Rehabilitation Tool Research Articles

Assessing the Efficacy of Lokomat Training in Pediatric Physiotherapy for Cerebral Palsy: A Progress Evaluation

Background: Gait disturbances in children with cerebral palsy can increase the hindrance caused by loss of independence and social engagement. The Lokomat, developed by Hocoma, shows promise as a supplementary tool for gait rehabilitation. This study investigates the impact of Lokomat training on gait parameters and trends observed during training. Methods: A total of 26 children (13 male individuals) with a diagnosis of cerebral palsy (CP), aged 4 to 23 years, were enrolled in the study. Patients participated in a standard comprehensive rehabilitation program with additional Lokomat training sessions. Gait function was assessed using the Timed Up and Go Test (TUG) and the 10 m walking test (10mWT) at the beginning and end of the rehabilitation period. Changes in Lokomat parameters (step number, session duration, speed, body weight support, and guidance force) were also analysed. Results: The median duration of the 10mWT and TUG significantly decreased across the groups after the treatment program. The highest increases were observed for the number of steps taken. Across the entire cohort, the linear trend curves for distance and number of steps exhibited near-perpendicular alignment with the horizontal axis, suggesting significant improvement in these parameters. A consistent trend was noted for speed, with the trend line aligned parallel with the horizontal axis. Decreasing trends were observed for body weight support and guidance force. Conclusions: Therapy with the Lokomat functioning as the active gait orthosis can be used as a form of support to the standard rehabilitation protocol for patients with CP.

A feasibility and usability study of a virtual reality tool (VESPA 2.0) for cognitive rehabilitation in patients with mild cognitive impairment: an ecological approach

A feasibility and usability study of a virtual reality tool (VESPA 2.0) for cognitive rehabilitation in patients with mild cognitive impairment: an ecological approach

Source localization of mu-rhythm event related desynchronization in EEG during tactile imagery

Tactile imagery remains a relatively understudied phenomenon in the field of mental imagery research. However, alongside motor imagery, this technique holds promise as an effective tool for sensorimotor rehabilitation following stroke and spinal cord injuries. In this study, conducted with 22 healthy volunteers, we investigated the source localization of mu-rhythm event related desynchronization (Event-Related Desynchronization, ERD) using multi-channel electroencephalogram recordings and subsequent inverse problem solution with the sLORETA method. All participants exhibited ERD during tactile imagery task, as well as under vibrotactile stimulation. It was demonstrated that mu-rhythm ERD during vibrotactile stimulation, as well as tactile imagery, was localized in the sensorimotor areas of the contralateral hemisphere. Within the source space, ERD in the postcentral gyrus was significantly stronger compared to the precentral gyrus. These findings indicate that tactile imagery, akin to the perception of real tactile stimuli, leads to prominent activation of sensorimotor cortical areas, consistent with the general understanding of the shared neural substrate during mental imagery and perception.

Subjective and functional outcome measures to evaluate performance of pediatric cochlear implant

BackgroundThe majority of research on the effects of cochlear implants has been on clinical evaluations of efficacy (hearing and speech skills and auditory thresholds). But it is unclear how much clinical efficacy metrics (speech, hearing, and language tests) actually demonstrate how beneficial cochlear implants (CI) are in everyday circumstances. In this study, we aim to assess the performance of a child’s current CI with both subjective and functional outcomes measures. Also, we aimed to assess factors affecting these outcomes after CI.MethodsThe study group included 45 cochlear-implanted children, and their chronological age ranges between 4 and 12 years. Children were divided according to their language age into three groups: group 1 (G1) includes15 children with a language age of less than 2 years, group 2 (G2) includes 15 children with a language age of 2 to less than 4 years, and group 3 (G3) includes 15 children with language age 4 to 6 years. Assessment was done in two sessions: one for phoniatric evaluation and another for audiological evaluation.ResultsCI enabled children to develop speech perception in a closed manner evidenced by the early speech perception (ESP) test with pattern perception being the easiest and monosyllabic words being the most difficult and the least to develop. Most children with CI were able to control their voice, to a lesser extent to use speech in meaningful use in social situations and to develop communication strategies in oral situations which were the least to develop, and this was evident by Meaningful Use of Speech Scale. Children with CI were able to acquire language, and their receptive language was better than expressive language, but their language age was below their chronological age.ConclusionThe cochlear implant is an effective rehabilitative tool for the treatment of prelingually deafened children, and this was evident by our results. A hierarchal approach of speech assessment according to the language age of the child and selection of age-appropriate speech perception test is very important to assess cochlear-implanted children Speech recognition had a high degree of variability. Early implantation age and increased duration of implant experience were the most important factors associated with good performance with CI, better speech perception, and better language outcomes.

