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Physiotherapy robots offer a feasible and promising solution for achieving safe and efficient treatment. Among these, acupoint recognition is the core component that ensures the precision of physiotherapy robots. Although the research on the acupoint recognition such as hand and ear has been extensive, the accurate location of acupoints on the back of the human body still faces great challenges due to the lack of significant external features. This paper designs a two-stage acupoint recognition method, which is achieved through the cooperation of two detection networks. First, a lightweight RTMDet network is used to extract the effective back range from the image, and then the acupoint coordinates are inferred from the extracted back range, reducing the inference consumption caused by invalid information. In addition, the RTMPose network based on the SimCC framework converts the acupoint coordinate regression problem into a classification problem of sub-pixel block subregions on the X and Y axes by performing sub-pixel-level segmentation of images, significantly improving detection speed and accuracy. Meanwhile, the multi-layer feature fusion of CSPNeXt enhances feature extraction capabilities. Then, we designed a physiotherapy interaction interface. Through the three-dimensional coordinates of the acupoints, we independently planned the physiotherapy task path of the physiotherapy robot. We conducted performance tests on the acupoint recognition system and physiotherapy task planning in the physiotherapy robot system. The experiments have proven our effectiveness, achieving a recall of 90.17% on human datasets, with a detection error of around 5.78 mm. At the same time, it can accurately identify different back postures and achieve an inference speed of 30 FPS on a 4070Ti GPU. Finally, we conducted continuous physiotherapy tasks on multiple acupoints for the user. The experimental results demonstrate the significant advantages and broad application potential of this method in improving the accuracy and reliability of autonomous acupoint recognition by physiotherapy robots.

Digital physiotherapy, often referred to as “Telerehabilitation”, consists of applying rehabilitation using telecommunication technologies. The objective is to evaluate the effectiveness of therapeutic exercise when it is telematically prescribed. Methods: We searched PubMed, Embase, Scopus, SportDiscus and PEDro (30 December 2022). The results were obtained by entering a combination of MeSH or Emtree terms with keywords related to telerehabilitation and exercise therapy. RCTs on patients over 18 years and two groups were included, one working with therapeutic exercise through telerehabilitation and one working with conventional physiotherapy group. Results: a total of 779 works were found. However, after applying the inclusion criteria, only 11 were selected. Telerehabilitation is most frequently used to treat musculoskeletal, cardiac and neurological pathologies. The preferred telerehabilitation tools are videoconferencing systems, telemonitoring and online platforms. Exercise programs ranged from 10 to 30 min and were similar in both intervention and control groups. In all the studies, results proved to be similar for telerehabilitation and face-to-face rehabilitation in both groups when measuring functionality, quality of life and satisfaction. Conclusion: this review generally concludes that intervention through telerehabilitation programs is as feasible and efficient as conventional physiotherapy in terms of functionality level and quality of life. In addition, telerehabilitation shows high levels of patients’ satisfaction and adherence, being values equivalent to traditional rehabilitation.

