Innovative Rehabilitation Research Articles

The “F-Words” in Pediatric Oncology: Improving Pediatric Cancer Care Through Innovative Thinking and Rehabilitation for Optimal Quality of Life

The “F-Words” in Pediatric Oncology: Improving Pediatric Cancer Care Through Innovative Thinking and Rehabilitation for Optimal Quality of Life

Wearable device data-driven athlete injury detection and rehabilitation monitoring algorithm

In recent years, sports wearable technology has completely changed the way athletes prepare, compete, and recover. Wearable technology has a lot to offer in the rehabilitation process, which is essential to an athlete’s return to their best performance. Wearable devices for athlete injury detection pose potential challenges like data quality, security, and privacy, impacting accuracy, reliability, and effectiveness. To solve these problems, an innovative injury detection and rehabilitation monitoring (IDRM) system was proposed for athletes. By employing an adjustable recurrent neural network (ARNN) to detect anomalies in injury risks such as abnormal joint movements in athletes. In this study, biomechanics data was collected from sports athletes through wearable devices, and the wearable system provided feedback to the user. A redefined convolutional neural network (RCNN) was utilized to monitor the rehabilitation process. This system tracks athlete’s rehabilitation progress and ensures that progress monitors were performed correctly, and the system, feasibility was evaluated on 10 healthy subjects performing 4 different rehabilitation exercises. Each exercise was performed four times monitoring and validation. The data was preprocessed using a Gaussian filter to remove noise from the obtained data. Then the features are extracted using independent component analysis (ICA) for dimensionality reduction from preprocessed data. The proposed method is implemented using Python software. In comparative analysis, the performance of ARNN showed high performance, with an F1-measure of 91.6%, accuracy of 93.5%, recall of 92.8%, and precision of 91.4%. With a 95% accuracy rate, 98% F1 measure, 94% precision, and 93% recall, the RCNN model functioned effectively. The result showed the proposed method achieved better performance in athlete injury detection and accurately recognizing all rehabilitation monitoring. This study provides a complete approach to athlete health management by highlighting the integration of rehabilitation monitoring and injury detection into an overall structure.

Beyond the cochlea: exploring the multifaceted nature of hearing loss in primary mitochondrial diseases.

Primary mitochondrial diseases, with diverse systemic manifestations, often present with auditory impairments due to mitochondrial dysfunction. This study provides an in-depth exploration of auditory deficits in primary mitochondrial diseases, highlighting the impact of various pathogenic variants on both cochlea and neural/central auditory functions. An observational study involving 72 adults with primary mitochondrial diseases was conducted. Participants underwent extensive audiological evaluations including pure-tone audiometry, tympanometry, acoustic reflex thresholds, quick speech-in-noise test, listening in spatialized noise-sentences test, auditory-evoked brainstem responses and distortion product otoacoustic emissions. Multivariate analysis of covariance and logistic regression analyses assessed the influence of various pathogenic DNA variants, accounting for age, cognitive status via the Montreal Cognitive Assessment and disease severity through the Newcastle Mitochondrial Disease Adult Scale. Participants with the pathogenic m.3243A>G/T variants (m.3243A>G n = 40; m.3243A>T n = 1) exhibited significant elevations in pure-tone audiometry thresholds, especially at high frequencies, suggesting cochlea involvement. Notably, the listening in spatialized noise-sentences test showed significant spatial processing deficits in the m.3243A>G/T group, possibly indicating a unique mutation-specific impact on central auditory processing. Auditory-evoked brainstem response results highlighted a higher likelihood of auditory brainstem response abnormalities in this group, further substantiating neural/central auditory pathway involvement. This study emphasizes the heterogeneous nature of hearing impairment in primary mitochondrial diseases, with a genotype-phenotype correlation, particularly in the m.3243A>G/T group. These insights advocate for personalized, genotype-specific auditory assessments and targeted management strategies. Conventional hearing aids and cochlear implants are ineffective for those with central auditory dysfunctions related to mitochondrial mutations. There is an urgent need for innovative rehabilitation strategies catering for both cochlear and neural/central auditory pathways.

