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Human Pose Estimation (HPE) is a computer vision application that utilizes deep learning techniques to precisely locate Key Joint Points (KJPs), enabling the accurate description of a person’s pose. HPE models can be extended to facilitate Range of Motion (ROM) assessment by leveraging patient photographs. This study aims to evaluate and compare the performance of HPE models for assessing upper limbs ROM. A physiotherapist evaluated the degrees of ROM in shoulders (flexion, extension, and abduction) and elbows (flexion and extension) for fifty-two participants using both Universal Goniometer (UG) and five HPE models. Participants were instructed to repeat each movement three times to obtain measurements with the UG, then positioned while photos were captured using the NLMeasurer mobile application. The paired t-test, bias, and error measures were employed to evaluate the difference and agreement between measurement methods. Results indicated that the MoveNet Thunder INT16 model exhibited superior performance. Root Mean Square Errors obtained through this model were

Motor impairment is a common issue in stroke patients, often affecting the upper limbs. To this standpoint, robotic neurorehabilitation has shown to be highly effective for motor function recovery. Notably, Machine learning (ML) may be a powerful technique able to identify the optimal kind and intensity of rehabilitation treatments to maximize the outcomes. This retrospective observational research aims to assess the efficacy of robotic devices in facilitating the functional rehabilitation of upper limbs in stroke patients through ML models. Specifically, clinical scales, such as the Fugl-Meyer Assessment (A-D) (FMA), the Frenchay Arm Test (FAT), and the Barthel Index (BI), were used to assess the patients’ condition before and after robotic therapy. The values of these scales were predicted based on the patients’ clinical and demographic data obtained before the treatment. The findings showed that ML models have high accuracy in predicting the FMA, FAT, and BI, with R-squared (R2) values of 0.79, 0.57, and 0.74, respectively. The findings of this study suggest that integrating ML into robotic therapy may have the capacity to establish a personalized and streamlined clinical practice, leading to significant improvements in patients’ quality of life and the long-term sustainability of the healthcare system.

This present work is aimed at conducting fundamental and exploratory studies of the mechanisms of electrical impedance signal formation. This paper also considers morphofunctional changes in forearm tissues during the performance of basic hand actions. For this purpose, the existing research benches were modernized to conduct experiments of mapping forearm muscle activity by electrode systems on the basis of complexing the electrical impedance signals and electromyography signals and recording electrode systems’ pressing force using force transducers. Studies were carried out with the involvement of healthy volunteers in the implementation of vertical movement of the electrode system and ultrasound transducer when the subject’s upper limb was positioned in the bed of the stand while performing basic hand actions in order to identify the relationship between the morphofunctional activity of the upper limb muscles and the recorded parameters of the electro-impedance myography signal. On the basis of the results of the studies, including complex measurements of neuromuscular activity on healthy volunteers such as the signals of electro-impedance myography and pressing force, analyses of the morphofunctional changes in tissues during action performance on the basis of ultrasound and MRI studies and the factors influencing the recorded signals of electro-impedance myography are described. The results are of fundamental importance and will enable reproducible electro-impedance myography signals, which, in turn, allow improved anthropomorphic control.

In recent years, wearable systems based on inertial sensors opened new perspectives for functional motor assessment with respect to the gold standard motion capture systems. The aim of this study was to validate an experimental set-up based on 17 body-worn inertial sensors (Awinda, Xsens, The Netherlands), addressing specific body segments with respect to the state-of-the art system (VICON, Oxford Metrics Ltd., Oxford, UK) to assess upper limb kinematics in obese, with respect to healthy subjects. Twenty-three obese and thirty healthy weight individuals were simultaneously acquainted with the two systems across a set of three tasks for upper limbs (i.e., frontal arm rise, lateral arm rise, and reaching). Root Mean Square error (RMSE) was computed to quantify the differences between the measurements provided by the systems in terms of range of motion (ROM), whilst their agreement was assessed via Pearson’s correlation coefficient (PCC) and Bland–Altman (BA) plots. In addition, the signal waveforms were compared via one-dimensional statistical parametrical mapping (SPM) based on a paired t-test and a two-way ANOVA was applied on ROMs. The overall results partially confirmed the correlation and the agreement between the two systems, reporting only a moderate correlation for shoulder principal rotation angle in each task (r~0.40) and for elbow/flexion extension in obese subjects (r = 0.66), whilst no correlation was found for most non-principal rotation angles (r < 0.40). Across the performed tasks, an average RMSE of 34° and 26° was reported in obese and healthy controls, respectively. At the current state, the presence of bias limits the applicability of the inertial-based system in clinics; further research is intended in this context.