Background:In inflammatory arthritis, especially rheumatoid arthritis, the upper extremities are affected in 80-90% of cases, with the wrist being most frequently affected. In these patients, the motor function of the upper extremities is often impaired, leading to disability as the disease progresses. Chronic inflammatory joint disease and/or joint degeneration may further alter the proprioceptive sense, resulting in reduced sensorimotor control. To improve motor performance and proprioceptive control, specific exercise approaches should be incorporated into the rehabilitation program. While conscious proprioception is usually assessed by measuring joint position, the unconscious component of proprioception remains a challenge as there is no established method to assess it directly. Unconscious neuromuscular control of joints involves the activation of muscles through feed-forward control mechanisms leading to changes in electromyographic (EMG) activity. In addition to measuring motor performance, analyzing the EMG activity of the surrounding muscles of the affected joint can provide valuable insights into unconscious proprioception and also help to assess the effects of exercise on muscle recruitment.Objectives:The aim of this study was to investigate the effects of proprioceptive exercises on conscious (joint position sense) and unconscious proprioception (surface EMG signals of the forearm muscles) as well as on motor performance measures such as grip and pinch strength, reaction time and upper extremity stability in healthy individuals.Methods:A total of 41 healthy individuals (25 males, 16 females) aged 20 to 30 years (mean age 23.12 ± 2.23 years) were included in this study. Participants were randomly assigned to either group 1, which received a combination of proprioceptive exercises and traditional upper extremity exercises, or group 2, which received only traditional upper extremity exercises. Both groups performed non-dominant upper extremity exercises twice a week over a 6-week period. Motor performance outcomes included measurement of wrist position sense (flexion, extension, radial and ulnar deviation) using a validated goniometric platform, measurement of grip and pinch strength using a dynamometer, measurement of reaction time using the Nelson test, and assessment of upper extremity stability using the Y-balance test. The measurements were taken at the baseline and after the 6-week training program for both extremities. Surface electromyography (EMG) results were recorded from specific forearm and finger muscles using a Noraxon EMG device. EMG analysis was performed with an amplifier gain of x1500 mV, a bandpass filter between 10-400 Hz, a sampling rate of 5000 Hz and a common mode rejection ratio (CMRR) of 90 dB. The EMG analysis included tasks involving isotonic joint motion and grasping. EMG measurements were normalized based on the participant’s maximal isometric contraction.Results:Grip strength increased and reaction time decreased in both groups. However, when comparing the two groups, group 1 was found to have significantly higher EMG muscle activity in the finger flexors (p=0.01) and extensors (p=0.007) and in the wrist flexors (p=0.02; p=0.04) during grasping compared to group 2. In addition, increased activation of wrist flexors (p=0.03) and finger flexors (p=0.02) was found during isotonic motion.Conclusion:The integration of proprioceptive exercises into the rehabilitation program has been shown to yield additional benefits in improving unconscious wrist proprioception. In patients with rheumatic diseases involving wrist, such as rheumatoid arthritis, it is possible to incorporate proprioceptive exercises into the treatment program to enhance sensorimotor control of the joints.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Background:Osteoarthritis, the most common joint disease in the world, is one of the degenerative diseases whose incidence increases with advancing age, causing pain and restriction of movement, resulting in loss of function in individuals [1]. One of the most preferred surgical methods in its treatment is total knee arthroplasty [2]. However, the effects of total knee arthroplasty on proprioception are still controversial [3]. Some authors have emphasized that total knee arthroplasty improves proprioception and balance, while others have reported no difference in knee proprioception [4,5].Objectives:The aim of this study is to evaluate the knee joint position sense of individuals who have undergone total knee arthroplasty and to compare it with individuals with osteoarthritis and healthy individuals. Additionally, the study aims to investigate the relationship between knee joint position sense and balance, physical performance, and reaction time.Methods:The study included 60 individuals (37 females, 23 males) including 20 unilateral total knee arthroplasty, 20 knee osteoarthritis and 20 healthy volunteers. Individuals’ joint position sense was evaluated with “RateFastGonio®” application, balance with “Berg Balance Test”, physical performance with “Timed Up and Go” and “Stair Climb” tests, and reaction time with “Nelson Foot Reaction” test.Results:There was no statistically significant difference between the 3 groups in joint position sense at 15° (p=0.169), 45° (p=0.159) and 60° flexion (p=0.241). When the relationship between joint position sense and other parameters was analyzed, it was observed that timed up and go values had statistically significant, positive correlations with 15° joint position sense values in the healthy (p=0.011; r=0.558) and osteoarthritis (p=0.034; r=0.475) groups. In addition, reaction time values were found to have a statistically significant, positive correlation with 60° joint position sensation values only in the osteoarthritis (p=0.049; r=0.446) group.Conclusion:The results of our study showed that total knee arthroplasty did not improve individuals’ proprioception, but did not cause enough proprioceptive loss to show a significant difference. Furthermore, the fact that joint position sense was positively and moderately associated with reaction time and timed up-and-go test may indicate that improving proprioception may also improve these parameters.REFERENCES:[1] Yelin E, Murphy L, Cisternas MG, Foreman AJ, Pasta DJ, Helmick CG. Medical care expenditures and earnings losses among persons with arthritis and other rheumatic conditions in 2003, and comparisons with 1997. Arthritis Rheum. 2007;56(5).[2] Papakostidou I, Dailiana ZH, Papapolychroniou T, Liaropoulos L, Zintzaras E, Karachalios TS, et al. Factors affecting the quality of life after total knee arthroplasties: A prospective study. BMC Musculoskelet Disord. 2012;13.[3] Xue YY, Shi JN, Zhang K, Zhang HH, Yan SH. The effects of total knee arthroplasty on knee proprioception of patients with knee osteoarthritis: a meta-analysis. J Orthop Surg Res. 2022 Dec 7;17(1):258.[4] Swanik CB, Lephart SM, Rubash HE. Proprioception, Kinesthesia, and Balance after Total Knee Arthroplasty with Cruciate-Retaining and Posterior Stabilized Prostheses. Journal of Bone and Joint Surgery. 2004;86(2).[5] Fuchs S, Tibesku CO, Frisse D, Genkinger M, Laaß H, Rosenbaum D. Clinical and functional comparison of uni- and bicondylar sledge prostheses. Knee Surgery, Sports Traumatology, Arthroscopy. 2005;13(3).Acknowledgements:NIL.Disclosure of Interests:None declared.