A critical review and systematic design approach for innovative upper-limb rehabilitation devices

This paper conducts a thorough literature review and assessment of prevailing upper-limb rehabilitation devices, scrutinizing their strengths and limitations. The focus of this work is mainly on soft exosuit devices but some rigid and hybrid exoskeleton devices are also discussed as a comparative mean. Subsequently, this manuscript delineates explicit design guidelines with the intent of fostering a systematic approach toward innovation in the realm of upper-limb rehabilitation technology. Through an examination of current concepts and technological paradigms, this study seeks to contribute nuanced insights aimed at optimizing both efficacy and user experience in rehabilitation device design. The culmination of this critical analysis results in the proposal of a systematic design procedure to inform and influence the trajectory of specific user-tailored innovations within the domain of upper-limb rehabilitation devices.The proposed approach enables the identification of features and weaknesses in existing devices, facilitating also the design of innovative solutions for unsolved issues in the field of wearable robotics. A design example is presented to clarify the proposed design procedure.

An Interactive Vision-Based 3D Augmented Reality System for In-Home Physical Rehabilitation: A Qualitative Inquiry to Inform System Development.

Postoperative physical rehabilitation is crucial after total joint replacement (TJR). However, completing the recommended levels of postoperative physical exercise is challenging for many older adults with TJR. Lack of adequate postoperative physical exercise has negative consequences on rehabilitation outcomes. Innovative rehabilitation tools for postoperative physical exercises are needed to ensure successful rehabilitation outcomes among older adults with TJR. The aim of this study is to explore key knowledge users' perspectives about how to design an interactive vision-based three-dimensional augmented reality system (3D ARS) to support in-home postoperative physical rehabilitation for older adults with TJR. We conducted a qualitative descriptive study involving 11 semi-structured interviews and six focus groups with 42 older adults with TJR and four unrelated family caregivers. Data were analysed using thematic analysis. Participant insights were grouped into two main themes: (1) dreaming up possibilities and (2) being pragmatic. The first theme captured participants' reflections on the potential utility of a 3D ARS for postoperative physical rehabilitation and features that could be embedded in the 3D ARS to support successful postoperative physical rehabilitation. The second theme captured participants' reflections on practical issues and considerations that could impact access and usage of the 3D ARS. These findings provide researchers, rehabilitation providers and system developers with the foundations for designing, implementing and evaluating innovative augmented reality tools that support effective in-home physical rehabilitation among older adults with TJR. Research users (i.e., individuals and organisations invested in and using the research findings) were actively engaged throughout this work. Specifically, a meeting was held between the research team and representatives of an Expert by Experience team (individuals with lived experience), which was established to support the National Research Council's (organisation) Aging in Place programme. During this meeting, the idea to develop and evaluate an ARS for postoperative physical rehabilitation of older adults with TJR was supported. Research users had the opportunity to review the current study protocol and provide feedback on the study design, offering direction to maximize the relevance and usefulness of our findings to the National Research Council Canada's Aging in Place programme. Research users contributed to participant recruitment efforts and the development of the interview guide. Two Experts by Experience also agreed to be on the Advisory Panel for this multi-phased study, supporting active engagement and centring the voice of research users in knowledge creation and implementation. These experts reviewed a brief report of the current study findings, and continue to guide how the study findings are used to inform the next phase of this multi-phased research.

