit the mobility of the spine, [...] Read more.

Scoliosis is an abnormality of the spinal curvature that severely affects the musculoskeletal, respiratory, and nervous systems. Conventionally, it is treated using rigid spinal braces. These braces are static, rigid, and passive in nature, and they (largely) limit the mobility of the spine, resulting in other spinal complexities. Moreover, these braces do not have precise control over how much force is being applied by them. Over-exertion of force may deteriorate the spinal condition. This article presents a novel active soft brace that allows mobility to the spine while applying controlled corrective forces that are regulated by varying the tensions in elastic bands using low-power light weight twisted string actuators (TSAs). This article focuses on the actuator and contact force modeling of the active soft brace (ASB). The actuator modeling is required to translate the twisting of string in terms of contraction of the string’s length, whereas the contact force modeling helps in estimating the net resultant force exerted by the band on the body using single point pressure/force sensors. The actuators (TSAs) are modeled as helix geometry and validated using a laser position sensor. The results showed that the model effectively tracked the position (contraction in length) with root mean square error (RMSE) of 1.7386 mm. The contact force is modeled using the belt and pulley contact model and validated by building a custom testbed. The actuator module is able to regulate the pressure in the range 0–6 Kpa, which is comparable to 0–8 Kpa pressure regulated in rigid braces. This makes it possible to verify and demonstrate the working principle of the proposed active soft brace. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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11 pages, 2685 KiB

Open AccessArticle

Automatic Identification of Failure in Hip Replacement: An Artificial Intelligence Approach

by Mattia Loppini, Francesco Manlio Gambaro, Katia Chiappetta, Guido Grappiolo, Anna Maria Bianchi and Valentina D. A. Corino

Bioengineering 2022, 9(7), 288; https://doi.org/10.3390/bioengineering9070288 - 29 Jun 2022

Cited by 12 | Viewed by 3026

Abstract

Background: Total hip arthroplasty (THA) follow-up is conventionally conducted with serial X-ray imaging in order to ensure the early identification of implant failure. The purpose of this study is to develop an automated radiographic failure detection system. Methods: 630 patients with THA were [...] Read more.

Background: Total hip arthroplasty (THA) follow-up is conventionally conducted with serial X-ray imaging in order to ensure the early identification of implant failure. The purpose of this study is to develop an automated radiographic failure detection system. Methods: 630 patients with THA were included in the study, two thirds of which needed total or partial revision for prosthetic loosening. The analysis is based on one antero-posterior and one lateral radiographic view obtained from each patient during routine post-surgery follow-up. After pre-processing for proper standardization, images were analyzed through a convolutional neural network (the DenseNet169 network), aiming to predict prosthesis failure. The entire dataset was divided in three subsets: training, validation, and test. These contained transfer learning and fine-tuning algorithms, based on the training dataset, and were implemented to adapt the DenseNet169 network to the specific data and clinical problem. Results: After the training procedures, in the test set, the classification accuracy was 0.97, the sensitivity 0.97, the specificity 0.97, and the ROC AUC was 0.99. Only five images were incorrectly classified. Seventy-four images were classified as failed, and eighty as non-failed with a probability >0.999. Conclusion: The proposed deep learning procedure can detect the loosening of the hip prosthesis with a very high degree of precision. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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Review

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21 pages, 340 KiB

Open AccessReview

Virtual Reality for the Rehabilitation of Acquired Cognitive Disorders: A Narrative Review

by Valentina Catania, Francesco Rundo, Simonetta Panerai and Raffaele Ferri

Bioengineering 2024, 11(1), 35; https://doi.org/10.3390/bioengineering11010035 - 28 Dec 2023

Cited by 10 | Viewed by 4186

Abstract

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation [...] Read more.

This review article explores the use of Virtual Reality (VR) technology in cognitive rehabilitation for individuals with neurological conditions, such as stroke, traumatic brain injury, and neurodegenerative diseases. The introduction highlights the challenges posed by cognitive impairments and the limitations of traditional rehabilitation methods. VR is presented as a transformative tool that immerses individuals in interactive environments, offering promising opportunities for enhancing cognitive functions and improving quality of life. This article covers the foundational principles of VR, its applications across different clinical conditions and cognitive domains, and evaluates empirical evidence supporting its efficacy. It also discusses the advantages, limitations, challenges, and ethical considerations in the use of VR for cognitive rehabilitation. This review concludes by exploring future developments, including advancements in VR technology, the integration of Augmented Reality (AR) and artificial intelligence (AI), and the importance of standardized assessment tools for the objective evaluation of rehabilitation outcomes. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

31 pages, 8260 KiB

Open AccessReview

Exo Supportive Devices: Summary of Technical Aspects

by António Diogo André and Pedro Martins

Bioengineering 2023, 10(11), 1328; https://doi.org/10.3390/bioengineering10111328 - 17 Nov 2023

Cited by 2 | Viewed by 1951

Abstract

Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement [...] Read more.