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.

Efficacy of Bihemispheric tDCS in Rehabilitation of Non-Fluent Aphasia: A Single-subject Pilot Study

Objective: Transcranial direct current stimulation (tDCS) has emerged as a potentially effective complementary tool in rehabilitation of aphasia. However, there is no consensus regarding the optimal tDCS montage to augment language outcomes in aphasia. Against this background, the present study aimed to examine efficacy of tDCS combined with language therapy in aphasia rehabilitation and to compare two different montages. Methods: A right-handed participant suffering from chronic, non-fluent aphasia following stroke affecting the left hemisphere underwent a 5-week procedure involving tDCS coupled with language therapy. The procedure comprised two 5-day treatments of bihemispheric tDCS (over inferior frontal and posterior temporal sites determined using the international 10-20 EEG system). As part of both treatments, the left hemispheric targets were excited through anodal tDCS while simultaneously inhibiting their right-hemispheric homologues through cathodal tDCS. Baseline, post-treatment and follow-up assessments were obtained using a comprehensive language assessment tool. Results: An increase in language outcomes, particularly in repetition, was observed following the treatments. It was also found that therapy gains were more robust following bihemispheric stimulation of the posterior temporal sites compared to the inferior frontal targets. Conclusion: Bihemispheric tDCS coupled with language therapy appears to be effective in remediating language symptoms, particularly in terms of the repetition ability, in aphasia.

A DISTINCTIVE APPROACH TO REHABILITATE PATIENT WITH BILATERAL MAXILLECTOMY DEFECT BY TWO-PIECE HOLLOW OBTURATOR- CASE REPORT

An obturator is a common tool for prosthetic rehabilitation following invasive surgery, particularly in a total maxillectomy case. However, loss of teeth, palatal denture-bearing area, and vestibular retentive undercuts leaves an inadequate anatomic base to construct the definitive prosthesis. This results in compromised retention and stability. The retention problem can be resolved by fabricating an obturator that engages remaining undercuts. But in such acquired large defects, if all undercuts are engaged, the prosthesis may become too heavy, non-retentive, and challenging to insert, particularly in patients with very high and large defects. Therefore, in this case fabrication of two-piece magnet retained hollow obturator was described to make a prosthesis light weight with the use of thermoplastic polyvinyl chloride sheet in first part which provides adequate retention by engaging the desirable undercuts. The second part of the obturator was made hollow by the use of urinary catheter that was removed easily after completion of denture processing. After this, both the parts were attached together with the use of magnets. This technique is economical and easy to use to restore both function and esthetics in patients with bilateral maxillectomy defect.

Effects of a Wearable-Based Intervention on the Hemiparetic Upper Limb in Persons With Stroke: A Randomized Controlled Trial.

Wearables have emerged as a transformative rehabilitation tool to provide self-directed training in the home. Objective. In this study, we examined the efficacy of a novel wearable device, "Smart Reminder" (SR), to provide home-based telerehabilitation for hemiparetic upper limb (UL) training in persons with stroke. Forty stroke survivors from community support groups were randomized (stratified by the period after stroke onset and impairment severity) to either the SR group or the sham device group. Participants received either 20 hours of telerehabilitation using the SR device or training with pictorial handouts and a sham device over 4 weeks. In addition, all participants wore a standard accelerometer for 3 hours each day, 5 times a week, outside the prescribed training. Participants were assessed by a masked assessor at baseline, post-intervention (week 4), and follow-up (week 8). The outcome measures included Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Action Research Arm Test, Motor Activity Log, muscle strength, active range of motion and amount of movement of the UL, and compliance rate of training. The SR group improved substantially in their FMA-UE scores after treatment (mean difference = 2.05, P = .036) compared to the sham group. Also, adherence to the training using the SR device was significantly higher, 97%, than the sham group, 82.3% (P = .038). The 4-week telerehabilitation program using a "SR" device demonstrated potential efficacy in improving FMA-UE scores of the hemiparetic upper limb. However, it did not significantly enhance the performance of the affected limb in daily activities. The trial was registered on ClinicalTrial.gov (URL: http://www.clinicaltrials.gov) with the identifier NCT05877183.