Telemedicine-assisted exercise program (TAEP) for coronary heart disease

Introduction & Purpose Cardiovascular diseases (CVD) are a common cause of declining physical performance and quality of life. Despite the recommendation of physical activity as class 1A in the American Heart Association’s guidelines for cardiac rehabilitation (Pelliccia et al., 2021) and the clear need for innovative rehabilitation programs, no tele-medical exercise program has been adopted into standard care (Scherrenberg et al., 2021; Snoswell et al., 2020). Classic CVD exercise therapy typically includes group ergometer and strength training. The primary aim of this project was to integrate exercise as a pillar of therapy in the HerzMobil Tirol project, leading to the implementation of a telemedicine-assisted exercise program. Methods Patients enrolled in the CHD project had the opportunity to participate in TAEP. The initial and final therapeutic examinations included a medical history interview, the 1-minute sit-to-stand test (STS; Strassmann et al., 2013) and standardized EQ-5D-5L to assess the quality of life. Based on the guidelines and the classic CVD therapy the TAEP participants completed a twelve-week home-based exercise program. It included endurance training (5 days/week for 30 minutes) and video-guided strength, mobility and coordination training (2-3 times/week), where the focus was on strength training. The program was analysed and adapted individually by an exercise therapist. The intensity was controlled using the Borg scale and the talk test (Bok et al., 2022). Results 22 patients completed the TAEP, 77% (n = 17) were male and 23% (n = 5) were female and the median age was 61 (53-71) years. During the twelve weeks, the patients completed a median of 257 (213-351) minutes per week of endurance-oriented exercise training (e.g. walking or cycling) and performed video-guided home-based strength training with a median of twice (1-2) per week. 95% of patients fulfilled the recommendations for endurance training and 64% for strength training. The TAEP participants showed a significant (p < 0.001) increase in STS with a median of 37% (18-24). There was a significant improvement in quality of life according to the EQ-5D-5L health scale with a median from 70 (60-85) to 83 (79-95; p < 0.001). Discussion The current literature on cardiovascular diseases and exercise as therapy continues to underline the importance of physical activity for the prevention and treatment of these conditions. Studies indicate that regular exercise can reduce the risk of cardiovascular diseases and serves as an effective complement to pharmacological therapy. The results of the present project show that the integration of exercise therapy into a telemedical care program is feasible and effective. However, the lack of a control group and the small sample size made it difficult to compare the results directly and if the observed changes are actually attributable to the TAEP. Conclusion In our programme, we have learned that (1) a doctor’s recommendation for exercise therapy and (2) personal contact between the exercise therapist and the patient are key to patients’ adherence to exercise therapy. The TAEP was well received by the patients and feasible irrespective of the patients’ age. In the age of digitalisation, telemedicine-supported training therapy is an option in cardiac rehabilitation, even for people in remote catchment areas. References Bok, D., Rakovac, M., & Foster, C. (2022). An examination and critique of subjective methods to determine exercise intensity: The talk test, feeling scale, and rating of perceived exertion. Sports Medicine, 52(9), 2085–2109. https://doi.org/10.1007/s40279-022-01690-3 Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J.-P., Corrado, D., Drezner, J. A., Halle, M., Hansen, D., Heidbuchel, H., Myers, J., Niebauer, J., Papadakis, M., Piepoli, M. F., Prescott, E., Roos-Hesselink, J. W., Graham Stuart, A., … Rakhit, D. (2021). 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease. European Heart Journal, 42(1), 17–96. https://doi.org/10.1093/eurheartj/ehaa605 Scherrenberg, M., Wilhelm, M., Hansen, D., Völler, H., Cornelissen, V., Frederix, I., Kemps, H., & Dendale, P. (2021). The future is now: A call for action for cardiac telerehabilitation in the COVID-19 pandemic from the secondary prevention and rehabilitation section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology, 28(5), 524–540. https://doi.org/10.1177/2047487320939671 Strassmann, A., Steurer-Stey, C., Lana, K. D., Zoller, M., Turk, A. J., Suter, P., & Puhan, M. (2013). Population-based reference values for the 1-min sit-to-stand test. International Journal of Public Health, 58(6), 949–953. https://doi.org/10.1007/s00038-013-0504-z Snoswell, C. L., Taylor, M. L., Comans, T. A., Smith, A. C., Gray, L. C., & Caffery, L. J. (2020). Determining if telehealth can reduce health system costs: Scoping review. Journal of Medical Internet Research, 22(10), Article e17298. https://doi.org/10.2196/17298

Advancements in Metacarpal Fracture Management: A Narrative Review of Rehabilitative Strategies.

Metacarpal fractures are prevalent injuries that can significantly impact hand functionality if not managed effectively. This narrative review examines recent advancements in treatment strategies, comparing conservative and surgical interventions, and evaluates the role of early mobilization and innovative rehabilitation techniques. We analyze evidence showing that surgical treatment with low-profile titanium plates provides superior stabilization, enabling earlier mobilization and better functional outcomes compared to conservative methods or K-wire fixation. Early mobilization, facilitated by metacarpal braces or controlled active exercises, enhances recovery and reduces the need for extended physical therapy. We also explore the integration of technology in rehabilitation, which has improved patient adherence and satisfaction. The review highlights the importance of personalized treatment plans and discusses the potential of novel rehabilitation approaches to optimize metacarpal fracture management. Future research should focus on refining these strategies and developing standardized protocols to enhance hand function and patient satisfaction.