Human societies have been trying to mitigate the suffering of individuals with physical impairments, with a special effort in the last century. In the 1950s, a new concept arose, finding similarities between animal exoskeletons, and with the goal of medically aiding human movement (for rehabilitation applications). There have been several studies on using exosuits with this purpose in mind. So, the current review offers a critical perspective and a detailed analysis of the steps and key decisions involved in the conception of an exoskeleton. Choices such as design aspects, base materials (structure), actuators (force and motion), energy sources (actuation), and control systems will be discussed, pointing out their advantages and disadvantages. Moreover, examples of exosuits (full-body, upper-body, and lower-body devices) will be presented and described, including their use cases and outcomes. The future of exoskeletons as possible assisted movement solutions will be discussed—pointing to the best options for rehabilitation. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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18 pages, 3426 KiB

Open AccessReview

Gait Analysis in Neurorehabilitation: From Research to Clinical Practice

by Mirjam Bonanno, Alessandro Marco De Nunzio, Angelo Quartarone, Annalisa Militi, Francesco Petralito and Rocco Salvatore Calabrò

Bioengineering 2023, 10(7), 785; https://doi.org/10.3390/bioengineering10070785 - 30 Jun 2023

Cited by 14 | Viewed by 5445

Abstract

When brain damage occurs, gait and balance are often impaired. Evaluation of the gait cycle, therefore, has a pivotal role during the rehabilitation path of subjects who suffer from neurological disorders. Gait analysis can be performed through laboratory systems, non-wearable sensors (NWS), and/or [...] Read more.

When brain damage occurs, gait and balance are often impaired. Evaluation of the gait cycle, therefore, has a pivotal role during the rehabilitation path of subjects who suffer from neurological disorders. Gait analysis can be performed through laboratory systems, non-wearable sensors (NWS), and/or wearable sensors (WS). Using these tools, physiotherapists and neurologists have more objective measures of motion function and can plan tailored and specific gait and balance training early to achieve better outcomes and improve patients’ quality of life. However, most of these innovative tools are used for research purposes (especially the laboratory systems and NWS), although they deserve more attention in the rehabilitation field, considering their potential in improving clinical practice. In this narrative review, we aimed to summarize the most used gait analysis systems in neurological patients, shedding some light on their clinical value and implications for neurorehabilitation practice. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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22 pages, 6018 KiB

Open AccessReview

A Review of Brain Activity and EEG-Based Brain–Computer Interfaces for Rehabilitation Application

by Mostafa Orban, Mahmoud Elsamanty, Kai Guo, Senhao Zhang and Hongbo Yang

Bioengineering 2022, 9(12), 768; https://doi.org/10.3390/bioengineering9120768 - 5 Dec 2022

Cited by 39 | Viewed by 9598

Abstract

Patients with severe CNS injuries struggle primarily with their sensorimotor function and communication with the outside world. There is an urgent need for advanced neural rehabilitation and intelligent interaction technology to provide help for patients with nerve injuries. Recent studies have established the [...] Read more.

Patients with severe CNS injuries struggle primarily with their sensorimotor function and communication with the outside world. There is an urgent need for advanced neural rehabilitation and intelligent interaction technology to provide help for patients with nerve injuries. Recent studies have established the brain-computer interface (BCI) in order to provide patients with appropriate interaction methods or more intelligent rehabilitation training. This paper reviews the most recent research on brain-computer-interface-based non-invasive rehabilitation systems. Various endogenous and exogenous methods, advantages, limitations, and challenges are discussed and proposed. In addition, the paper discusses the communication between the various brain-computer interface modes used between severely paralyzed and locked patients and the surrounding environment, particularly the brain-computer interaction system utilizing exogenous (induced) EEG signals (such as P300 and SSVEP). This discussion reveals with an examination of the interface for collecting EEG signals, EEG components, and signal postprocessing. Furthermore, the paper describes the development of natural interaction strategies, with a focus on signal acquisition, data processing, pattern recognition algorithms, and control techniques. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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17 pages, 1570 KiB

