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A new stream of research and development responds to changes in life expectancy across the world. It includes technologies which enhance well-being of individuals, specifically for older people. The ACCOMPANY project focuses on home companion technologies and issues surrounding technology development for assistive purposes. The project responds to some overlooked aspects of technology design, divided into multiple areas such as empathic and social human-robot interaction, robot learning and memory visualisation, and monitoring persons’ activities at home. To bring these aspects together, a dedicated task is identified to ensure technological integration of these multiple approaches on an existing robotic platform, Care-O-Bot®3 in the context of a smart-home environment utilising a multitude of sensor arrays. Formative and summative evaluation cycles are then used to assess the emerging prototype towards identifying acceptable behaviours and roles for the robot, for example role as a butler or a trainer, while also comparing user requirements to achieved progress. In a novel approach, the project considers ethical concerns and by highlighting principles such as autonomy, independence, enablement, safety and privacy, it embarks on providing a discussion medium where user views on these principles and the existing tension between some of these principles, for example tension between privacy and autonomy over safety, can be captured and considered in design cycles and throughout project developments.

Abstract Background Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer (FM) outcome measure. Methods We demonstrate the design of our clinical trial and its results analysed using a novel statistical approach based on a multivariate analytical model. This paper provides the rational for using multivariate models in robot-mediated clinical trials and draws conclusions from the clinical data gathered during the GENTLE/S study. Results The FM outcome measures recorded during the baseline (8 sessions), robot-mediated therapy (9 sessions) and sling-suspension (9 sessions) was analysed using a multiple regression model. The results indicate positive but modest recovery trends favouring both interventions used in GENTLE/S clinical trial. The modest recovery shown occurred at a time late after stroke when changes are not clinically anticipated. Conclusion This study has applied a new method for analysing clinical data obtained from rehabilitation robotics studies. While the data obtained during the clinical trial is of multivariate nature, having multipoint and progressive nature, the multiple regression model used showed great potential for drawing conclusions from this study. An important conclusion to draw from this paper is that this study has shown that the intervention and control phase both caused changes over a period of 9 sessions in comparison to the baseline. This might indicate that use of new challenging and motivational therapies can influence the outcome of therapies at a point when clinical changes are not expected. Further work is required to investigate the effects arising from early intervention, longer exposure and intensity of the therapies. Finally, more function-oriented robot-mediated therapies or sling-suspension therapies are needed to clarify the effects resulting from each intervention for stroke recovery.

Background/objectives: The association between egg consumption and dementia is unclear. We carried out a population-based case-control study in China to determine the independent association of egg consumption with dementia., Methods: We randomly recruited 233 participants with dementia and 233 without dementia from the community health service clinics and the dementia management system in Guangzhou, China to examine their dietary intakes over the past two years and other risk factors for chronic diseases. Egg consumption was categorised by frequency as Non-consuming/

While many robot-aided solutions have been proposed for the rehabilitation of the distal segment of the upper limb, very few take into account the synergy between the wrist and fingers to allow them to train simultaneously in a home environment. WiGlove is a passive robotic orthosis designed to address this need. This wearable, wireless device enables stroke survivors to perform flexion/extension exercises of both the wrist and fingers while performing ADL or playing therapeutic computer games. As a part of its user-centred design process, this paper presents a case study of a 6-week feasibility evaluation of the WiGlove conducted at a stroke survivor's home without assistance from the therapists. The participant trained with the device for an average of 48 minutes a day and showed a noticeable reduction in the spasticity of the fingers and improved performance in the box and block test. He expressed satisfaction with its usability and suitability for the home environment. These results show overwhelmingly positive outcomes in terms of its acceptance, usability and effectiveness in offering home-based rehabilitation of the wrist and fingers.

Background: Metabolic syndrome (MetS) is a condition caused by a combination of cardiometabolic risk factors (CMR). MetS leads to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), both of which place a burden on not only the patients but also the healthcare system. Diagnostic criteria for MetS vary, and there is no universal tool to detect it. Recently, many studies have found positive associations between the atherogenic index of plasma (AIP) and some CMR factors. Therefore, a comprehensive review was needed to recapitulate these studies and qualitatively estimate the likelihood of AIP being associated with CMR. We aimed to review and summarise observational data on AIP and CMR factors and verify their association., Materials and Methods: A review of observational studies was conducted by searching "atherogenic index of plasma" in PubMed, One Search, and the Cochrane library. A total of 2068 articles were screened, and 32 were included after excluding paediatric, non-human and interventional studies, and those carried out on cohorts with conditions unrelated to MetS or on lipid-lowering medication. The Newcastle-Ottawa scale was used to assess their quality., Results: Most studies that reported high waist circumference (WC), triglycerides (TG), insulin resistance (IR) and low high-density lipoprotein cholesterol (HDL-C) concentration, also reported high AIP. Few studies investigated blood pressure (BP) and some discrepancies existed between their results., Conclusion: AIP may be associated with WC, TG, IR, and HDL-C. It is unclear if AIP is associated with BP. The current study's results should be used to inform futureward a meta-analysis to be seen quantitatively. It is also recommended that more cohort studies stratified by gender and ethnicity be performed to ascertain if AIP can predict MetS before it manifests.

High carbohydrate, lower fat (HCLF) diets are recommended to reduce cardiometabolic disease (CMD) but low carbohydrate high fat (LCHF) diets can be just as effective. The effect of LCHF on novel insulin resistance biomarkers and the metabolome has not been fully explored. The aim of this study was to investigate the impact of an ad libitum 8-week LCHF diet compared with a HCLF diet on CMD markers, the metabolome, and insulin resistance markers. n = 16 adults were randomly assigned to either LCHF (n = 8, <50 g CHO p/day) or HCLF diet (n = 8) for 8 weeks. At weeks 0, 4 and 8, participants provided fasted blood samples, measures of body composition, blood pressure and dietary intake. Samples were analysed for markers of cardiometabolic disease and underwent non-targeted metabolomic profiling. Both a LCHF and HCLF diet significantly (p < 0.01) improved fasting insulin, HOMA IR, rQUICKI and leptin/adiponectin ratio (p < 0.05) levels. Metabolomic profiling detected 3489 metabolites with 78 metabolites being differentially regulated, for example, an upregulation in lipid metabolites following the LCHF diet may indicate an increase in lipid transport and oxidation, improving insulin sensitivity. In conclusion, both diets may reduce type 2 diabetes risk albeit, a LCHF diet may enhance insulin sensitivity by increasing lipid oxidation.