The efficacy of virtual reality-based rehabilitation in improving motor function in patients with stroke: a systematic review and meta-analysis.

Stroke is a major cause of adult disability, prompting the exploration of innovative rehabilitation methods. Virtual rehabilitation (VR), leveraging technological advances, has gained popularity as a treatment for stroke recovery. The authors conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) published in English within the last decade, adhering to the PRISMA guidelines. The authors searched databases such as Medline/PubMed, and the Cochrane Library using specific search keywords and Medical Subject Headings (MeSH). The methodological quality was assessed using the PEDro scale, focusing on RCTs involving adult stroke patients undergoing VR rehabilitation, with outcomes related to motor function and quality of life. The authors included 15 studies in our meta-analysis. VR rehabilitation offers several advantages over traditional therapy, such as enhanced feedback and increased patient motivation. Engaging VR environments helps improve focus during treatment, potentially boosting recovery from post-stroke impairments. VR therapies significantly benefit motor function, which can improve activities of daily living and overall quality of life. VR has demonstrated efficacy in improving motor function and quality of life for stroke survivors. Future research should explore patient variability and refine intervention methods. Incorporating VR into rehabilitation programs could optimize stroke recovery outcomes.

A critical review of transitioning from conventional actuators to artificial muscles in upper-limb rehabilitation devices

Brain injuries resulting from spinal cord injuries, strokes, or cerebral palsy are among the traumas most capable of compromising the motor activities of human limbs, hence the necessity for the development of exoskeletons dedicated to the rehabilitation of these organs. This review examines the landscape of actuators essential for the design of cutting-edge upper-limb rehabilitation exoskeletal structures. Beyond merely surveying the current types of actuators available, the paper aims to provide guidelines for selecting actuators that fit optimally with the objectives of upper-limb rehabilitation. The description starts with a brief discussion on the biomechanics of the upper limbs, focusing on the kinematics of pivotal joints (wrist, elbow, shoulder). Subsequently, the existing actuators are systematically reviewed, offering detailed insights into their primary features, operational principles, strengths, weaknesses, and noteworthy applications within the realm of rehabilitation robotics. After the discussion about the actuators, the paper advances by furnishing valuable guidelines for actuators’ selection tailored for upper limb rehabilitation. These guidelines discuss crucial factors, such as the forces required and the natural Range Of Motions (ROMs) of upper limb joints. Finally, the manuscript serves as a valuable resource for researchers, engineers, and practitioners involved in the development of innovative upper-limb rehabilitation devices.

The Identification, Spatial Distribution, and Reconstruction Mode of Abandoned Mining Areas

The rehabilitation of abandoned mining sites is an increasingly pressing issue in the context of sustainable development. Recent research has emphasized the need for a holistic approach to the abandoned mining sites and their environmental rehabilitation. Based on field analysis, environmental assessments, satellite imagery processing and geographic information operations, this paper pushes forward the existing knowledge by conducting a comprehensive assessment of abandoned mining sites in the Romanian Carpathians and by proposing innovative and sustainable rehabilitation solutions. Our findings highlight that abandoned mining sites and their surrounding territories in the Romanian mountains have significant ecological imbalances and complex socio-economic issues. The findings also suggest that by adopting innovative, integrated, and sustainability-oriented approaches, territories affected by mining can be transformed into valuable and sustainable spaces to meet human needs. We conclude by presenting the importance of innovation in ecological reconstruction and spatial–functional reintegration of mining sites in mountain areas as a useful tool in making fair decisions, both in the context of implementing appropriate development policies as well as for the resilience and environmental sustainability of mining-affected mountain areas.

Use of cortical hemodynamic responses in digital therapeutics for upper limb rehabilitation in patients with stroke