Open AccessSystematic Review

Use and Effectiveness of Electrosuit in Neurological Disorders: A Systematic Review with Clinical Implications

by David Perpetuini, Emanuele Francesco Russo, Daniela Cardone, Roberta Palmieri, Andrea De Giacomo, Raffaello Pellegrino, Arcangelo Merla, Rocco Salvatore Calabrò and Serena Filoni

Bioengineering 2023, 10(6), 680; https://doi.org/10.3390/bioengineering10060680 - 2 Jun 2023

Cited by 9 | Viewed by 3697

Abstract

Electrical stimulation through surface electrodes is a non-invasive therapeutic technique used to improve voluntary motor control and reduce pain and spasticity in patients with central nervous system injuries. The Exopulse Mollii Suit (EMS) is a non-invasive full-body suit with integrated electrodes designed for [...] Read more.

Electrical stimulation through surface electrodes is a non-invasive therapeutic technique used to improve voluntary motor control and reduce pain and spasticity in patients with central nervous system injuries. The Exopulse Mollii Suit (EMS) is a non-invasive full-body suit with integrated electrodes designed for self-administered electrical stimulation to reduce spasticity and promote flexibility. The EMS has been evaluated in several clinical trials with positive findings, indicating its potential in rehabilitation. This review investigates the effectiveness of the EMS for rehabilitation and its acceptability by patients. The literature was collected through several databases following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Positive effects of the garment on improving motor functions and reducing spasticity have been shown to be related to the duration of the administration period and to the dosage of the treatment, which, in turn, depend on the individual’s condition and the treatment goals. Moreover, patients reported wellbeing during stimulation and a muscle-relaxing effect on the affected limb. Although additional research is required to determine the efficacy of this device, the reviewed literature highlights the EMS potential to improve the motor capabilities of neurological patients in clinical practice. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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24 pages, 2926 KiB

Open AccessSystematic Review

Effectiveness of Mechanical Horse-Riding Simulator-Based Interventions in Patients with Cerebral Palsy—A Systematic Review and Meta-Analysis

by Esteban Obrero-Gaitán, Desirée Montoro-Cárdenas, Irene Cortés-Pérez and María Catalina Osuna-Pérez

Bioengineering 2022, 9(12), 790; https://doi.org/10.3390/bioengineering9120790 - 11 Dec 2022

Cited by 5 | Viewed by 3347

Abstract

Background: Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in [...] Read more.

Background: Mechanical horse-riding simulator (HRS) exercises are a type of therapy based on the use of robotic or mechanical devices that produces movement similar to a real horse with the aim of simulating hippotherapy. This review analyses the effectiveness of HRS therapies in patients with cerebral palsy (CP). Methods: A systematic review and a meta-analysis were carried out by searching studies in PubMed Medline, SCOPUS, Web of Science, CINAHL, PEDro and SciELO up until October 2022. We selected clinical trials that assessed the effectiveness of HRS therapy, compared to other interventions, in patients with CP. The main variables were gross motor function (its global score and dimensions, such as sitting ability), functional balance, spasticity, hip range of motion (ROM), posturographic balance and satisfaction. The risk of bias was assessed using the Cochrane Risk of Bias Tool. The pooled effect was calculated using Cohen’s Standardized Mean Difference (SMD) for a 95% confidence interval (95% CI). Results: Twelve studies were included in the systematic review, and 10 were included in the meta-analysis, providing data from 343 patients with spastic diplegic CP. Our findings revealed that HRS plus physiotherapy is more effective than physiotherapy in improving the total gross motor function (SMD 0.98; 95% CI 0.35–1.62), sitting ability of the gross motor function (SMD 0.84; 95% CI 0.32–1.36) and functional balance (SMD 0.6; 95% CI 0.1–1.08), and HRS therapy is better than sham to improve pelvic abduction ROM (SMD 0.79; 95% CI 0.21–1.37). Conclusions: Horse-riding simulator-based therapy is an effective therapy to improve gross motor function, functional balance and abduction pelvic ROM in children with CP, in comparison to physiotherapy or sham. Full article

(This article belongs to the Special Issue Bioengineering for Physical Rehabilitation)

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