This paper investigates the EEG spectral feature modulations associated with fatigue induced by robot-mediated upper limb gross and fine motor interactions. Twenty healthy participants were randomly assigned to perform a gross motor interaction with HapticMASTER or a fine motor interaction with SCRIPT passive orthosis for 20 min or until volitional fatigue. Relative and ratio band power measures were estimated from the EEG data recorded before and after the robot-mediated interactions. Paired-samples t -tests found a significant increase in the relative alpha band power and a significant decrease in the relative delta band power due to the fatigue induced by the robot-mediated gross and fine motor interactions. The gross motor task also significantly increased the (θ + α)/β and α/β ratio band power measures, whereas the fine motor task increased the relative theta band power. Furthermore, the robot-mediated gross movements mostly changed the EEG activity around the central and parietal brain regions, whereas the fine movements mostly changed the EEG activity around the frontopolar and central brain regions. The subjective ratings suggest that the gross motor task may have induced physical fatigue, whereas the fine motor task may have induced mental fatigue. Therefore, findings affirm that changes to localised brain activity patterns indicate fatigue developed from the robot-mediated interactions. It can also be concluded that the regional differences in the prominent EEG spectral features are most likely due to the differences in the nature of the task (fine/gross motor and distal/proximal upper limb) that may have differently altered an individual's physical and mental fatigue level. The findings could potentially be used in future to detect and moderate fatigue during robot-mediated post-stroke therapies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dissanayake, Steuber and Amirabdollahian.)

Background: Increasing protein intake (above the Recommended Dietary Amount) alone or with resistance-based exercise is suggested to improve cardiometabolic health; however, randomized controlled trials (RCTs) are needed to confirm this., Methods: The Liverpool Hope University-Sarcopenia Aging Trial (LHU-SAT) was a 16 week RCT (ClinicalTrials.gov Identifier: NCT02912130) of 100 community-dwelling older adults [mean age: 68.73 ± 5.80 years, body mass index: 27.06 ± 5.18 kg/m 2 (52% women)] who were randomized to four independent groups [Control (C), Exercise (E), Exercise + Protein (EP), Protein (P)]. E and EP completed supervised and progressive resistance-based exercise (resistance exercise: two times per week, functional circuit exercise: once per week), while EP and P were supplemented with a leucine-enriched whey protein drink (three times per day) based on individual body weight (0.50 g/kg/meal, 1.50 g/kg/day). Outcome measures including arterial stiffness (pulse wave velocity), fasting plasma/serum biomarkers [glucose/glycated haemoglobin, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein, insulin, resistin, leptin, adiponectin, C-reactive protein, tumour necrosis factor-alpha, interleukin-6, cystatin-C, & ferritin], insulin resistance (HOMA-IR), and kidney function (eGFR) were measured before and after intervention., Results: Total protein intake (habitual diet plus supplementation) increased to 1.55 ± 0.69 g/kg/day in EP and to 1.93 ± 0.72 g/kg/day in P, and remained significantly lower (P < 0.001) in unsupplemented groups (E: 1.08 ± 0.33 g/kg/day, C: 1.00 ± 0.26 g/kg/day). At 16 weeks, there was a group-by-time interaction whereby absolute changes in LDL-cholesterol were lower in EP [mean difference: -0.79 mmol/L, 95% confidence interval (CI): -1.29, -0.28, P = 0.002] and P (mean difference: -0.76 mmol/L, 95% CI: -1.26, -0.26, P = 0.003) vs. C. Serum insulin also showed group-by-time interactions at 16 weeks whereby fold changes were lower in EP (mean difference: -0.40, 95% CI: -0.65, -0.16, P = 0.001) and P (mean difference: -0.32, 95% CI: -0.56, -0.08, P = 0.009) vs. C, and fold changes in HOMA-IR improved in EP (mean difference: -0.37, 95% CI: -0.64, -0.10, P = 0.007) and P (mean difference: -0.27, 95% CI: -0.53, -0.00, P = 0.048) vs. C. Serum resistin declined in P only (group-by-time interaction at 16 weeks: P = 0.009). No other interactions were observed in outcome measures (P > 0.05), and kidney function (eGFR) remained unaltered., Conclusions: Sixteen weeks of leucine-enriched whey protein supplementation alone and combined with resistance-based exercise improved cardiometabolic health markers in older adults., (© 2021 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.)

Background: Recent evidence highlights racquet sports as being associated with a substantially reduced risk of CVD mortality. The purpose of this investigation was to evaluate clustered cardiometabolic risk (CMR) and arterial stiffness in recreational adult tennis players., Methods: Forty-three recreational tennis players (T) and a matched group of 45 healthy, active non-tennis (NT) players, mean age (±SEM) 41.6±1.8 years participated in this cross-sectional comparative study. Measurements included emerging and traditional CMR factors with pulse wave analysis/velocity utilised to assess indexes of arterial stiffness. Clustered cardiometabolic risk was calculated using two composites: CMR1 (central aortic systolic blood pressure, carotid-femoral pulse wave velocity, percentage body fat, HDL-C and maximal oxygen uptake) and CMR2 (brachial systolic blood pressure, triglycerides, TC:HDL-C, percentage body fat, HbA1c and maximal oxygen uptake)., Results: Analysis of covariance, controlling for age, revealed T had significantly lower (healthier) CMR1 scores than NT (EMM±SEM, T: -0.48±0.3 vs. NT: 0.50±0.3, P=0.03). Similarly, T also demonstrated lower clustered CMR2 scores (EMM, T: -0.66±0.4 vs. NT: 0.59±0.4, P=0.04). Augmentation index of the pulse pressure wave, normalised to heart rate 75 bpm (AIx75), was lower in T vs NT (EMM, T: 10.7±1.7% vs. NT: 12.7±1.6%; P=0.03), when controlling for age and gender., Conclusions: Tennis appears to be a suitable and effective physical activity modality for targeting cardiometabolic and vascular health and should be more frequently advocated in physical activity promotion strategies.