BackgroundStroke causes long-term disabilities, highlighting the need for innovative rehabilitation strategies for reducing residual impairments. This study explored the potential of functional near-infrared spectroscopy (fNIRS) for monitoring cortical activation during rehabilitation using digital therapeutics.MethodsThis cross-sectional study included 18 patients with chronic stroke, of whom 13 were men. The mean age of the patients was 67.0 ± 7.1 years. Motor function was evaluated through various tests, including the Fugl–Meyer assessment for upper extremity (FMA-UE), grip and pinch strength test, and box and block test. All the patients completed the digital rehabilitation program (MotoCog®, Cybermedic Co., Ltd., Republic of Korea) while being monitored using fNIRS (NIRScout®, NIRx Inc., Germany). Statistical parametric mapping (SPM) was employed to analyze the cortical activation patterns from the fNIRS data. Furthermore, the K-nearest neighbor (K-NN) algorithm was used to analyze task performance and fNIRS data to classify the severity of motor impairment.ResultsThe participants showed diverse task performances in the digital rehabilitation program, demonstrating distinct patterns of cortical activation that correlated with different motor function levels. Significant activation was observed in the ipsilesional primary motor area (M1), primary somatosensory area (S1), and contralateral prefrontal cortex. The activation patterns varied according to the FMA-UE scores. Positive correlations were observed between the FMA-UE scores and SPM t-values in the ipsilesional M1, whereas negative correlations were observed in the ipsilesional S1, frontal lobe, and parietal lobe. The incorporation of cortical hemodynamic responses with task scores in a digital rehabilitation program substantially improves the accuracy of the K-NN algorithm in classifying upper limb functional levels in patients with stroke. The accuracy for tasks, such as the gas stove-operation task, increased from 44.4% using only task scores to 83.3% when these scores were combined with oxy-Hb t-values from the ipsilesional M1.ConclusionsThe results advocated the development of tailored digital rehabilitation strategies by combining the behavioral and cerebral hemodynamic data of patients with stroke. This approach aligns with the evolving paradigm of personalized rehabilitation in stroke recovery, highlighting the need for further extensive research to optimize rehabilitation outcomes.

Efficiency of interval hypoxia-hyperoxytherapy in the rehabilitation of patients with nonspecific musculosceletal low back pain: results of а randomized placebo-controlled study

BACKGROUND: Considering the high prevalence and social significance of nonspecific musculoskeletal lower back pain, the use of innovative non-drug rehabilitation methods, particularly interval hypoxia-hyperoxytherapy, is relevant. AIM: To evaluate the efficiency of the interval hypoxia-hyperoxytherapy in the complex medical rehabilitation of patients with nonspecific musculoskeletal lower back pain. MATERIALS AND METHODS: This randomized placebo-controlled study enrolled 62 patients (male, n=35; female n=27, aged 34–63 years) with nonspecific musculoskeletal lower back pain. All patients were randomized into two groups. The study group (n=34) received 10 procedures of hypoxia–hyperoxytherapy, and the comparison group (n=28) received 10 placebo procedures of breathing therapy. All groups underwent a 2-week standard rehabilitation program: 10 procedures of low-intensity laser therapy and low-frequency electrostatic therapy and 10 group sessions of physical exercises. The study group was breathing hypoxic (FiO2 13%–15%) and hyperoxic (FiO2 up to 40%) gas mixture through a mask in the interval mode using “ReOxy.” The duration of 1–4 procedures was 30 min and 5–10 procedures took 40 min. The placebo procedures were performed using masks with atmospheric air hole. Rehabilitation diagnosis by domains b28013, b7303, b7600, and d4500 of the International Classification of Functioning, Disability and Health (ICF), back pain and general health on a 100-mm visual analog scale, Lequesne index, 10-m walking test, Spielberger–Khanin reactive anxiety test, and Beck depression inventory were evaluated at baseline and week 2. RESULTS: After 2 weeks the values of the qualifiers of ICF domains significantly improved in the study group, back pain decreased by 65.2% (р 0.01), the Lequesne index by 76.1% (р 0.01), the 10-m walking test by 42.4% (р 0.05), the reactive anxiety level by 50.5% (р 0.01), and depression symptoms by 69.7% (р 0.01), whereas the general health improved by 71.2% (р 0.01), with statistically significant differences from the comparison group in all parameters (р 0.05). CONCLUSION: 2-week rehabilitation program, including interval hypoxia-hyperoxytherapy, reduces back pain and improves rehabilitation diagnosis based on the ICF, general health, functional status and psychoemotional state in patients with nonspecific musculoskeletal lower back pain.

Might patients with cerebellar ataxia benefit from the Computer Assisted Rehabilitation ENvironment (CAREN)? A pilot study focusing on gait and balance.