A comprehensive assessment tool of acute-phase rehabilitation is associated with clinical outcomes in patients after cardiovascular surgery.

Perme intensive care unit (ICU) mobility score is a comprehensive mobility assessment tool; however, its usefulness and validity for patients after cardiovascular surgery remain unclear. We investigated the association between the Perme Score and clinical outcomes after cardiovascular surgery. We retrospectively enrolled 249 consecutive patients admitted to the ICU after cardiac and/or major vascular surgery. The Perme Score contains categories on mental status, potential mobility barriers, muscle strength and mobility level and was assessed within 2days after surgery. The outcomes of physical recovery were the number of days until 100-m ambulation achievement and 6-min walk distance (6MWD) at hospital discharge. The endpoint was a composite outcome of all-cause mortality and/or all-cause unplanned readmission. We analyzed the associations of the Perme Score with physical recovery and the incidence of clinical events. After adjusting for clinical confounding factors, a higher Perme Score was an independent factor of earlier achievement of 100-m ambulation (hazard ratio: 1.039, 95% confidence interval [CI]: 1.012-1.066) and higher 6MWD (β: 0.293, P = .001). During the median follow-up period of 1.1years, we observed an incidence rate of 19.4/100 person-years. In the multivariate Poisson regression analysis, a higher Perme Score was significantly and independently associated with lower rates of all-cause death/readmission (incident rate ratio: 0.961, 95% CI: 0.930-0.992). The Perme Score within 2days after cardiovascular surgery was associated with physical recovery during hospitalization and clinical events after discharge. Thus, it may be useful for predicting clinical outcomes.

Virtual Reality as a Therapeutic Tool in Spinal Cord Injury Rehabilitation: A Comprehensive Evaluation and Systematic Review.

Introduction: The spinal rehabilitation process plays a crucial role in SCI patients' lives, and recent developments in VR have the potential to efficiently engage SCI patients in therapeutic activities and promote neuroplasticity. Objective: The primary objective of this study is to assess a complete review of the extended impacts of VR-assisted training on spine rehabilitation in SCI patients. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) through a single database search in PubMed/Medline between the dates 1 January 2010 and 1 February 2024. MESH terms and keywords were combined in the following search strategy: (Augmented Reality OR VR OR Virtual Reality) AND (Spine OR Spinal) AND Rehabilitation. Included articles were written in English, involved adults with SCI, included an intervention with VR, AR, or any mixed reality system, and assessed changes in outcomes after the intervention. Results: The search produced 257 articles, and 46 of them were allocated for data extraction to evaluate 652 patients. Both when VR training was analyzed and reviewed separately, and when compared to traditional training, the findings exhibited predominantly promising outcomes, reflecting a favorable trend in the study. VR technologies were used in different settings and customizations, and the medium total time of VR training among the studies was 60.46 h per patient. Conclusions: This auspicious outcome of the study further motivates the intervention of VR and AR in the rehabilitation of SCI patients along with ameliorating their overall holistic well-being.

Patient routing system in rehabilitation after treatment for oncogynecological pathologies

Background. In recent years, oncogynecological diseases have been diagnosed more frequently in women of reproductive age. Despite the high efficiency of treatment measures, significant shortcomings in the rehabilitation system for such patients are noted.Objective: to present the continuity and features of the rehabilitation system for patients of oncogynecological profile.Material and methods. This review included 75 relevant publications from authoritative sources that presented unique findings. The search was conducted in Russian and foreign online libraries, databases and search engines. PRISMA recommendations were used for search and screening.Results. Oncogynecological patients need special attention in providing them medical care at the recovery stage. It is important to adhere to the principle of continuity between all steps of rehabilitation system: immediately after treatment, in rehabilitation department, and on outpatient stage. This system has been developed in Russia, but it needs scaling and solving a number of problems, ranging from a shortage of rehabilitation doctors, limited use of promising rehabilitation tools to insufficient provision of psychological assistance and the absence of generally accepted comprehensive rehabilitation system. At the same time, there is sufficient set of traditional and high-tech rehabilitation methods to provide highly specialized care.Conclusion. Aggressive treatment of oncogynecological diseases has a detrimental effect on the general well-being of women, significantly reducing their quality of life. Previously, proper provision of rehabilitation care encountered the rigidity of the system both at methodological and administrative levels. Recently, there have been positive shifts in solving problems of providing care to oncogynecological patients, however, the presented measures are not enough to qualitatively change the situation.