Background: Metabolic Syndrome (MetS) is a cluster of risk factors for diabetes and cardiovascular diseases with pathophysiology strongly linked to aging. A range of circulatory metabolic biomarkers such as inflammatory adipokines have been associated with MetS; however, the diagnostic power of these markers as MetS risk correlates in elderly has yet to be elucidated. This cross-sectional study investigated the diagnostic power of circulatory metabolic biomarkers as MetS risk correlates in older adults., Methods: Hundred community dwelling older adults (mean age: 68.7 years) were recruited in a study, where their blood pressure, body composition and Pulse Wave Velocity (PWV) were measured; and their fasting capillary and venous blood were collected. The components of the MetS; and the serum concentrations of Interleukin-6 (IL-6), Tumor Necrosis Factor-α (TNF-α), Plasminogen Activator Inhibitor-I (PAI-I), Leptin, Adiponectin, Resistin, Cystatin-C, C-Reactive Protein (CRP), insulin and ferritin were measured within the laboratory, and the HOMA1-IR and Atherogenic Index of Plasma (AIP) were calculated., Results: Apart from other markers which were related with some cardiometabolic (CM) risk, after Bonferroni correction insulin had significant association with all components of Mets and AIP. These associations also remained significant in multivariate regression. The multivariate odds ratio (OR with 95% confidence interval (CI)) showed a statistically significant association between IL-6 (OR: 1.32 (1.06-1.64)), TNF-α (OR: 1.37 (1.02-1.84)), Resistin (OR: 1.27 (1.04-1.54)) and CRP (OR: 1.29 (1.09-1.54)) with MetS risk; however, these associations were not found when the model was adjusted for age, dietary intake and adiposity. In unadjusted models, insulin was consistently statistically associated with at least two CM risk factors (OR: 1.33 (1.16-1.53)) and MetS risk (OR: 1.24 (1.12-1.37)) and in adjusted models it was found to be associated with at least two CM risk factors and MetS risk (OR: 1.87 (1.24-2.83) and OR: 1.25 (1.09-1.43)) respectively. Area under curve (AUC) for receiver operating characteristics (ROC) demonstrated a good discriminatory diagnostics power of insulin with AUC: 0.775 (0.683-0.866) and 0.785 by cross validation and bootstrapping samples for at least two CM risk factors and AUC: 0.773 (0.653-0.893) and 0.783 by cross validation and bootstrapping samples for MetS risk. This was superior to all other AUC reported from the ROC analysis of other biomarkers. Area under precision-recall curve for insulin was also superior to all other markers (0.839 and 0.586 for at least two CM risk factors and MetS, respectively)., Conclusion: Fasting serum insulin concentration was statistically linked with MetS and its risk, and this link is stronger than all other biomarkers. Our ROC analysis confirmed the discriminatory diagnostic power of insulin as CM and MetS risk correlate in older adults.

Background: For Dietetics students, starting university means developing the knowledge and skills required to be a healthcare practitioner. This pilot study aimed to explore the perceptions and views of the students on their drivers and barriers of healthy eating while studying Dietetics at university., Methods: A qualitative study was undertaken with a purposive sample of six final year Dietetic students at a UK university. Semi-structured in-depth interviews were used to elicit students' experiences and perceptions of barriers to healthy eating. Interview data were analysed thematically., Results: Five themes emerged from the interview data including studying Dietetics, placement, influence of significant others, food security, and social and cultural aspects of the university life, with several sub-themes, and perspectives about the future beyond the university life., Conclusions: The findings suggest a potential need for Dietetics course providers to consider the range of barriers to healthy eating that students may encounter whilst studying and how these may undermine their ability to develop healthy eating practices and effective professional skills. Further research is required that explores the extent of barriers to healthy eating and examine whether these impinge upon effective practice.

Background: Previous research has reported that elite Gaelic football players' carbohydrate (CHO) intakes are sub-optimal, especially, in the lead up to competitive matches. Despite clear decrements in running performance across elite Gaelic football matches, there are no studies that have investigated nutrition interventions on match-related Gaelic football performance. The aim of this study was to determine whether a higher-CHO diet in line with sports nutrition guidelines can improve Gaelic football-related performance compared to lower CHO intakes previously observed in Gaelic footballers., Methods: Twelve Gaelic football players completed a Gaelic football simulation protocol (GFSP) on two occasions after consuming a high-CHO diet (7 g·kg -1 ) (HCHO) or an energy-matched lower-CHO diet (3.5 g·kg -1 ) (L-CHO) for 48 h. Movement demands and heart rate were measured using portable global positioning systems devices. Countermovement jump height (CMJ) and repeated-sprint ability (RSA) were measured throughout each trial. Expired respiratory gases were collected throughout the trial using a portable gas analyser. Blood samples were taken at rest, half-time, and post-simulation., Results: There was no significant difference in total distance ( p = 0.811; η 2 = 0.005) or high-speed running distance (HSRD) covered between both trials. However, in the second half of the HCHO trial, HSRD was significantly greater compared to the second half of the LCHO trial ( p = 0.015). Sprint distance covered during GFSP was significantly greater in HCHO (8.1 ± 3.5 m·min -1 ) compared with LCHO (6.4 ± 3.2 m·min -1 ) ( p = 0.011; η 2 = 0.445). RSA performance ( p < 0.0001; η 2 = 0.735) and lower body power (CMJ) ( p < 0.0001; η 2 = 0.683) were significantly greater during the HCHO trial compared to LCHO. Overall CHO oxidation rates were significantly greater under HCHO conditions compared to LCHO (3.3 ± 0.5 vs. 2.7 ± 0.6 g·min -1 ) ( p < 0.001; η 2 = 0.798). Blood lactate concentrations were significantly higher during HCHO trial versus LCHO ( p = 0.026; η 2 = 0.375). There were no significant differences in plasma glucose, non-esterified fatty acids (NEFAs), and glycerol concentration between trials. In both trials, all blood metabolites were significantly elevated at half-time and post-trial compared to pre-trial., Conclusion: These findings indicate that a higher-CHO diet can reduce declines in physical performance during simulated Gaelic football match play.