Introduction: Ataxia is a neurological symptom that causes decreased balance, loss of coordination, and gait alterations. Innovative rehabilitation devices like virtual reality (VR) systems can provide task-oriented, repetitive and intensive training with multisensorial feedback, thus promoting neuroplastic processes. Among these VR technologies, the Computer Assisted Rehabilitation ENvironment (CAREN) associates a split belt treadmill on a 6-degrees of freedom platform with a 180° VR screen and a Vicon motion capture system to monitor patients' movements during training sessions. Methods: Eight patients affected by cerebellar ataxia were enrolled and received 20 sessions of CAREN training in addition to standard rehabilitation treatment. Each patient was evaluated at the beginning and at the end of the study with 3D gait analysis and clinical scales to assess balance, gait function and risk of falls. Results: We found improvements in kinematic, kinetic, and electromyographic parameters (as per pre-post- CAREN training), as well as in clinical outcomes, such as balance and risk of falls in ataxic patients. In addition, we found that trunk rotation improved, after CAREN intervention, approximating to the normative values. Discussion: Our results suggested that CAREN might be useful to improve specific biomechanical parameters of gait in ataxic patients.

An innovative cardiac rehabilitation based on the power-force-velocity profile to further improve cardiorespiratory capacities in coronary artery disease patients

An innovative cardiac rehabilitation based on the power-force-velocity profile to further improve cardiorespiratory capacities in coronary artery disease patients

Effects of Serious Games in Older Adults With Mild Cognitive Impairment.

The rising prevalence of mild cognitive impairment (MCI) has spurred interest in innovative cognitive rehabilitation approaches, including serious games. This review summarizes randomized clinical trials (RCTs) exploring the impact of serious games on MCI patients. We conducted a comprehensive data search using key terms such as "gamification," "digital therapy," "cognition," "mild cognitive impairment," and "Alzheimer's disease." We exclusively considered published RCTs, excluding animal studies and basic research. We identified eight RCTs. Four RCTs examined the effects of serious games using cognitive training for MCI patients. Notably, one study found that non-specific training (Nintendo Wii) significantly enhanced cognitive function and quality of life compared to cognition-specific computer training (CoTras). Among the remaining three RCTs, one specifically demonstrated that personalized serious game-based cognitive training yielded superior cognitive outcomes and reduced depressive symptoms. One RCT focused on serious games incorporating physical exercise, highlighting the effectiveness of kinetic-based exergaming in enhancing overall cognition. Three RCT focused on combined cognitive training and physical exercise. A double-blind RCT revealed that progressive resistance training or standalone physical exercise outperformed the combined approach in improving executive function and global cognition. Two additional RCTs reported positive outcomes, including improvements in cognitive function and electroencephalogram patterns associated with game-based interventions. Serious games, whether focusing on cognitive training, physical exercise, or a combination of both, have potential to improve cognitive and functional outcomes in individuals with MCI. Further research and standardization of protocols are needed to better understand the full potential of serious games in MCI.

INNOVATION AND DIGITAL TRANSFORMATION IN HEALTHCARE. PROCESS OPTIMIZATION OF REHABILITATION ACTIVITIES IN IN REHABILITATION CARDIOLOGY IN SUPPORT OF PATIENT AND TEAM

Abstract Physical activity is a treatment for preventing and treating a wide range of diseases; its prescription must be precise and accurate in order to optimize the effects avoiding at the same time clinical risks due to frequent patients’ frailty.To deploy a “comprehensive digital rehabilitation” means to digitalize the whole process: from clinical and instrumental evaluations to the subsequent coherent prescriptions of the rehabilitation and care–related activities, from the case management planning – described in the individual rehabilitative project – to the individual rehabilitative program – that takes shape in semi–automated scheduling and in digitalized reporting. The deployed software must be easy to use and reliable, and must ensure safety, guaranteeing the exchange of clinical information among the team members. For all these reasons, we have pre–set pathways that, starting from the main and secondary clinical diagnosis (using the ICD classification) and based thereafter on the WHO ICF classification, the rehabilitation processes are governed in a standardized tailored granularity for each single patient by the aid of a computerized expert system. Even if it what just stated appears an oxymoron, thanks to the digital transformation and the adoption of the Internet of Things, it is possible to easily implement a personalized rehabilitation program through a shared and standardized ontology, providing benefits both to the patient and to the rehabilitation team. Based on this, the rehabilitation services that can be provided have been defined, providing not only those provided for by national and regional nomenclators but also those peculiar to the activities in our Institutes. The digital gym goes beyond the concept of equipment in a gym space; the gym space becomes both physical and virtual. The goal is the networking of "basic" and innovative rehabilitation equipment, even placed in different environments, through the philosophy of IoT, that path of technological development whereby, through the Internet network, potentially every object of daily experience acquires its own identity in the digital world. All this will allow for real–time feedback of data and measurements for the development of a personalized digital record. The digital platform, telemedicine and cloud computing, begin to enable an integration of people, equipment and data.

