Search Results (1,694)

Introduction: We sought to evaluate the effects of a 12-week pulmonary rehabilitation (PR) program on lung function, mechanics, as well as pulmonary and systemic inflammation in a cohort of 33 individuals with moderate to severe post-COVID-19. Material and Methods: The pulmonary rehabilitation (PR) program employed a combination of aerobic and resistance exercises. Thirty minutes of treadmill training at 75% of the maximum heart rate, combined with 30 min resistance training consisting of 75% of one maximum repetition, three times a week throughout 12 weeks. Results: PR improved the lung function, FVC (p < 0.02), FEV1 (p < 0.02), FEV1/FVC (p < 0.01), MEF25% (p < 0.006), MEF50% (p < 0.03), and MEF75% (p < 0.02). PR also positively influenced lung mechanics, reducing respiratory impedance (Z5Hz, p < 0.03), respiratory reactance (X5Hz, p < 0.01), resistance of the entire respiratory system (R5Hz, p < 0.03), central airway resistance (RCentral, p < 0.03), and peripheral airway resistance (RPeripheral, p < 0.02). Moreover, muscle strength gains were evident, with significant improvements observed in hand grip strength for both the right (p < 0.02) and left (p < 0.01) hands, as well as maximal inspiratory (p < 0.02) and expiratory (p < 0.03) pressures. Additionally, PR exhibited anti-inflammatory effects by reducing the pro-inflammatory cytokines IL-1β (p < 0.0001) and IL-6 (p < 0.0001) and increasing the anti-inflammatory IL-1RA (p < 0.0004) and IL-10 (p < 0.003) and anti-viral IFN-γ (p < 0.0002) and IFN-β (p < 0.008) cytokines in breath condensate and serum samples. Conclusions: Collectively, these findings highlight the effectiveness of PR in ameliorating COVID-19 sequel across respiratory system, skeletal muscle, and immune responses. This highlights its promising potential as a therapeutic intervention for individuals recovering from COVID-19. Full article

Background and Objectives: Despite the significant impacts of cognitive impairment on patients with chronic obstructive pulmonary disease (COPD), there is limited information available on healthcare workers’ (HCWs) perceptions, current practice, and barriers to managing COPD patients with cognitive impairment. Materials and Methods: A cross-sectional questionnaire was distributed to HCWs in Saudi Arabia between April and December 2023. The collected responses were analysed using descriptive statistics and logistic regression models. Results: A total of 890 participants, including nursing, physical, and respiratory therapists, completed the online questionnaire. Over two-thirds of the study participants indicated not having sufficient knowledge or adequate training in managing cognitive impairment in patients with COPD. The majority of HCWs perceive cognitive impairment to underdiagnose COPD (83%), underestimate COPD severity (81%), exacerbate COPD symptoms (80%), and interfere with self-management (81%) and pulmonary rehabilitation (81%). However, less than 45% (n = 394) reported having the potential to recognise signs of cognitive impairment during patient encounters. Logistic regression analysis revealed that male healthcare practitioners were more likely to recognise cognitive impairment than females (OR: 1.48; 95% CI: 1.13 to 1.95; p < 0.001). Physical and respiratory therapists were more likely to identify cognitive impairment compared to nurses. Additionally, having more years of experience (≥10 years, OR: 1.63; 95% CI: 1.02 to 2.61; p = 0.001) and adequate knowledge of cognitive impairment (OR: 6.23; 95% CI: 4.18 to 9.29; p = 0.001) were strongly associated with better recognition. Confidence in managing cognitively impaired COPD patients was low, attributed to poor training (64%), inadequate knowledge (64%), and the absence of standardised procedures (58%). Conclusions: HCWs agreed upon the negative impacts associated with cognitive impairment in patients with COPD. However, the potential of recognising signs of cognitive impairment and confidently dealing with the existence of cognitive impairment in COPD is not optimal, owing to poor training and limited knowledge. A focus should be given to managing comorbidities alongside COPD. Full article