Given the widespread debate on the definition of the terms “Body Schema” and “Body Image”, this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.

Pullover and straight arm pulldown exercises are commonly used in resistance exercise programs to improve sports performance or in physical activity health programs. This study aimed to evaluate the individual electromyographic (EMG) activity of the pectoralis major (clavicular, sternal, and costal portions), latissimus dorsi, anterior deltoid, triceps brachii, and rectus abdominis muscles in a barbell pullover exercise at a 100% biacromial width and a straight arm pulldown exercise at a 100% and 150% biacromial width and to compare the EMG activity in these selected muscles and exercises. Twenty healthy and physically active adults performed a set of eight repetitions of each exercise against 30% of their body mass. The barbell pullover exercise presented a higher EMG activity (p ≤ 0.01) than the straight arm pulldown exercise in both biacromial widths in all evaluated muscles except for the latissimus dorsi and the triceps brachii. These muscles showed the highest EMG activity in the straight arm pulldown exercise at both biacromial widths. In all of the exercises and muscles evaluated, the concentric phase showed a greater EMG activity than the eccentric phase. In conclusion, the barbell pullover exercise can highlight muscle activity in the pectoralis major (mainly in the sternal and lower portions), triceps brachii, and rectus abdominis muscles. However, the straight arm pulldown exercise at 100% and 150% biacromial widths could be a better exercise to stimulate the latissimus dorsi and triceps brachii muscles. Moreover, all exercises showed significantly greater EMG activity (p < 0.001) in the concentric phase than in the eccentric phase for all the evaluated muscles.

Robotic exoskeletons are active devices that assist or counteract the movements of the body limbs in a variety of tasks, including in industrial environments or rehabilitation processes. With the introduction of textile and soft materials in these devices, the effective motion transmission, mechanical support of the limbs, and resistance to physical disturbances are some of the most desirable structural features. This paper proposes an evaluation protocol and assesses the mechanical support properties of a servo-controlled robotic exoskeleton prototype for rehabilitation in upper limbs. Since this prototype was built from soft materials, it is necessary to evaluate the mechanical behavior in the areas that support the arm. Some of the rehabilitation-supporting movements such as elbow flexion and extension, as well as increased muscle tone (spasticity), are emulated. Measurements are taken using the reference supplied to the system’s control stage and then compared with an external high-precision optical tracking system. As a result, it is evidenced that the use of soft materials provides satisfactory outcomes in the motion transfer and support to the limb. In addition, this study lays the groundwork for a future assessment of the prototype in a controlled laboratory environment using human test subjects.

Many qualitative and quantitative Magnetic Resonance Imaging (MRI) techniques have been applied to evaluate muscle fat degeneration in Duchenne muscular dystrophy (DMD) subjects, but only few studies have focused on the upper limbs. We reviewed the literature in order to evaluate the association between muscle MRI findings and motor function levels in the upper limbs of DMD patients. Ten studies with upper limb muscle MRI data were available. Four explored all upper limb segments, while six explored only the forearm. Functional assessments were performed in nine of the ten studies. All of the studies showed a significant correlation between muscle MRI changes and motor function levels in both ambulant and non-ambulant DMD patients.

Neuromotor rehabilitation and recovery of upper limb functions are essential to improve the life quality of patients who have suffered injuries or have pathological sequels, where it is desirable to enhance the development of activities of daily living (ADLs). Modern approaches such as robotic-assisted rehabilitation provide decisive factors for effective motor recovery, such as objective assessment of the progress of the patient and the potential for the implementation of personalized training plans. This paper focuses on the design, development, and preliminary testing of a wearable robotic exoskeleton prototype with autonomous Artificial Intelligence-based control, processing, and safety algorithms that are fully embedded in the device. The proposed exoskeleton is a 1-DoF system that allows flexion-extension at the elbow joint, where the chosen materials render it compact. Different operation modes are supported by a hierarchical control strategy, allowing operation in autonomous mode, remote control mode, or in a leader-follower mode. Laboratory tests validate the proper operation of the integrated technologies, highlighting a low latency and reasonable accuracy. The experimental result shows that the device can be suitable for use in providing support for diagnostic and rehabilitation processes of neuromotor functions, although optimizations and rigorous clinical validation are required beforehand.