Role of Virtual Rehabilitation in Total Knee Arthroplasty: Functional Outcomes and Cost-Effectiveness

This review article aims to explore the role of virtual rehabilitation in total knee arthroplasty in terms of functional outcomes and cost-effectiveness. Total knee arthroplasty (TKA) is a widely performed surgery for end-stage knee osteoarthritis, requiring supervised rehabilitation for rapid recovery and pain relief. Virtual rehabilitation has been evolving as an alternative to the traditional rehabilitation program in the recent years especially during the predicament of COVID-19 pandemic. Virtual rehabilitation leverages virtual reality (VR) technology to provide innovative, engaging, and measurable rehabilitation services that can complement or replace traditional therapy approaches. Virtual reality and telerehabilitation represent evolving fields in TKA rehabilitation, offering advantages over traditional therapy in terms of cost-effectiveness, improved outcomes, enhanced exercise adherence, and reduced barriers to accessing postoperative therapy. Despite the need for more research and standardized protocols, VR-based rehabilitation holds significant potential for optimizing the recovery process for patients undergoing TKA. The research indicates that VR-based rehabilitation programs for TKA patients have utilized a variety of interactive virtual environments, gaming activities, and feedback mechanisms to supplement traditional physical therapy exercises. Virtual rehabilitation for TKA encourages clinician-patient interaction beyond the hospital setting and offers the advantages of cost savings, convenience, at-home monitoring, and coordination of care, improved functional outcomes, increased exercise adherence, better balance performance, and psychological benefits like reduced stress and anxiety, all of which are geared to improve adherence and overall patient satisfaction. This review article outlines the importance of virtual rehabilitation in TKA, emphasizing cost-effectiveness and improved balance and function while maintaining enhanced adherence and exercise performance. This article also delves into the mode of administration of VR-based rehabilitation and its delivery, safety concerns, advantages and disadvantages, as well as the most common VR-based rehabilitation protocols for TKA. Further, it discusses the implications of virtual rehabilitation in the healthcare system and future directions for virtual rehabilitation in TKA. In conclusion, the evidence indicates that virtual physical therapy (PT) with remote clinical oversight is a safe, effective, and more cost-effective alternative to traditional in-person PT for patients undergoing TKA. Keywords: Virtual rehabilitation, virtual physical therapy, telehealth, telerehabilitation, total knee arthroplasty.

Comprehensive Review on Distal Femur Fractures: From Epidemiology to Treatment Strategies.

Distal femur fractures present a substantial orthopedic challenge, necessitating a comprehensive exploration spanning epidemiology, anatomy, classification, diagnosis, and treatment strategies. This review thoroughly analyzes the multifaceted aspects surrounding distal femur fractures. It delves into the definition and epidemiology, shedding light on the incidence, age distribution, and associated risk factors. An exhaustive examination of the distal femur's anatomy, encompassing ligaments and tendons, establishes the groundwork for understanding fracture patterns and subsequent classification according to the AO Foundation/Orthopaedic Trauma Association (AO/OTA) system. Diagnostic considerations encompass physical examination and various imaging modalities, emphasizing the critical importance of prompt and accurate assessment. The extensive discussion on treatment options ranges from non-surgical management, including casting and traction, to surgical interventions, such as open reduction and internal fixation, intramedullary nailing, and external fixation. The implications for clinical practice underscore the necessity for tailored approaches based on fracture characteristics to optimize patient outcomes. However, this review also emphasizes areas necessitating further investigation, including exploring predictive biomarkers, advanced surgical techniques, and innovative rehabilitation protocols. Insights from long-term outcomes and quality-of-life assessments in diverse populations offer promising avenues for enhancing the comprehensive management of distal femur fractures. Continuous research in these areas can refine treatment strategies and elevate the standard of care for individuals grappling with this intricate orthopedic condition.