Blood Flow Restriction Training Improves Muscular Outcomes in Patients With Chronic Ankle Instability: A Critically Appraised Topic

Clinical Scenario: The high recurrence of lateral ankle sprains progresses to chronic ankle instability (CAI) and can affect many athletes in all sports. CAI is often associated with a decrease in muscle strength, an increase in pain, a decrease in the range of motion, and a decrease in balance or neuromuscular control. The use of blood flow restriction (BFR) with CAI can increase muscular outcomes and be used as a rehabilitation tool. Clinical Question: Is there evidence to suggest that BFR improves strength, muscle activation, and/or cross-sectional area of the lower leg musculature in those with CAI? Clinical Bottom Line: There is moderate evidence to support therapeutic exercise with low-intensity BFR in patients with CAI. The evidence concluded a significant improvement in BFR to increase muscle activation of the fibularis longus, anterior tibialis, vastus lateralis, and soleus. There is moderate evidence suggesting BFR can induce strength gains in the muscles of the lower extremity in patients with CAI. Strength of Recommendation: The comprehensive evidence is a Strength of Recommendation Taxonomy (SORT) Grade B, with a level of evidence of 2, according to the Centre for Evidence-Based Medicine (CEBM) for the studies included.

Early screening of post-stroke fall risk: A simultaneous multimodal fNIRs-EMG study.

Stroke is the third-leading cause of death and disability, and poststroke falls (PSF) are common at all stages after stroke and could even lead to injuries or death. Brain information from functional near-infrared spectroscopy (fNIRs) may precede conventional imaging and clinical symptoms but has not been systematically considered in PSF risk prediction. This study investigated the difference in brain activation between stroke patients and healthy subjects, and this study was aimed to explore fNIRs biomarkers for early screening of PSF risk by comparing the brain activation in patients at and not at PSF risk. In this study, we explored the differences in brain activation and connectivity between stroke and healthy subjects by synchronizing the detection of fNIRs and EMG tests during simple (usual sit-to-stand) and difficult tasks (sit-to-stand based on EMG feedback). Thereby further screened for neuroimaging biomarkers for early prediction of PSF risk by comparing brain activation variability in poststroke patients at and not at fall risk during simple and difficult tasks. The area under the ROC curve (AUROC), sensitivity, and specificity were used to compare the diagnostic effect. A total of 40 patients (22 not at and 18 at PSF risk) and 38 healthy subjects were enrolled. As the difficulty of standing task increased, stroke patients compared with healthy subjects further increased the activation of the unaffected side of supplementary motor area (H-SMA) and dorsolateral prefrontal cortex-Brodmann area 46 (H-DLFC-BA46) but were unable to increase functional connectivity (Group*Task: p < 0.05). More importantly, the novel finding showed that hyperactivation of the H-SMA during a simple standing task was a valid fNIRs predictor of PSF risk [AUROC 0.74, p = 0.010, sensitivity 77.8%, specificity 63.6%]. This study provided novel evidence that fNIR-derived biomarkers could early predict PSF risk that can facilitate the widespread use of real-time assessment tools in early screening and rehabilitation. Meanwhile, this study demonstrated that the higher brain activation and inability to increase the brain functional connectivity in stroke patients during difficult task indicated the inefficient use of brain resources.

Audiophonologopedic Telerehabilitation: Advantages and Disadvantages from User Perspectives.

Technological advancements and the COVID-19 pandemic have highlighted the importance of digital tools for patient care and rehabilitation. This study explores user perspectives on telerehabilitation, comparing it to traditional methods and identifying criteria for determining its suitability for different patients and clinical conditions. This study was carried out during the period of May-September 2021. Questionnaires were administered to 48 users in rehabilitation for audiophonologopedic and neurodevelopmental disorders in three rehabilitation centres in central Italy. The user responses predominantly emphasize the benefits of time saving (68.75%) and cost-efficiency (37.5%), specifically regarding time saving due to travel and expenses incurred to go to where the therapy is carried out. The disadvantages include increased distraction (60.42%) in following the instructions remotely and logistic problems (39.58%). Patients with hearing loss were subjected to a larger number of telerehabilitation sessions, positively rating this alternative method. Patients with speech and language delay and autism spectrum disorder (ASD) prefer traditional treatment. This study reveals a favourable perception of telerehabilitation as a therapy approach to be regarded as a supplement or temporary option to the irreplaceable face-to-face one. More research, as well as a larger sample sizes, will be useful to increase the significance of the correlations reported in this study.