Electroencephalography neurofeedback (EEG-NFB) training can induce changes in the power of targeted EEG bands. The objective of this study is to enhance and evaluate the specific changes of EEG power spectral density that the brain-machine interface (BMI) users can reliably generate for power augmentation through EEG-NFB training. First, we constructed an EEG-NFB training system for power augmentation. Then, three subjects were assigned to three NFB training stages, based on a 6-day consecutive training session as one stage. The subjects received real-time feedback from their EEG signals by a robotic arm while conducting flexion and extension movement with their elbow and shoulder joints, respectively. EEG signals were compared with each NFB training stage. The training results showed that EEG beta (12–40 Hz) power increased after the NFB training for both the elbow and the shoulder joints’ movements. EEG beta power showed sustained improvements during the 3-stage training, which revealed that even the short-term training could improve EEG signals significantly. Moreover, the training effect of the shoulder joints was more obvious than that of the elbow joints. These results suggest that NFB training can improve EEG signals and clarify the specific EEG changes during the movement. Our results may even provide insights into how the neural effects of NFB can be better applied to the BMI power augmentation system and improve the performance of healthy individuals.

Cervical spinal cord injury is damage to the spinal cord that causes temporary or permanent changes in body functions below the site of the injury. In particular, the impairment of the upper limbs limits the patient’s autonomy in the execution of activities of daily living. This paper illustrates the use of a low-cost robot with a virtual reality platform for upper limb rehabilitation of cervical spinal cord injury patients. Vibration and pressure haptic feedback sensations are provided thanks to a custom-made thimble feedback device. The virtual reality platform consists of three different virtual rehabilitation games developed in Unity. They provide the user with the opportunity to interact with the virtual scene using free hands thanks to the data collected by a hand tracking system. During the therapy session, quantitative data about the motor performance are collected. Each virtual reality environment can be modified in settings according to the patients’ needs. A proof of concept was performed with both healthy subjects and spinal cord injured patients to evaluate the platform and its usability. The data saved during the sessions are analyzed to validate the importance of haptic feedback and stored both for patients and therapists to control the performance and the recovery process.

Processing and control systems based on artificial intelligence (AI) have progressively improved mobile robotic exoskeletons used in upper-limb motor rehabilitation. This systematic review presents the advances and trends of those technologies. A literature search was performed in Scopus, IEEE Xplore, Web of Science, and PubMed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology with three main inclusion criteria: (a) motor or neuromotor rehabilitation for upper limbs, (b) mobile robotic exoskeletons, and (c) AI. The period under investigation spanned from 2016 to 2020, resulting in 30 articles that met the criteria. The literature showed the use of artificial neural networks (40%), adaptive algorithms (20%), and other mixed AI techniques (40%). Additionally, it was found that in only 16% of the articles, developments focused on neuromotor rehabilitation. The main trend in the research is the development of wearable robotic exoskeletons (53%) and the fusion of data collected from multiple sensors that enrich the training of intelligent algorithms. There is a latent need to develop more reliable systems through clinical validation and improvement of technical characteristics, such as weight/dimensions of devices, in order to have positive impacts on the rehabilitation process and improve the interactions among patients, teams of health professionals, and technology.

The use of videogames and motion capture systems in rehabilitation contributes to the recovery of the patient. This systematic review aimed to explore the works related to these technologies. The PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses) was used to search the databases Scopus, PubMed, IEEE Xplore, and Web of Science, taking into consideration four aspects: physical rehabilitation, the use of videogames, motion capture technologies, and upper limb rehabilitation. The literature selection was limited to open access works published between 2015 and 2020, obtaining 19 articles that met the inclusion criteria. The works reported the use of inertial measurement units (37%), a Kinect sensor (48%), and other technologies (15%). It was identified that 26% used commercial products, while 74% were developed independently. Another finding was that 47% of the works focus on post-stroke motor recovery. Finally, diverse studies sought to support physical rehabilitation using motion capture systems incorporating inertial units, which offer precision and accessibility at a low cost. There is a clear need to continue generating proposals that confront the challenges of rehabilitation with technologies which offer precision and healthcare coverage, and which, additionally, integrate elements that foster the patient’s motivation and participation.