Background Home-based motor rehabilitation after stroke has a great potential to promote task-specific and context-specific training in a familiar, functionally rich context, supporting more personalised, engaging, and adaptable rehabilitation experiences. This review aims to map existing practices in home-based motor rehabilitation after stroke and critically examine whether this potential is fully utilized and identify strengths and limitations. It further explores how healthcare professionals can optimise their planning and delivery of interventions. Methods A scoping review was conducted following the PRISMA guidelines. Comprehensive searches were conducted in 5 databases: PubMed, CINAHL, MEDLINE, APA PsycINFO and Web of Science. Two reviewers independently screened the studies for eligibility and extracted characteristics of each study into a data charting table. Results Sixty-six studies met the inclusion criteria. The results highlighted a consistent implementation of task-specific exercises but limited implementation of context-specific stimuli, inadequate training dosage, and limited contextual adaptation to the home environment. Further, instructional methods tended to be overly prescriptive, co-design strategies applied inconsistently, and caregiver engagement often underutilised. Conclusions Existing practices do not fully utilize the potential of home-based rehabilitation. We argue clinical work should prioritise early-phase interventions with adequate intensity and develop pedagogical frameworks to guide home modifications and instructional methods. The framework should support progressive and engaging practice, and fully adopt co-designed, person-centred approaches that meaningfully involve family caregivers.

Background In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability. Methods We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE. Results Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention. Conclusions Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources. Trial registration PROSPERO: Reg no 190409 Registration date 01AUG 2020.

Anterior cruciate ligament (ACL) reinjury rates among athletes remain very high despite screening protocols designed to assess readiness for return to sport. To better identify biomechanical risk factors for ACL injury, combining neurocognitive challenges and high-impact tasks would more closely resemble sporting demands. We investigated the influence of secondary cognitive tasks on landing mechanics during bilateral drop vertical jumps (DVJs) among athletes following ACL reconstruction and whether sex affected these results. We also assessed whether adding secondary cognitive tasks to DVJs influenced loading asymmetries. Forty individuals (20 males) performed three DVJ conditions: (1) without secondary cognitive tasks (DVJ), (2) with secondary cognitive tasks targeting fast decision-making and inhibitory control of the motor action (DVJmot), and (3) with secondary cognitive tasks targeting fast decision-making, inhibitory control, attention, and short-term memory (DVJcogmot). We collected movement mechanics time-series data during the first 100 ms of landing using a motion capture system and force plates and compared outcomes between the three DVJs using functional t-tests. Secondary cognitive tasks altered trunk, hip, knee, and ankle landing mechanics (adjusted p-values < 0.05), representing more upright and stiffer landings. Loading asymmetries were increased by unloading the injured limb (adjusted p-values < 0.05). We found no differences between DVJmot and DVJcogmot or between males and females. Adding secondary cognitive tasks to DVJs better identifies landing mechanics associated with an increased ACL injury risk and inadequate rehabilitation. Future research should focus on optimizing the challenge point of the cognitive and motor tasks and how to best integrate them in RTS testing.