Comparing the effectiveness of robotic plantarflexion resistance and biofeedback between overground and treadmill walking

Individuals with diminished walking performance caused by neuromuscular impairments often lack plantar flexion muscle activity. Robotic devices have been developed to address these issues and increase walking performance. While these devices have shown promise in their ability to increase musculature engagement of the lower limbs when used on a treadmill, most have not been developed or validated for overground walking and community use. Overground walking may limit the effectiveness of robotic devices due to differences in gait characteristics between walking terrains and reduced user engagement. The purpose of this study was to validate our multimodal robotic gait training system for overground walking in individuals with neuromuscular gait impairments. This untethered wearable robotic device can provide an ankle resistive torque proportional to the users’ biological ankle torque. The device can also provide audio biofeedback based on users’ plantar pressure intending to increase ankle power and muscle activity of the plantar flexors. Seven individuals with cerebral palsy participated. Participants walked overground and on a treadmill with our robotic gait training system in a single testing session. Results showed all seven participants to increase peak plantar flexor muscle activity, 10.3% on average, when walking with the gait trainer overground compared to treadmill. When compared to typical baseline overground walking, overground gait trainer use caused individuals to have slightly less knee joint excursion (3°) and moderately more ankle joint excursion (7°). This work supports our vision of using the wearable robotic device as a gait aid and rehabilitation tool in the home and community settings.

The Antigravity Treadmill as a Postoperative and Injury Rehabilitation Tool: Reduction in Contact Forces and Muscle Activity With Reduced Weight Running.

To investigate the effects of reduced weight running on the antigravity (AG) treadmill on maintenance of normal muscle activation and reduction of plantar forces in healthy subjects. Descriptive laboratory study. Clinical sports medicine center. Twenty healthy subjects (10 male and 10 female) aged 18 to 29 years. Subjects running at 6.5 miles per hour on a standard treadmill and on the AG treadmill at 100%, 90%, 80%, 70%, 60%, and 50% of bodyweight levels. Dynamic plantar loading data were recorded using pressure insoles. Surface electromyography electrodes with imbedded accelerometers were used to estimate timing and magnitude of muscle activity, stride length, and cadence. There was a significant, sequential reduction in peak pressure, maximum force, and force time integral (FTI) with decreasing bodyweight. A 50% bodyweight reduction resulted in a 51% reduction in maximum force and a 59% reduction in FTI in the heel, as compared with 19% to 28% at the metatarsal heads. There was reduced contact area in the heel and midfoot at and below 70% BW. Lower limb muscle activity decreases with reduced bodyweight while maintain normal muscle recruitment timing. The AG treadmill provides a reduction in loading forces while maintaining normal muscle recruitment patterns. Decreased BW running preferentially unloads the hindfoot. The AG treadmill can be an effective rehabilitation tool following foot or ankle injury and may prove superior to other limited weight-bearing methods.

Wavelet Coherence Analysis of Post-Stroke Intermuscular Coupling Modulated by Myoelectric-Controlled Interfaces.

Intermuscular coupling reflects the corticospinal interaction associated with the control of muscles. Nevertheless, the deterioration of intermuscular coupling caused by stroke has not received much attention. The purpose of this study was to investigate the effect of myoelectric-controlled interface (MCI) dimensionality on the intermuscular coupling after stroke. In total, ten age-matched controls and eight stroke patients were recruited and executed elbow tracking tasks within 1D or 2D MCI. Movement performance was quantified using the root mean square error (RMSE). Wavelet coherence was used to analyze the intermuscular coupling in alpha band (8-12 Hz) and beta band (15-35 Hz). The results found that smaller RMSE of antagonist muscles was observed in both groups within 2D MCI compared to 1D MCI. The alpha-band wavelet coherence was significantly lower in the patients compared to the controls during elbow extension. Furthermore, a decreased alpha-band and beta-band wavelet coherence was observed in the controls and stroke patients, as the dimensionality of MCI increased. These results may suggest that stroke-related neural impairments deteriorate the motor performance and intermuscular coordination pattern, and, further, that MCI holds promise as a novel effective tool for rehabilitation through the direct modulation of muscle activation pattern.