The effects of vibrating shoe insoles on standing balance, walking, and ankle-foot muscle activity in adults with diabetic peripheral neuropathy

BackgroundPeripheral neuropathy is one of the most common complications of type 2 diabetes, which can lead to impaired balance and walking. Innovative footwear devices designed to stimulate foot sensory receptors, such as vibrating insoles, could offer a new route to improve motor impairments in people with diabetic peripheral neuropathy (DPN). Research questionDoes wearing vibrating insoles for the first time alter measures of balance, walking, and ankle-foot muscle activity, in people with DPN? MethodsA randomised cross-over study was conducted with 18 ambulant men and women with a diagnosis of DPN. Participants performed tests of standing balance (Bertec® force platform) under four conditions (foam/firm surface, eyes open/closed) and level-ground walking (GAITRite® instrumented walkway), whilst wearing vibrating and non-vibrating (control) insoles on two separate occasions (one insole/session). Electromyography (EMG) was used to assess soleus, medial gastrocnemius, tibialis anterior, peroneus longus activity during balance tests. Outcomes included centre of pressure (CoP) sway, EMG amplitude, spatiotemporal gait patterns, and Timed Up and Go test. One sample t-tests were used to explore %differences in outcomes between insole conditions. ResultsWearing vibrating insoles led to a reduction (improvement) in CoP elliptical area, when standing on a foam surface with eyes closed, relative to non-vibrating insoles (P=0.03). Applying perceptible vibrations to the soles of the feet also reduced the EMG amplitude in soleus (P=0.01 and P=0.04) and medial gastrocnemius (P=0.03 and P=0.09) when standing with eyes closed on firm and foam surfaces. SignificanceOur findings of signs of improved balance and altered muscle activity with suprasensory vibrating insoles provides new insights into how these devices can be used to inform innovative rehabilitation approaches in individuals with DPN. This will be strengthened by further research into possible clinical benefits of these devices – given that the effects we detected were small with uncertain clinical meaning.

Innovative approaches in the rehabilitation of military prisoners of war and residents of temporarily occupied territories

Background. As of January 4, 2024, 2828 military personnel and civilians have been released from Russian captivity [1, 2]. All of them require rehabilitation, both physical and psychological. Considering the large number of military and civilian individuals facing psychological difficulties due to war-related traumas and stressful situations, the development of innovative rehabilitation methods becomes a strategically important task. Taking into account the complexity of the causes of armed conflicts, it is evident that special programs and measures need to be developed for the psychological rehabilitation of servicemen who have experienced psychologically traumatic conditions during military-professional activities. Special attention should be given to the development of individualized approaches that consider the unique needs and experiences of each affected individual, providing them with the opportunity to recover not only physically but also psychologically. Among the main directions of psychological rehabilitation of the personality, a reevaluation of practices focused on self-identification and autonomy is considered. This includes the exploration of new communicative territories and the creation of meanings in accordance with the stage of the life path. It is noted that the construction of new meanings and their personal interpretation is facilitated during a productive, symmetrical dialogue between the traumatized individual and the psychotherapist. Such dialogue helps reconstruct life history, transform an extraordinary event into one of the elements of a series of events, and accept a new demarcation of boundaries between peaceful and war experiences, pre-war and present friends, former and current values, plans, and preferences. The purpose of the paper is to highlight the research on the development of integrated and effective support aimed at the physical, mental and social recovery of prisoners of war and civilians who were in the temporarily occupied territories. Materials and Methods. Meta-analysis; interviews, history taking; medical assessment of physical condition; assessment of mental condition, namely psychiatric examination; psychological assessment – questionnaire to determine the level of stress, anxiety, depression and other mental symptoms. Results. A significant number of prisoners of war and individuals who have been in temporarily occupied territories or captivity require targeted psychological rehabilitation measures. According to the results of numerous studies, 70% of individuals still experience maladaptation one to two years later. This is manifested in the inability to adapt to civilian life, including symptoms such as fear, high levels of anxiety, lack of optimism and activity in various situations, as well as problems with alcohol, drugs, and others [3–5]. Conclusions. The study of innovative approaches to the rehabilitation of prisoners of war and persons from the temporarily occupied territories confirms the need for individualized strategies that facilitate their return to normal functioning in society.