This study designs and develops a wearable exoskeleton piano assistance system for individuals recovering from neurological injuries, aiming to help users regain the ability to perform complex tasks such as playing the piano. While soft robotic exoskeletons have proven effective in rehabilitation therapy and daily activity assistance, challenges remain in performing highly dexterous tasks due to structural complexity and insufficient motion accuracy. To address these issues, we developed a modular division method based on multi-domain mapping and a top-down process model. This method integrates the functional domain, structural domain, and user needs domain, and explores the principles and methods for creating functional construction modules, overcoming the limitations of traditional top-down approaches in design flexibility. By closely combining layout constraints with the design model, this method significantly improves the accuracy and efficiency of module configuration, offering a new path for the development of piano practice assistance devices. The results demonstrate that this device innovatively combines piano practice with rehabilitation training and through the introduction of ontological modeling methods, resolves the challenges of multidimensional needs mapping. Based on five user requirements (P), we calculated the corresponding demand weight (K), making the design more aligned with user needs. The device excels in enhancing motion accuracy, interactivity, and comfort, filling the gap in traditional piano assistance devices in terms of multi-functionality and high adaptability, and offering new ideas for the design and promotion of intelligent assistive devices. Simulation analysis, combined with the motion trajectory of the finger’s proximal joint, calculates that 60° is the maximum bending angle for the aforementioned joint. Physical validation confirms the device’s superior performance in terms of reliability and high-precision motion reproduction, meeting the requirements for piano-assisted training. Through multi-domain mapping, the top-down process model, and modular design, this research effectively breaks through the design flexibility and functional adaptability bottleneck of traditional piano assistance devices while integrating neurological rehabilitation with music education, opening up a new application path for intelligent assistive devices in the fields of rehabilitation medicine and arts education, and providing a solution for cross-disciplinary technology fusion and innovative development. Full article

Background. Wearable powered exoskeletons could be used to provide robotic-assisted gait training (RAGT) in people with stroke (PwST) and walking disability. The study aims to compare the differences in cardiac function, fatigue, and workload during activities of daily living (ADLs), while wearing an exoskeleton. Methods. Five PwST were recruited in this pilot cross-sectional study. We observed three experimental conditions: walking without and with the UAN.GO exoskeleton and walking with the UAN.GO combined with the OPTIGO walker. Each condition included five trials related to ADLs such as sitting and walking. Results. No statistically significant difference was found between heart rate and R–R of ECG data while comparing all the observed conditions during each respective trial. The NASA Task Load Index did not show significant differences across all trials, except for a significant difference between Condition 2 and Condition 3 in Trial 4 (p = 0.043). However, walking and sit-to-stand tasks seem to be more challenging according to the NASA-TLX. Only one participant scored over 70 points on the System Usability Scale. The TSQ-WT scores for conditions 2 and 3 were 62 (56.5–72.5) and 70 (66.5–75) points, respectively. Conclusions. This study suggests that UAN.GO exoskeleton could be used for RAGT in PwST with disability without compromising cardiovascular function. Full article

Objective: To assess the effects of a two-week course of intensive impairment-oriented arm rehabilitation for chronic stroke survivors on motor function. Methods: An observational cohort study that enrolled chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis, who received a two-week course of impairment-oriented and technology-supported arm rehabilitation (1:1 participant–therapist setting), which was carried out daily (five days a week) for four hours. The outcome measures were as follows: the primary outcome was the arm motor function of the affected arm (mild paresis: BBT, NHPT; severe paresis: Fugl-Meyer arm motor score). The secondary outcomes were measures of finger strength, active ROM, spasticity, joint mobility/pain, somatosensation, emotional distress, quality of life, acceptability, and adverse events. Results: One hundred chronic stroke survivors (≥6 months after stroke) with mild to severe arm paresis were recruited. The training was acceptable (drop-out rate 3%; 3/100). The clinical assessment indicated improved motor function (SMD 0.42, 95% CI 0.36–0.49; n = 97), reduced spasticity/resistance to passive movement, and slightly improved joint mobility/pain and somatosensation. The technology-based objective measures corroborated the improved active range of motion for arm and finger joints, reduced finger spasticity/resistance to passive movement, and the increased amount of use in daily life, but there was no effect on finger strength. The patient’s emotional well-being and quality of life were positively influenced. Adverse events were reported by the majority of participants (51%, 49/97) and were mild. Conclusions: Structured intensive impairment-oriented and technology-supported arm rehabilitation can promote motor function among chronic stroke survivors with mild to severe arm paresis and is an acceptable and tolerable form of treatment when supervised and adjusted by therapists. Full article