The Exercise Benefits/Barriers Scale (EBBS) research instrument has been extensively used to investigate the perceived benefits and barriers of exercise in a range of settings. In order to examine theoretical contentions and translate the findings, it is imperative to implement measurement tools that operationalize the constructs in an accurate and reliable way. The original validation of the EBBS proposed a nine-factor structure for the research tool, examined the EBBS factor structure, and suggested that various factors are important for the testing of the perception of exercise benefits and barriers, whereas a few items and factors may not be vital. The current study conducted a confirmatory factor analysis (CFA) using hierarchical testing in 565 participants from the northwest region of the United Kingdom, the results of which provided evidence for a four-factor structure of the benefits measure, with the Comparative Fit Index (CFI) = 0.943, Tucker-Lewis Index (TLI) = 0.933, and root means square error of approximation (RMSEA) = 0.051, namely life enhancement, physical performance, psychological outlook, and social interaction, as well as a two-factor structure of the barrier measures, with the CFI = 0.953, TLI = 0.931, and RMSEA = 0.063, including exercise milieu and time expenditure. Our findings showed that for a six-factor correlated model, the CFI = 0.930, TLI = 0.919, and RMSEA = 0.046. The multi-group CFA provided support for gender invariance. The results indicated that after three decades of the original validation of the EBBS, many of the core factors and items are still relevant for the assessment of higher-order factors; however, the 26-item concise tool proposed in the current study displays a better parsimony in comparison with the original 43-item questionnaire. Overall, the current study provides support for a reliable, cross-culturally valid EBBS within the UK adult population, however, it proposes a shorter and more concise version compared with the original tool, and gives direction for future research to focus on the content validity for assessing the perception of the barriers to physical activity.

Studies on improving the adaptability of upper limb rehabilitation training do not often consider the implications of muscle fatigue sufficiently. In this study, electromyogram features were used as fatigue indicators in the context of human-robot interaction. They were utilised for auto-adaptation of the task difficulty, which resulted in a prolonged training interaction. The electromyogram data was collected from three gross-muscles of the upper limb in 30 healthy participants. The experiment followed a protocol for increasing the muscle strength by progressive strength training, that was an implementation of a known method in sports science for muscle training, in a new domain of robotic adaptation in muscle training. The study also compared how the participants in three experimental conditions perceived the change in task difficulty levels. One task benefitted from robotic adaptation (Intervention group) where the robot adjusted the task difficulty. The other two tasks were control groups 1 and 2. There was no difficulty adjustment at all in Control 1 group and the difficulty was adjusted manually in Control 2 group. The results indicated that the participants could perform a prolonged progressive strength training exercise with more repetitions with the help of a fatigue-based robotic adaptation, compared to the training interactions, which were based on manual/no adaptation. This study showed that it is possible to alter the level of the challenge using fatigue indicators, and thus, increase the interaction time. The results of the study are expected to be extended to stroke patients in the future by utilising the potential for adapting the training difficulty according to the patient's muscular state, and also to have a large number repetitions in a robot-assisted training environment., Competing Interests: The authors have declared that no competing interests exist.

Background & Aims: When body height cannot be measured, it can be predicted from ulna length (UL). However, commonly used published prediction equations may not provide useful estimates in adults from all ethnicities. This study aimed to evaluate the relationship between UL and height in adults from diverse ethnic groups and to consider whether this can be used to provide useful prediction equations for height in practice., Methods: Standing height and UL were measured in 542 adults at seven UK locations. Ethnicity was self-defined using UK Census 2011 categories. Data were modelled to give two groups of height prediction equations based on UL, sex and ethnicity and these were tested against an independent dataset (n = 180)., Results: UL and height were significantly associated overall and in all groups except one with few participants (P = 0.059). The new equations yielded predicted height (H p ) that was closer to measured height in the Asian and Black subgroups of the independent population than the Malnutrition Universal Screening Tool (MUST) equations. For Asian men, (H p (cm) = 3.26 UL (cm) + 83.58), mean difference from measured (95% confidence intervals) was -0.6 (-2.4, +1.2); Asian women, (H p  = 3.26 UL + 77.62), mean difference +0.5 (-1.4, 2.4) cm. For Black men, H p  = 3.14 UL + 85.80, -0.4 (-2.4, 1.7); Black women, H p  = 3.14 UL + 79.55, -0.8 (-2.8, 1.2). These differences were not statistically significant while predictions from MUST equations were significantly different from measured height., Conclusions: The new prediction equations provide an alternative for estimating height in adults from Asian and Black groups and give mean predicted values that are closer to measured height than MUST equations., (Copyright © 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Introduction: Studies on adaptive robot-assisted upper limb training interactions do not often consider the implications of muscle fatigue sufficiently., Methods: To explore this, we initially assessed muscle fatigue in 10 healthy subjects using two electromyogram features, namely average power and median power frequency, during an assist-as-needed interaction with HapticMaster robot. Since robotic assistance resulted in a variable fatigue profile across participants, a completely tiring experiment, without a robot in the loop, was also designed to confirm the results., Results: A significant increase in average power and a decrease in median frequency were observed in the most active muscles. Average power in the frequency band of 0.8-2.5 Hz and median frequency in the band of 20-450 Hz are potential fatigue indicators. Also, comparing the Spearman's correlation coefficients (between the electromyogram average power and the kinematic force) across trials indicated that correlation was reduced as individual muscles were fatigued., Conclusions: Confirming fatigue indicators, this study concludes that robotic assistance based on user's performance resulted in lesser muscle fatigue, which caused an increase in electromyogram-force correlation. We now intend to utilise the electromyogram and kinematic features for auto-adaptation of therapeutic human-robot interactions., (© The Author(s) 2020.)

Purpose: To investigate the effects of exercise in combination with, or without, a leucine-enriched whey protein supplement on muscle mass, fat mass, myoelectrical muscle fatigue and health-related quality of life ( HR- QOL) in older adults., Methods: 100 community-dwelling older adults [52% women, age: 69 ± 6 years (mean ± SD)] were randomised to four [Control (C); Exercise (E); Exercise + Protein (EP); Protein (P)] independent groups. E and EP groups completed 16 weeks of exercise [resistance (2 times/week) and functional (1 time/week]. EP and P groups were also administered a leucine-enriched whey protein supplement (3 times/day) based on body weight (1.5 g/kg/day). Muscle and fat mass (bioelectrical impedance analysis), myoelectrical muscle fatigue (surface electromyography) and HR- QOL (WHOQOL-BREF) were measured pre- and post-intervention., Results: At post-intervention, the rectus femoris (E: - 4.8%/min, p = 0.007, ES = 0.86; EP: - 3.3%/min, p = 0.045, ES = 0.58) and bicep femoris (E: - 3.9%/min, p < 0.001, ES = 1.46; EP: - 4.3%/min, p < 0.001, ES = 1.58) muscles became more resistant to fatigue in the E and EP groups, respectively (p < 0.05 versus C). HR- QOL improved in the E group only. Muscle and fat mass did not change (p > 0.05)., Conclusion: Physical exercise is a potent method to improve myoelectrical muscle fatigue and HR- QOL in older adults. However, leucine-enriched whey protein did not augment this response in those already consuming sufficient quantities of protein at trial enrolment.