Research shows many positive effects from physical exercise. The present study examined the impact of a structured physical exercise program compared to treatment as usual on the gross motor skills of children diagnosed with autism spectrum disorder (ASD). Participants included 20 children, from 4 to 7 years old, who were assigned to two groups; an experimental group (n = 10) who received a structured physical exercise program for 60-min sessions, three times a week for eight weeks, and a control group (n = 10) who received conventional physiotherapy. Gross motor skills were assessed with the Abbreviated Development Scale -3 before and after the physical exercise program. The experimental group exhibited significant improvements in gross motor skills compared to the control group. This study suggests that structured physical exercise programs can improve gross motor skills in children with ASD.

Background To date, no consensus exists as to whether one exercise type is more effective than another in chronic neck pain. This systematic review and meta-analysis of systematic reviews aimed to summarize the literature on the effect of various exercise types used in chronic neck pain and to assess the certainty of the evidence. Methods We searched the databases Ovid MEDLINE, Embase, Cochrane Library, SportDiscus, and Web of Science (Core Collection) for systematic reviews and meta-analyses on adults between 18 and 70 years with chronic neck pain lasting ≥ 12 weeks which investigated the effects of exercises on pain and disability. The included reviews were grouped into motor control exercise (MCE), Pilates exercises, resistance training, traditional Chinese exercise (TCE), and yoga. Study quality was assessed with AMSTAR-2 and the level of certainty for the effects of the exercise through GRADE. A narrative analysis of the results was performed and in addition, meta-analyses when feasible. Results Our database search resulted in 1,794 systematic reviews. We included 25 systematic reviews and meta-analyses including 17,321 participants (overlap not accounted for). The quality of the included reviews ranged from critically low to low ( n  = 13) to moderate to high ( n  = 12). We found low to high certainty of evidence that MCE, Pilates exercises, resistance training, TCE, and yoga have short-term positive effects on pain and that all exercise types except resistance training, show positive effects on disability compared to non-exercise controls. We found low to moderate certainty of evidence for conflicting results on pain and disability when the exercise types were compared to other exercise interventions in the short-term as well as in intermediate/long-term apart for yoga, as no long-term results were available. Conclusion Overall, our findings show low to high certainty of evidence for positive effects on pain and disability of the various exercise types used in chronic neck pain compared to non-exercise interventions, at least in the short-term. Based on our results, no optimal exercise intervention for patients with chronic neck pain can be recommended, since no large differences between the exercise types were shown here. Because the quality of the included systematic reviews varied greatly, future systematic reviews need to increase their methodological quality. Trial registration Prospero CRD42022336014.

Motor-cognitive dual tasks are used to investigate the interplay between gait and cognition. Dual task walking in patients with Parkinson’s disease (PD) results in decreased gait speed and more importantly in an increased fall risk. There is evidence that physical training may improve gait during dual task challenge. Physiotherapy and treadmill walking are known to improve single task gait. The aim of this study was to investigate the impact of individualized physiotherapy or treadmill training on gait during dual task performance. 105 PD patients were randomly assigned to an intervention group (physiotherapy or treadmill). Both groups received 10 individual interventional sessions of 25 min each and additional group therapy sessions for 14 days. Primary outcome measure was the dual task gait speed. Secondary outcomes were additional gait parameters during dual task walking, UPDRS-III, BBS and walking capacity. All gait parameters were recorded using sensor-based gait analysis. Gait speed improved significantly by 4.2% (treadmill) and 8.3% (physiotherapy). Almost all secondary gait parameters, UPDRS-III, BBS, and walking capacity improved significantly and similarly in both groups. However, interaction effects were not observed. Both interventions significantly improved gait in patients with mild to moderate PD. However, treadmill walking did not show significant benefits compared to individualized physiotherapy. Our data suggest that both interventions improve dual task walking and therefore support safe and independent walking. This result may lead to more tailored therapeutic preferences.