Parkinson’s disease is the second most common neurodegenerative disease worldwide, characterized by bradykinesia, rigidity, tremor, and postural instability. These symptoms often lead to significant postural deformities and an increased risk of falls, severely impacting the quality of life. Conventional rehabilitation methods have shown benefits, but recent advancements suggest that virtual reality (VR) could offer a promising alternative. This scoping review aims to analyze the current literature to evaluate the effectiveness of VR in the postural rehabilitation of patients with PD. A scientific literature search was performed using the following databases: PubMed, PEDro, Cochrane, and Google Scholar, focusing on randomized controlled trials (RCTs) published in English. Our selection criteria included studies that compared VR-based rehabilitation to traditional methods regarding posture-related outcomes. We identified and analyzed nine RCTs that met our inclusion criteria. The results consistently demonstrated that VR-based rehabilitation leads to greater improvements in balance and gait compared to conventional therapy. Key findings include significant enhancements in balance confidence and postural control and a reduction in fall rates. The superior efficacy of VR-based rehabilitation can be attributed to its engaging and immersive nature, which enhances patient motivation and adherence to therapy. VR allows for precise, repeatable training scenarios tailored to individual patient needs, providing a safe environment to practice and improve motor skills. In conclusion, VR-based rehabilitation represents an innovative approach with substantial potential to improve the quality of life for PD patients. However, limitations such as small sample sizes and short intervention durations in existing studies highlight the need for larger multicenter trials with longer follow-up periods to confirm these findings. Full article

People with fibromyalgia syndrome (FMS) may have difficulty attending rehabilitation sessions. We investigated the feasibility (adherence and satisfaction) of implementing an 8-week home-based somatosensory, entirely remote, self-training programme using the TrainPain smartphone app in people with FMS. The secondary aim was to evaluate the effect on pain symptoms. The training was performed 15 min/day, 7 days/week for 8 weeks. Participants identified the number of vibrations emitted by vibrotactile pods positioned on the most painful site and the contralateral side of the body. They completed the Brief Pain Inventory before, during (4 weeks), and at the end of the 8-week programme. At 8 weeks, they also rated satisfaction and the overall perceived change. The app recorded session completion. Of the 34 individuals recruited, 29 (mean, age 46 [SD] 9 years; 27 women; median duration of symptoms 7 [5;10] years) completed all assessments. Participants completed 75% of sessions and rated the programme easy-to-use and enjoyable, 94% would recommend the programme, and 38% reported a very strong improvement at 8 weeks. Pain intensity reduced from pre to post (effect size 0.77), as did interference (effect size 0.7 to 1.17). This treatment could be a useful addition to a multidisciplinary, multicomponent approach to FMS. Full article

Training wheelchair skills are vital for enhancing independence and safety. Traditional training methods require significant time and resources, limiting accessibility. Virtual reality (VR) offers an innovative solution by simulating real-life environments for training, reducing risks and costs. However, the effectiveness of VR in complementing real-life training remains underexplored. This review investigates how VR can complement traditional wheelchair training by assessing the strengths and limitations of existing VR systems. A literature review of 28 studies on VR applications for wheelchair training from 2017 to 2024 was conducted, focusing on studies that detailed VR environments and training programs. It was found that most VR systems were designed for powered wheelchair users with joystick navigation. VR environments included tasks from basic navigation to complex real-world scenarios. While VR showed potential in improving skills and engagement, challenges included the lack of standard methods for evaluating effectiveness and cybersickness. Overall, VR can be a valuable complementary tool for wheelchair training, especially for powered users. Future research should standardise protocols, and address side effects. Full article

The aims of this study were to assess the efficacy of the rate of perceived exertion (RPE) scale based on the number of repetitions in reserve (RIR) before exhaustion for the prescription of resistance training in cardiac rehabilitation and to compare it to the percentage of estimated one-repetition maximum (1RM) prescription method. Sixteen male patients (age 60 ± 8) with history of coronary artery disease were randomly assigned to two resistance training rehabilitation protocols lasting nine weeks and consisting of three sessions per week, with the same exercise selection, number of sets and repetitions, and rest periods, but different load prescription method (RPE vs. %1RM). Patients’ strength was evaluated pre- and post-intervention. Patients in the RPE group showed significant increases in strength across all the exercises of the protocol (leg press 24.25 ± 17.07 kg; chest press 7.25 ± 3.41 kg; seated row 13.88 ± 7.57 kg; leg extension 14.24 ± 4.53 kg; shoulder press 5.75 ± 4.06 kg; lat pulldown 7.50 ± 4.66 kg). Post-intervention between-group analysis showed no differences in strength gains (leg press p = 0.955; chest press p = 0.965; seated row p = 0.763; leg extension p = 0.565; shoulder press p = 0.868; lat pulldown p = 0.780) and trivial effect sizes (ES) for one prescription method over the other (leg press ES = −0.03; chest press ES = 0.00; seated row ES = 0.10; leg extension ES = −0.29; shoulder press ES = 0.18; lat pulldown ES = 0.05). RPE based on RIR seems to be an effective prescription method for resistance training in cardiac rehabilitation, showing similar efficacy to the standardized practice of percentage of 1RM. Full article