Background: The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines., Hypothesis: Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers., Study Design: Cross-sectional study., Level of Evidence: Level 3., Methods: Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness., Results: Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, -0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, -0.16 ± 1.70; P < 0.05)., Conclusion: The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis., Clinical Relevance: The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.

Context: Assessing the relationship between single nutrients and frailty fails to take into consideration the interactions between nutrients. An increasing number of investigations in recent years have evaluated the association between dietary patterns and frailty., Objective: This systematic review and meta-analysis was conducted to summarize the association between dietary patterns and frailty., Data Sources: PubMed, Scopus, and Google Scholar were searched for epidemiological studies published up to April 2018 that assessed the association between dietary patterns and frailty., Study Selection: Cohort or cross-sectional studies that examined dietary patterns via an a priori or an a posteriori method in relation to risk of frailty without considering any specific age range were included. Studies were excluded if they examined single nutrients, single foods, or single food groups., Data Extraction: Pooled effect sizes of eligible studies and their corresponding 95%CIs were estimated using random-effects models. When publication bias was present, trim and fill analysis was conducted to adjust the pooled effect., Results: A total of 13 studies with 15 effect sizes were identified. Results from 9 cohort and cross-sectional studies were included in the meta-analysis. Higher adherence to a healthy dietary pattern was associated with lower odds of frailty (odds ratio = 0.69; 95%CI, 0.57-0.84; P < 0.0001; I2 =92.1%; P for heterogeneity < 0.0001)., Conclusions: The findings suggest that a diet high in fruit, vegetables, and whole grains may be associated with reduced risk of frailty. Nevertheless, additional longitudinal studies are needed to confirm the association of dietary patterns with frailty., (© The Author(s) 2019. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Rehabilitative exercise for people suffering from upper limb impairments has the potential to improve their neuro-plasticity due to repetitive training. Our study investigates the usefulness of Electroencephalogram and Electromyogram (EMG) signals for incorporation in humanrobot interaction loop. Twenty healthy participants recruited who performed a series of physical and cognitive tasks, with an inherent fatiguing component in those tasks. Here we report observed effects on EMG signals. Participants performed a Biceps curl repetitions using a suitable dumbbell in three phases. In phase 1, the initial weight was set to achieve maximum voluntary contraction (MVC). Phase 2 followed with 80 % MVC and phase 3 had 60% MVC. After each phase, they had a break around 3 minutes. EMG data were acquired from Biceps, Triceps, and Brachioradialis muscles. Different EMG features were explored to inform on muscle fatigue during this interaction. Comparing EMG during the first and last dumbbell of each phase demonstrated that the muscle fatigue had caused an increase in the average power (94% of cases) and amplitude (91%) and a decrease in the mean (80%) and the median frequency (57%) of EMG, which was more noticeable in Biceps. The results from integrated EMG showed a continuous rise in all three muscles which was more pronounced in Biceps muscle. Given these results, we identify EMG average power as the most reliable feature for informing on muscle fatigue.

Objective: To investigate the effects of a 16-week concurrent exercise regimen [resistance exercise (RE) + functional exercise (FE)] in combination with, or without, a leucine-enriched whey protein isolate supplement on muscle strength, physical functioning, aerobic capacity, and cardiometabolic health in older adults (≥60 years). Physical activity levels were also evaluated 6 months post-cessation of the intervention., Methods: Forty-six, community-dwelling, previously untrained males, and females [age: 68 ± 5 years (mean ± SD); BMI: 27.8 ± 6.2 kg/m 2 ] who completed the trial were initially randomized to one of two independent arms [Exercise n = 24 (E); Exercise+Protein n = 22 (EP)]. Both arms completed 16 weeks of RE (performed to fatigue) (2 times/week) with FE (1 time/week) on non-consecutive days. Additionally, EP were administered a leucine-enriched whey protein supplement (3 times/day) for 16 weeks based on individual body-weight (1.5 g/kg/day)., Results: As a result of dietary supplementation, protein intake increased in EP (∼1.2 ± 0.4 to 1.5 ± 0.7 g/kg/day) during the intervention. Maximal strength (1RM) values for leg press (E: +39 ± 7 kg, p = 0.006; EP: +63 ± 7 kg, p < 0.001), chest press (E: +22 ± 4 kg, p < 0.001; EP: +21 ± 6 kg, p < 0.001), and bicep curl (E: +7 ± 0 kg, p = 0.002; EP: +6 ± 1 kg, p = 0.008) significantly increased in E and EP respectively, with no differences between arms ( p > 0.05). Physical functioning in the obstacle course (E: -5.1 ± 6.8 s, p < 0.001; EP: -2.8 ± 0.8 s, p < 0.001) and short-physical performance battery scores (E: +0.5 ± 0.5, p = <0.001; EP: +0.4 ± 0.5, p = 0.038), and aerobic capacity in the 6-min walk test (E: +37 ± 24 m, p = 0.014; EP: +36 ± 3 m, p = 0.005) improved in E and EP respectively, with no differences between arms ( p > 0.05). No significant change was observed for markers of cardiometabolic health (glycaemic control or blood pressure) ( p > 0.05). At follow-up, 86% of older adults reported to performing physical activity ≥1 per week. Of those, 61% were still participating in strength- and cardiovascular- based exercise., Conclusion: Concurrent exercise (RE + FE) offers a potent method to combat age-related muscle weakness, and our results suggest a high proportion of older adults may continue to exercise unsupervised. However, leucine-enriched whey protein isolate supplementation did not confer any additional benefit in those already consuming ample amounts of dietary protein at trial enrolment. Future trials should utilize a whole-foods approach and investigate the effects in frail and non-frail older adults habitually consuming the RDA of protein, to assess if a higher intake of protein is needed to delay the onset of muscle weakness., Trial Registration: Clinicaltrials.gov Identifier: NCT02912130.