Design and Investigation of a low-cost elbow rehabilitation tool

Electronic medical development focuses on creating an efficient rehabilitation device that will strengthen all surrounding muscles and enhance elbow performance. The elbow rehabilitation tool (ERT) provides sophisticated methods like exercise and motion analysis. The initiative is notable for its advanced assessment methods and adaptable training curricula, which offer users a thorough and successful therapeutic experience. The ERT includes elements like a stepper motor, variable resistor, steel wire, microcontroller, motor driver, and components created using a 3D printer. The experiment results show that the average systematic error percentage is about 82.857%, where seven healthy people have tested the ERT aged between 22 and 55 (five males and two females). The ERT also has achievement evaluation, which improves motivation and dedication to the recovery methods through an effective rehabilitation experience for users.

Comparative Analysis of Combined Topography-Guided Photorefractive Keratectomy and Corneal Crosslinking in Progressive Versus Stable Keratoconus.

To perform a comparative analysis of visual, refractive, and tomographic outcomes of combined topography-guided photorefractive keratectomy (TG-PRK) and corneal crosslinking (CXL) in patients with progressive versus stable keratoconus. Longitudinal retrospective case-control study. Patients with keratoconus submitted to simultaneous TG-PRK and CXL were included, with a minimum follow-up of 12 months up to 3 years. According to predefined disease progression criteria, patients were considered as progressive or stable. A total of 101 eyes from 93 patients were included, 62 considered progressive and 39 stable keratoconus. All baseline characteristics were similar between groups, except for age at surgery (progressive: 23.40 ± 4.22 years; stable: 35.97 ± 9.09; P < 0.001). Logarithm of the minimum angle of resolution CDVA improved significantly in progressive (baseline: 0.48 ± 0.24; 12 months: 0.33 ± 0.29; P < 0.001) and stable (baseline: 0.51 ± 0.24; 12 months: 0.28 ± 0.21; P < 0.001) patients, with no differences between groups. Maximum keratometry decreased significantly in progressive (baseline: 59.18 ± 5.63 diopters; 12 months: 54.73 ± 5.95; P < 0.001) and stable (baseline: 57.77 ± 5.02; 12 months: 53.59 ± 4.20; P < 0.001) patients, with no differences between groups. Index of surface variance significantly improved in progressive (baseline: 109.18 ± 31.74 diopters; 12 months: 94.11 ± 34.11; P < 0.001) and stable (baseline: 102.87 ± 29.52; 12 months: 86.95 ± 27.21; P < 0.001) patients, with no differences between groups. Other tomographic outcomes were also similar between groups. Pachymetry significantly decreased after surgery but remained stable throughout the follow-up. Combined TG-PRK and CXL is a safe and effective procedure for improving CDVA and regularizing the cornea, with comparable visual, refractive, and tomographic outcomes in both progressive and stable keratoconus. Combined TG-PRK and CXL may be added to the armamentarium of therapeutic tools for visual rehabilitation in patients with stable keratoconus.

Flexible Tribo‐Enhanced Piezoelectric Nanogenerator Based on Aluminium Ferrite Electrospun Hybrid Nanofibers for Energy Harvesting and Patient Rehabilitation Application

AbstractMechanical energy harvesters have recently emerged as promising options for self‐powering sensors and small electronic devices. In this work, aluminum ferrite (AlFeO3)/PVDF hybrid perovskite electrospun nanofiber‐based tribo‐enhanced piezoelectric nanogenerators (TPENGs) are developed for energy harvesting. The as‐fabricated TPENG achieves an average voltage output of 52.3 V and an average current output of 1.23 µA. Additionally, the power density of the TPENG is calculated to be 0.085 W.m−2 at an 80 MΩ external resistance load. A 3D‐printed device is fabricated, containing nylon fabric (tribo‐positive) as a rotor attached to printed fins, while six (AlFeO3)/PVDF hybrid perovskite electrospun nanofiber piezoelectric nanogenerators (PENGs) wrapped with Kapton tape (tribo‐negative) serve as the stator. The three printed fins of the device are moved by a string‐based pulley, generating an open circuit voltage of 200 V and a short circuit current of 4.5 µA. The as‐fabricated 3D‐printed device with TPENGs is used to power small electronics (e.g., LEDs and watch) and an exercise setup, allowing patients to generate power by pulling the attached string, thereby estimating the level of impairment. Integrating energy harvesting into rehabilitation motivates patients to move impaired body parts, enhancing TPENG's application in healthcare as a practical and engaging tool for patient rehabilitation.