Background and Objectives: Pelvic floor dysfunction and sexual health issues are common postpartum due to weakened pelvic muscles, significantly impacting women’s quality of life (QoL). Pelvic floor muscle training (PFMT) is a widely used approach to address these issues. This study aimed to compare the effectiveness of two rehabilitation methods—vibrating vaginal cones (VCG) and PFMT exercises (CG)—in improving pelvic floor muscle strength, reducing dyspareunia, and enhancing sexual function in postpartum women. Materials and Methods: This 1-year retrospective observational analysis evaluated 57 postpartum women presenting with perineal muscle relaxation and sexual dysfunction. Participants were assessed 3 months postpartum (T0) and after 3 months of therapy (T1) at the Pelvic Floor Rehabilitation Clinic of Santa Chiara Hospital, Pisa. Outcomes were measured using the pubococcygeus (PC) test for pelvic floor strength and the Female Sexual Function Index (FSFI) for sexual function. Results: The results revealed significant improvements in pelvic floor muscle strength and sexual function across both groups. While both interventions effectively reduced dyspareunia, the VCG group demonstrated superior outcomes, with 96.67% of participants reporting no pain compared to 80.95% in the CG. FSFI scores improved significantly in both groups, with greater enhancements in arousal, desire, and pain domains observed in the VCG group (p < 0.01). Vaginal cone therapy also resulted in slightly higher gains in overall pelvic floor strength. Conclusions: These findings suggest that vibrating vaginal cones may be a promising option for postpartum pelvic floor rehabilitation, with potential benefits for improving sexual satisfaction and reducing pain. Full article

This paper proposes a new model of collaborative filtering that introduces a user difference factor to address the issue of less pronounced similarity performance in traditional algorithms. The algorithm is applied to the recommendation of pilots’ core competency behavior indicators to support pilots’ daily training arrangements, improve their core competencies, and ensure civil aviation flight safety. Firstly, based on traditional collaborative filtering methods, a user difference factor is introduced to improve the Pearson similarity calculation model. Secondly, the advantages and disadvantages of collaborative filtering recommendation models were evaluated using various methods such as average absolute error, accuracy, recall, and diversity. Finally, the new model is applied to the recommendation of PLM core competency behavior indicators, providing a recommendation list of different pilot behavior indicators to support their rehabilitation or enhanced training plans and arrangements. The calculation results show that the new model of collaborative filtering demonstrates better advantages, not only reducing the MAE value, but also improving the accuracy, recall, and diversity of the calculation results, providing effective guidance and theoretical support for pilots’ flight training and safe flight. Full article

Purpose: Cognitive dysfunctions are still very common in the chronic phase of stroke when patients are discharged from neurorehabilitation centers. Even individuals who appear to have made a full clinical recovery may exhibit new deficiencies at home. Here, we present evidence of a novel kind of therapy at home aimed at contrasting the heterogenic evolution of stroke patients using a multidomain cognitive approach. Methods: Eighteen ischemic stroke patients were assessed in a within-subject longitudinal design (age 62.33 ± 11.1 years; eight men). Patients underwent the Tele-NeuroRehabilitation (TNR) multidomain cognitive training treatment using the Virtual Reality Rehabilitation System (VRRS) five times a week for 1 h sessions for four consecutive weeks. The protocol included the stimulation of specific cognitive functions, such as logical skills, praxis skills, attention, executive functions, memory, space time orientation and perception, and speech therapy. To determine neuropsychological changes, patients were evaluated before the sessions (T0), at the end of the sessions (T1), and after six months (T2). Results: The multidomain cognitive training induced a significant improvement in the working memory and language abilities as well as depression symptoms and alleviated caregiver burden. Most of this cognitive enhancement persisted after six months (T2), with the exception of depression symptoms. Otherwise, a significant decline in attention abilities was reported, thus demonstrating a lack of effect in this function. Conclusions: Our results suggest that multidomain cognitive TNR is a suitable protocol for reducing some cognitive and behavioral alterations in patients with strokes, with a beneficial impact also on the caregivers’ burden distress management. Further RCTs are warranted to validate this new kind of approach. Full article