There is currently a lack of research into the energy demands and associated nutritional intakes of elite Gaelic football players during the pre-season period, which is a crucial time of year for physical development. The aim of the current study was to investigate the dietary intake and energy expenditure (EE) of elite Gaelic football players during a typical pre-season week. Over a seven-day period, which included four training days and three rest days, dietary intake (validated self-reported estimated food diary) and EE (Sensewear Pro armband) were recorded in 18 male players from a single elite inter-county Gaelic football team. Average energy intake (EI) (3283 ± 483 kcal) was significantly ( p = 0.002) less than average EE (3743 ± 335 kcal), with a mean daily energy deficit of -460 ± 503 kcal. Training days elicited the greatest deficits between intake and expenditure. The mean carbohydrate (CHO) intake was 3.6 ± 0.7 g/kg/day, protein intake was 2.1 ± 0.5 g/kg/day, and fat intake was 1.6 ± 0.2 g/kg/day. These findings indicate that the dietary practices of the sampled players were inadequate to meet EE and CHO recommendations. Training days are of particular concern, with the players not altering energy and CHO intake to encounter increased energy demands. Education on nutritional strategies for elite Gaelic footballers should be considered in relation to training demands to avoid detriments to performance and health.

Frequently reported poor dietary habits of young adults increase their risk of metabolic syndrome (MetS). Excess adiposity is the most established predictor of MetS, and numerous anthropometric measures have been proposed as proxy indicators of adiposity. We aimed to assess prevalence of MetS in young adult population and to make comparison between weight- and shape-oriented measures of adiposity to identify the best index in association with measured body fat and as a risk predictor for MetS. Healthy males and females aged 18-25 years from the Northwest of England were recruited using convenience sampling ( n =550). As part of the assessment of the overall health of young adults, the biochemical variables and adiposity measures BMI, waist circumference (WC), waist-to-height ratio (WHtR), waist-to-hip ratio (WHR), new BMI, Body Adiposity Index (BAI), Clinica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE), and A Body Shape Index (ABSI) were assessed. Linear regression analysis was used to investigate the association between the proxy indices of adiposity and measured percentage body fat. The odds ratio with 95% confidence interval was used to investigate the relationship between cardiometabolic (CM) risk factors and proxy measures of adiposity. The discriminatory power of these measures for diagnosis of MetS was investigated using area under the receiver operating characteristic curve. Body weight-related indicators of adiposity, particularly CUN-BAE, had stronger association with measured body fat compared with body shape-related indices. In relation with MetS, body shape-related indices, particularly elevated WC and WHtR, had stronger associations with CM risk compared with body weight-related measures. Amongst all indices, the best predictor for CM risk was WHtR, while ABSI had the weakest correlation with body fat, MetS, and CM risk. Indices directly associated with WC and specifically WHtR had greater diagnostic power in detection of CM risk in young adults.

Background/objectives: Epidemiological studies investigating the association between fruit and vegetable consumption and cognitive function have produced inconclusive findings. The aim of this review was to systematically investigate if increased fruit and vegetable consumption is linked with decreased risk of cognitive impairment (CI)., Methods: We conducted a systematic literature search using four databases (PubMed, Embase, Cochrane Library, and Scopus) in October 2016 and identified cohort and cross-sectional studies, which estimated the risk of CI for fruit and vegetable consumption. The pooled odds ratio (OR) and 95% confidence interval (CI) were estimated by using a random effects model., Results: The six studies meeting inclusion criteria offered 10 effect sizes and the total of 17,537 participants in the analysis. Increased fruit and vegetable intake was associated with reduced risk of CI (OR: 0.79; 95% CI: 0.67-0.93; P = 0.006). The subgroup analysis demonstrated that in studies conducted in China (but not in Western countries), the corresponding reduction in risk of CI risk was significant (OR: 0.74; 95% CI: 0.61, 0.89; P = 0.002) and the relationship between fruits, vegetables, and CI did not differ by study design, type of exposure, and gender., Conclusion: Increased fruit and vegetable consumption is associated with the reduced risk of CI; however, such association might be dependent on the geographical region. Further prospective studies specifically designed to compare vegetables and fruit varieties, and also to determine the recommended amounts to prevent CI are warranted.

Purpose: The potential of service robots for seniors is given increasing attention as the ageing population in Western countries will continue to grow as well as the demand for home care. In order to capture the experience of living with a robot at home, a multi-perspective evaluation was conducted., Methods: Older adults (n = 10) were invited to execute an actual interaction scenario with the Care-O-bot ® robot in a home-like environment and were questioned about their experiences. Additionally, interviews were conducted with the elderly participants, informal carers (n = 7) and professional caregivers (n = 11)., Results: Seniors showed to be more keen to accept the robot than their caregivers and relatives. However, the robot in its current form was found to be too limited and participants wished the robot could perform more complex tasks. In order to be acceptable a future robot should execute these complex tasks based on the personal preferences of the user which would require the robot to be flexible and extremely smart, comparable to the care that is delivered by a human carer., Conclusions: Developing the functional features to perform activities is not the only challenge in robot development that deserves the attention of robot developers. The development of social behaviour and skills should be addressed as well. This is possible adopting a person-centred design approach, which relies on validation activities with actual users in realistic environments, similar to those described in this paper. Implications for rehabilitation Attitude of older adults towards service robots Potential of service robotsfor older adults.

With the successful uptake and inclusion of robotic systems in minimally invasive surgery and with the increasing application of robotic surgery (RS) in numerous surgical specialities worldwide, there is now a need to develop and enhance the technology further. One such improvement is the implementation and amalgamation of haptic feedback technology into RS which will permit the operating surgeon on the console to receive haptic information on the type of tissue being operated on. The main advantage of using this is to allow the operating surgeon to feel and control the amount of force applied to different tissues during surgery thus minimising the risk of tissue damage due to both the direct and indirect effects of excessive tissue force or tension being applied during RS. We performed a two-rater systematic review to identify the latest developments and potential avenues of improving technology in the application and implementation of haptic feedback technology to the operating surgeon on the console during RS. This review provides a summary of technological enhancements in RS, considering different stages of work, from proof of concept to cadaver tissue testing, surgery in animals, and finally real implementation in surgical practice. We identify that at the time of this review, while there is a unanimous agreement regarding need for haptic and tactile feedback, there are no solutions or products available that address this need. There is a scope and need for new developments in haptic augmentation for robot-mediated surgery with the aim of improving patient care and robotic surgical technology further.