Background : Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods : A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results : Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions : These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.

This paper presents a novel kinematic reconstruction of the human arm chain with five degrees of freedom and the estimation of the shoulder location during rehabilitation therapy assisted by end-effector robotic devices. This algorithm is based on the pseudoinverse of the Jacobian through the acceleration of the upper arm, measured using an accelerometer, and the orientation of the shoulder, estimated with a magnetic angular rate and gravity (MARG) device. The results show a high accuracy in terms of arm joints and shoulder movement with respect to the real arm measured through an optoelectronic system. Furthermore, the range of motion (ROM) of 50 healthy subjects is studied from two different trials, one trying to avoid shoulder movements and the second one forcing them. Moreover, the shoulder movement in the second trial is also estimated accurately. Besides the fact that the posture of the patient can be corrected during the exercise, the therapist could use the presented algorithm as an objective assessment tool. In conclusion, the joints’ estimation enables a better adjustment of the therapy, taking into account the needs of the patient, and consequently, the arm motion improves faster.

Background: Shoulder injuries are substantial problems in overhead athletes, and more studies are necessary to deepen the knowledge on this type of injury. The objective of this study was to compare the overall function and performance of female overhead athletes with and without a previous history of shoulder injuries., Methods: In this cross-sectional study, female overhead athletes with and without a previous shoulder injury were included. Muscular impairment, the stability of the shoulder, strength, scapular dyskinesia, functionality and sports performance were evaluated. A total of 50 females were included., Results: There were significant differences in strength ( p = 0.046) and stability ( p = 0.039) between groups, with a poorer score in the group with a history of shoulder injury. Regarding scapular dyskinesia, significant differences were also observed between groups ( p = 0.048), with higher levels of dyskinesia in the group with previous shoulder injury. Also, muscular impairment showed significant differences between groups for the three muscles evaluated ( p < 0.005). Additionally, the group without a previous shoulder injury presented with a significantly greater score in functionality ( p = 0.046) and sports performance ( p = 0.004)., Conclusion: In conclusion, previous shoulder injuries are an important factor to take into account in female overhead athletes. Players with a history of shoulder injury present clinical impairments during the game, leading to poorer functional status and performance in sport.

Current physiotherapy services may not be effective or suitable for certain patients due to lack of motivation, poor adherence to exercises, insufficient supervision and feedback or, in the worst case, refusal to continue with the rehabilitation plan. This paper introduces a novel approach for rehabilitation of upper limbs through KineActiv, a platform based on Microsoft Kinect v2 and developed in Unity Engine. KineActiv proposes exergames to encourage patients to perform rehabilitation exercises prescribed by a specialist, controls the patient′s performance, and corrects execution errors on the fly. KineActiv comprises a web platform where the physiotherapist can review session results, monitor patient health, and adjust rehabilitation routines. We recruited 10 patients for assessing the system usability as well as the system performance. Results show that KineActiv is a usable, enjoyable and reliable system, that does not cause any negative feelings.

Chronic intake of caffeine may produce a reduction in the potential performance benefits obtained with the acute intake of this substance. For this reason, athletes habituated to caffeine often use high doses of caffeine (≥9 mg/kg) to overcome tolerance to caffeine ergogenicity due to chronic intake. The main objective of the current investigation was to evaluate the effects of high caffeine doses on bar velocity during an explosive bench press throw in athletes habituated to caffeine. Twelve resistance-trained athletes, with a moderate-to-high chronic intake of caffeine (~5.3 mg/kg/day) participated in a randomized double-blind and randomized experimental design. Each participant performed three identical experimental sessions 60 min after the intake of a placebo (PLAC) or after the intake of 9 (CAF-9) or 12 mg/kg (CAF-12) of caffeine. In each experimental session, the athletes performed five sets of two repetitions of the bench press throw exercise with a load equivalent to 30% of their one-repetition maximum. In comparison to PLAC, the intake of caffeine increased peak and mean velocity ( p < 0.01) during the five sets of the bench press throw exercise. There were no significant differences in peak and mean bar velocity between the two doses of caffeine (CAF-9 vs. CAF-12; p = 0.91, = 0.96, respectively). The ingestion of high doses of caffeine was effective in producing an increase in mean and peak bar velocity during the bench press throw in a group of habitual caffeine users. However, using CAF-12 did not offer additional benefits for performance with respect to CAF-9.