Background/Objectives: Vestibular rehabilitation, an evidence-based physical therapy approach, plays a crucial role in managing and recovering from gaze and balance disorders, including those of central origin. This study, targeted at the community of Italian healthcare practitioners, is vital in understanding the application of vestibular rehabilitation in neurological disorders and in identifying knowledge gaps, barriers, and future directions. Methods: This is a cross-sectional study directed at healthcare professionals involved in neurorehabilitation in Italy. The survey consisted of 29 items grouped in 4 sections, which was estimated to take approximately 10 min to complete. The questions covered socio-demographic information, professional information, clinical practice, and future perspectives on vestibular rehabilitation. Results: Out of the 435 respondents, 290 completed the survey. Most of the respondents reported either no (32.87%) or little (42.91%) experience in vestibular rehabilitation. However, most participants (72.98%) recognized the importance of vestibular rehabilitation in treating neurological disorders. The most common condition treated was stroke (46.39%), while balance training (52.69%) and visual input exercises (26.35%) were the two most frequently used strategies. The main barriers to implementing vestibular rehabilitation in clinical practice were equipment cost and insufficient skills. Conclusions: Vestibular physical therapy is a promising complementary approach in neurorehabilitation. However, the study reveals a perceived lack of basic training in vestibular assessment and therapy. This suggests that more efforts are needed to bridge this knowledge gap and make necessary equipment more accessible. Full article

Background: There has been a growing interest in using inertial sensors to explore the temporal aspects of the Timed Up and Go (TUG) test. The current study aimed to analyze the spatiotemporal parameters and phases of the TUG test in patients with knee osteoarthritis (KOA) and compare the results with those of non-arthritic individuals. Methods: This study included 20 patients with KOA and 60 non-arthritic individuals aged 65 to 84 years. All participants performed the TUG test, and 17 spatiotemporal parameters and phase data were collected wirelessly using the BTS G-Walk inertial sensor. Results: Significant mobility impairments were observed in KOA patients, including slower gait speed, impaired sit-to-stand transitions, and reduced turning efficiency. These findings highlight functional deficits in individuals with KOA compared to their non-arthritic counterparts. Conclusions: The results emphasize the need for targeted physiotherapy interventions, such as quadriceps strengthening, balance training, and gait retraining, to address these deficits. However, the study is limited by its small sample size, gender imbalance, and limited validation of the BTS G-Walk device. Future research should include larger, more balanced cohorts, validate sensor reliability, and conduct longitudinal studies. Despite these limitations, the findings align with previous research and underscore the potential of inertial sensors in tailoring rehabilitation strategies and monitoring progress in KOA patients. Full article

Background/Objectives: For effective exercise prescription for patients with cardiovascular disease, it is important to determine the target heart rate at the level of the anaerobic threshold (AT-HR). The AT-HR is mainly determined by cardiopulmonary exercise testing (CPET). The aim of this study is to develop a machine learning (ML) model to predict the AT-HR solely from non-exercise clinical features. Methods: From consecutive 21,482 cases of CPET between 2 February 2008 and 1 December 2021, an appropriate subset was selected to train our ML model. Data consisted of 78 features, including age, sex, anthropometry, clinical diagnosis, cardiovascular risk factors, vital signs, blood tests, and echocardiography. We predicted the AT-HR using a ML method called gradient boosting, along with a rank of each feature in terms of its contribution to AT-HR prediction. The accuracy was evaluated by comparing the predicted AT-HR with the target HRs from guideline-recommended equations in terms of the mean absolute error (MAE). Results: A total of 8228 participants included healthy individuals and patients with cardiovascular disease and were 62 ± 15 years in mean age (69% male). The MAE of the AT-HR by the ML-based model was 7.7 ± 0.2 bpm, which was significantly smaller than those of the guideline-recommended equations; the results using Karvonen formulas with the coefficients 0.7 and 0.4 were 34.5 ± 0.3 bpm and 11.9 ± 0.2 bpm, respectively, and the results using simpler formulas, rest HR + 10 and +20 bpm, were 15.9 ± 0.3 and 9.7 ± 0.2 bpm, respectively. The feature ranking method revealed that the features that make a significant contribution to AT-HR prediction include the resting heart rate, age, N-terminal pro-brain natriuretic peptide (NT-proBNP), resting systolic blood pressure, highly sensitive C-reactive protein (hsCRP), cardiovascular disease diagnosis, and β-blockers, in that order. Prediction accuracy with the top 10 to 20 features was comparable to that with all features. Conclusions: An accurate prediction model of the AT-HR from non-exercise clinical features was proposed. We expect that it will facilitate performing cardiac rehabilitation. The feature selection technique newly unveiled some major determinants of AT-HR, such as NT-proBNP and hsCRP. Full article