The propose of this study was to assess the feasibility of using support vector machines in analysing myoelectric signals acquired using an off the shelf device, the Myo armband from Thalmic Lab, when performing hand grasp gestures. Participants (n = 26) took part in the study wearing the armband and producing a series of required gestures. Support vector machines were used to train a model using participant training values, and to classify gestures produced by the same participants. Different Kernel functions and electrode combinations were studied. Also we contrasted different lengths of training values versus different lengths for the classification samples. The overall accuracy was 94.9% with data from 8 electrodes, and 72% where only four of the electrodes were used. The linear kernel outperformed the polynomial, and radial basis function. Exploring the number of training samples versus the achieved classification accuracy, results identified acceptable accuracies (> 90%) for training around 2.5s, and recognising grasp with 0.2s of acquired data. The best recognised grasp was the hand closed (97.6%), followed by cylindrical grasp (96.8%), the lateral grasp (93.2%) and tripod (92%). These results allows us to progress to the next stage of work where the Myo armband is used in the context of robot-mediated stroke rehabilitation and also involves more dynamic interactions as well as gross upper arm movements.

Hyperaminoacidemia following ingestion of cows-milk may stimulate muscle anabolism and attenuate exercise-induced muscle damage (EIMD). However, as dairy-intolerant athletes do not obtain the reported benefits from milk-based products, A2 milk may offer a suitable alternative as it lacks the A1-protein. This study aimed to determine the effect of A2 milk on recovery from a sports-specific muscle damage model. Twenty-one male team sport players were allocated to three independent groups: A2 milk ( n = 7), regular milk ( n = 7), and placebo (PLA) ( n = 7). Immediately following muscle-damaging exercise, participants consumed either A2 milk, regular milk or PLA (500 mL each). Visual analogue scale (muscle soreness), maximal voluntary isometric contraction (MVIC), countermovement jump (CMJ) and 20-m sprint were measured prior to and 24, 48, and 72 h post EIMD. At 48 h post-EIMD, CMJ and 20-m sprint recovered quicker in A2 (33.4 ± 6.6 and 3.3 ± 0.1, respectively) and regular milk (33.1 ± 7.1 and 3.3 ± 0.3, respectively) vs. PLA (29.2 ± 3.6 and 3.6 ± 0.3, respectively) ( p < 0.05). Relative to baseline, decrements in 48 h CMJ and 20-m sprint were minimised in A2 (by 7.2 and 5.1%, respectively) and regular milk (by 6.3 and 5.2%, respectively) vs. PLA. There was a trend for milk treatments to attenuate decrements in MVIC, however statistical significance was not reached ( p = 0.069). Milk treatments had no apparent effect on muscle soreness ( p = 0.152). Following muscle-damaging exercise, ingestion of 500 mL of A2 or regular milk can limit decrements in dynamic muscle function in male athletes, thus hastening recovery and improving subsequent performance. The findings propose A2 milk as an ergogenic aid following EIMD, and may offer an alternative to athletes intolerant to the A1 protein.

Purpose: We drew on an interdisciplinary research design to examine stroke survivors' experiences of living with stroke and with technology in order to provide technology developers with insight into values, thoughts and feelings of the potential users of a to-be-designed robotic technology for home-based rehabilitation of the hand and wrist., Method: Ten stroke survivors and their family carers were purposefully selected. On the first home visit, they were introduced to cultural probe. On the second visit, the content of the probe packs were used as prompt to conduct one-to-one interviews with them. The data generated was analysed using thematic analysis. A third home visit was conducted to evaluate the early prototype., Results: User requirements were categorised into their network of relationships, their attitude towards technology, their skills, their goals and motivations. The user requirements were used to envision the requirements of the system including providing feedback on performance, motivational aspects and usability of the system. Participants' views on the system requirements were obtained during a participatory evaluation., Conclusion: This study showed that prior to the development of technology, it is important to engage with potential users to identify user requirements and subsequently envision system requirements based on users' views. Implications for Rehabilitation An understanding of how stroke survivors make sense of their experiences of living with stroke is needed to design home-based rehabilitation technologies. Linking stroke survivors' goals, motivations, behaviour, feelings and attitude to user requirements prior to technology development has a significant impact on improving the design.

Background: Assistive and robotic training devices are increasingly used for rehabilitation of the hemiparetic arm after stroke, although applications for the wrist and hand are trailing behind. Furthermore, applying a training device in domestic settings may enable an increased training dose of functional arm and hand training. The objective of this study was to assess the feasibility and potential clinical changes associated with a technology-supported arm and hand training system at home for patients with chronic stroke., Methods: A dynamic wrist and hand orthosis was combined with a remotely monitored user interface with motivational gaming environment for self-administered training at home. Twenty-four chronic stroke patients with impaired arm/hand function were recruited to use the training system at home for six weeks. Evaluation of feasibility involved training duration, usability and motivation. Clinical outcomes on arm/hand function, activity and participation were assessed before and after six weeks of training and at two-month follow-up., Results: Mean System Usability Scale score was 69 % (SD 17 %), mean Intrinsic Motivation Inventory score was 5.2 (SD 0.9) points, and mean training duration per week was 105 (SD 66) minutes. Median Fugl-Meyer score improved from 37 (IQR 30) pre-training to 41 (IQR 32) post-training and was sustained at two-month follow-up (40 (IQR 32)). The Stroke Impact Scale improved from 56.3 (SD 13.2) pre-training to 60.0 (SD 13.9) post-training, with a trend at follow-up (59.8 (SD 15.2)). No significant improvements were found on the Action Research Arm Test and Motor Activity Log., Conclusions: Remotely monitored post-stroke training at home applying gaming exercises while physically supporting the wrist and hand showed to be feasible: participants were able and motivated to use the training system independently at home. Usability shows potential, although several usability issues need further attention. Upper extremity function and quality of life improved after training, although dexterity did not. These findings indicate that home-based arm and hand training with physical support from a dynamic orthosis is a feasible tool to enable self-administered practice at home. Such an approach enables practice without dependence on therapist availability, allowing an increase in training dose with respect to treatment in supervised settings., Trial Registration: This study has been registered at the Netherlands Trial Registry (NTR): NTR3669 .

Purpose: In light of the increasing elderly population and the growing demand for home care, the potential of robot support is given increasing attention. In this paper, an inventory of activities was made that threaten independent living of elderly when becoming problematic. Results will guide the further development of an existing service robot, the Care-O-bot®., Method: A systematic literature search of PubMed was performed, focused on the risk factors for institutionalization. Additionally, focus group sessions were conducted in the Netherlands, United Kingdom and France. In these focus group sessions, problematic activities threatening the independence of elderly people were discussed. Three separate target groups were included in the focus group sessions: (1) elderly persons (n = 41), (2) formal caregivers (n = 40) and (3) informal caregivers (n = 32)., Results: Activities within the International Classification of Functioning domains mobility, self-care, and interpersonal interaction and relationships were found to be the most problematic., Conclusions: A distinct set of daily activities was identified that may threaten independent living, but no single activity could be selected as the main activity causing a loss of independence as it is often a combination of problematic activities that is person-specific. Supporting the problematic activities need not involve a robotic solution.

Robot-mediated post-stroke therapy for the upper-extremity dates back to the 1990s. Since then, a number of robotic devices have become commercially available. There is clear evidence that robotic interventions improve upper limb motor scores and strength, but these improvements are often not transferred to performance of activities of daily living. We wish to better understand why. Our systematic review of 74 papers focuses on the targeted stage of recovery, the part of the limb trained, the different modalities used, and the effectiveness of each. The review shows that most of the studies so far focus on training of the proximal arm for chronic stroke patients. About the training modalities, studies typically refer to active, active-assisted and passive interaction. Robot-therapy in active assisted mode was associated with consistent improvements in arm function. More specifically, the use of HRI features stressing active contribution by the patient, such as EMG-modulated forces or a pushing force in combination with spring-damper guidance, may be beneficial.Our work also highlights that current literature frequently lacks information regarding the mechanism about the physical human-robot interaction (HRI). It is often unclear how the different modalities are implemented by different research groups (using different robots and platforms). In order to have a better and more reliable evidence of usefulness for these technologies, it is recommended that the HRI is better described and documented so that work of various teams can be considered in the same group and categories, allowing to infer for more suitable approaches. We propose a framework for categorisation of HRI modalities and features that will allow comparing their therapeutic benefits.

Objectives: The repetitive and sometimes mundane nature of conventional rehabilitation therapy provides an ideal opportunity for development of interactive and challenging therapeutic games that have the potential to engage and motivate the players. Certain game design parameters that may encourage patients to actively participate by making the games more enjoyable have been identified. In this article, we describe a formative study in which we designed and evaluated some of these parameters with healthy subjects. Materials and Methods: The "operant conditioning" and "scoring" design parameters were incorporated in a remake of a classic labyrinth game, "Marble Maze." A group of participants ( n =37) played the game twice: Once in the control condition without both modalities and then with either one of the parameters or with both. Measures of game duration and number of fails in the game were recorded along with survey questionnaires to measure player perceptions of intrinsic motivation on the game. Results: Longer playtimes, higher levels of interest/enjoyment, and effort to play the game were recorded with the introduction of these parameters. Conclusions: This study provides an understanding on how game design parameters can be used to motivate and encourage people to play longer. With these positive results, future aims are to test the parameters with stroke patients, providing much clearer insight as to what influences these parameters have on patients undergoing therapy. The ultimate goal is to utilize game design in order to maintain longer therapeutic interaction between a patient and his or her therapy medium.

Stroke survivors often suffer impairments on their wrist and hand. Robot-mediated rehabilitation techniques have been proposed as a way to enhance conventional therapy, based on intensive repeated movements. Amongst the set of activities of daily living, grasping is one of the most recurrent. Our aim is to incorporate the detection of grasps in the machine-mediated rehabilitation framework so that they can be incorporated into interactive therapeutic games. In this study, we developed and tested a method based on support vector machines for recognizing various grasp postures wearing a passive exoskeleton for hand and wrist rehabilitation after stroke. The experiment was conducted with ten healthy subjects and eight stroke patients performing the grasping gestures. The method was tested in terms of accuracy and robustness with respect to intersubjects' variability and differences between different grasps. Our results show reliable recognition while also indicating that the recognition accuracy can be used to assess the patients' ability to consistently repeat the gestures. Additionally, a grasp quality measure was proposed to measure the capabilities of the stroke patients to perform grasp postures in a similar way than healthy people. These two measures can be potentially used as complementary measures to other upper limb motion tests.

Background: Rehabilitation robotics is progressing towards developing robots that can be used as advanced tools to augment the role of a therapist. These robots are capable of not only offering more frequent and more accessible therapies but also providing new insights into treatment effectiveness based on their ability to measure interaction parameters. A requirement for having more advanced therapies is to identify how robots can 'adapt' to each individual's needs at different stages of recovery. Hence, our research focused on developing an adaptive interface for the GENTLE/A rehabilitation system. The interface was based on a lead-lag performance model utilising the interaction between the human and the robot. The goal of the present study was to test the adaptability of the GENTLE/A system to the performance of the user., Methods: Point-to-point movements were executed using the HapticMaster (HM) robotic arm, the main component of the GENTLE/A rehabilitation system. The points were displayed as balls on the screen and some of the points also had a real object, providing a test-bed for the human-robot interaction (HRI) experiment. The HM was operated in various modes to test the adaptability of the GENTLE/A system based on the leading/lagging performance of the user. Thirty-two healthy participants took part in the experiment comprising of a training phase followed by the actual-performance phase., Results: The leading or lagging role of the participant could be used successfully to adjust the duration required by that participant to execute point-to-point movements, in various modes of robot operation and under various conditions. The adaptability of the GENTLE/A system was clearly evident from the durations recorded. The regression results showed that the participants required lower execution times with the help from a real object when compared to just a virtual object. The 'reaching away' movements were longer to execute when compared to the 'returning towards' movements irrespective of the influence of the gravity on the direction of the movement., Conclusions: The GENTLE/A system was able to adapt so that the duration required to execute point-to-point movement was according to the leading or lagging performance of the user with respect to the robot. This adaptability could be useful in the clinical settings when stroke subjects interact with the system and could also serve as an assessment parameter across various interaction sessions. As the system adapts to user input, and as the task becomes easier through practice, the robot would auto-tune for more demanding and challenging interactions. The improvement in performance of the participants in an embedded environment when compared to a virtual environment also shows promise for clinical applicability, to be tested in due time. Studying the physiology of upper arm to understand the muscle groups involved, and their influence on various movements executed during this study forms a key part of our future work.