Purpose To examine the feasibility of implementing voluntary hypoventilation at low lung volume (VHL) training during the 2024 Paralympic Games’ preparation of an elite SH6 (short-stature) para-badminton athlete and characterize associated arterial oxygen saturation (SpO 2 ) and heart rate (HR) responses. Methods During a 5-week intervention, 9 VHL-based training sessions were added, consisting of either repeated running-shuttle sprints or badminton-specific exercises performed with maximal end-expiratory breath holding (EEBH). SpO 2 and HR were monitored, rating of perceived exertion (RPE) was recorded, and hypoxic dose was quantified. Within-participant variability and response patterns across training conditions were characterized using visual inspection of the complete time-series data and summary descriptive metrics. Results In both training types, a marked decrease in SpO 2 occurred from the first to the last repetition of each set. Mean nadir SpO 2 was higher during repeated running-shuttle sprint sessions vs . badminton-specific exercise sessions (81.8 ± 2% vs . 76.3 ± 3%) due to a shorter EEBH duration (7.2 ± 0.7 s vs . 9.8 ± 0.9 s). Mean session SpO 2 , HR, and RPE did not differ between training types, but RPE decreased significantly across sessions, indicating improved tolerance to the VHL-induced hypoxic stimulus. Conclusions This case report demonstrates that VHL-based training with maximal EEBH is feasible, well tolerated, and capable of eliciting robust hypoxemic stimuli in an elite SH6 para-badminton athlete.
This study presents a case-based application of the Clinical Limits of Use Tool (CLOUT), specifically its clinical device testing component, to evaluate an off-road mobility device, the Invacare Top End Force CC handcycle. This component of CLOUT was operationalized into measurable variables and standardized test procedures through collaboration among therapists, engineers, and advisory expert users. The evaluation included structured interviews and controlled off-road testing assessing assembly, seating and positioning, transfers, obstacle negotiation, slope performance, terrain interaction, and safety. Results The results demonstrated that the handcycle performed effectively on moderate terrain, including dirt, gravel, and grass, and successfully navigated slopes up to approximately 29° and smaller obstacles. Performance limitations were identified in larger obstacle negotiation due to low ground clearance, as well as in transfers due to low seat height and limited support. Device performance was influenced by user strength and environmental conditions. This case study demonstrates how CLOUT can be applied as a structured and reproducible framework to evaluate mobility device performance in non-clinical environments. The findings highlight the importance of aligning user ability, device characteristics, and environmental demands to support safe and effective mobility. This approach may inform clinical decision-making, user training, and future development of standardized evaluation methods for off-road mobility technologies and beyond.
Users with Severe Speech Motor Impairment (SSMI) face difficulties interacting with digital systems due to limited speech and motor control. To address this, we present an eye gaze-based system that enables users with SSMI to generate short music using eye gaze control. The system combines a webcam-based eye-tracking with a music generation system that transforms user-selected images into music. A user study was conducted with 15 participants with SSMI across 74 sessions. The results show that the participants were able to interact with the system using gaze-based control, with an average engagement time of 61.38 seconds per session. Eye-tracking calibration accuracy varied across participants, reflecting individual differences in gaze control. These findings demonstrate the feasibility of gaze-based generative music interaction as an accessible assistive system for users with SSMI.
Purpose:Following upper limb amputation (ULA), resuming everyday activities is a primary goal for patients. In many cases, a prosthesis can assist patients by increasing physical function and overall well-being. This study aimed to investigate the relationship between prosthesis receipt and two domains - Ability to Participate in Social Roles and Activities (APSRA) and Pain Interference (PI). Materials and methods:A retrospective cross-sectional review of outcomes collected across private prosthetic clinics in the United States was performed. Individuals were included if they had an outcome collected before prosthesis receipt and within twelve months after prosthesis receipt. There were no exclusions based on level of amputation, etiology, or device type. Results:Univariate model results demonstrated a significant improvement in average APSRA (Baseline: 41.5±8.2 and Follow-up: 46.7±9.1, p<0.001). Additionally, PI significantly improved (Baseline: 58.5±8.5 and Follow-up: 54.9±9.3, p<0.001). These significant differences persisted when accounting for confounders such as age, hours worn, sex, amputation level, time since amputation, and time from first prosthesis delivery to follow-up. Conclusions:Prosthesis receipt improved individuals' ability to increase their activity and participation. This coincided with improvements in pain interference. Results from this study can aid clinical decision-making for clinicians and patients as they explore interventions following ULA.
Lower-limb impairment caused by neurological injury, musculoskeletal disorders, or reduced mobility often requires repetitive rehabilitation exercises, but continuous therapist-assisted therapy may be difficult to access in low-resource settings. In this study, we developed and preliminarily evaluated a low-cost, lightweight, portable hip-knee exoskeleton prototype capable of generating controlled hip and knee joint motion for rehabilitation-oriented range-of-motion training. The prototype was constructed mainly of 3D-printed polylactic acid parts and powered by a pair of high-torque servo motors in the hip and knee joints. A Bluetooth-connected Android app was programmed to offer two modes: rehabilitation mode for independent joint control and a gait-inspired sinusoidal mode that generates coordinated hip and knee joint trajectories. The cost of the materials used to construct the prototype is estimated to be USD 155 with a weight of about 2.1 kg. Joint motion performance was assessed through time-angle measurements at three predefined speed settings. The hip joint (approximately 60° movement) was achieved in 2.2, 1.6, and 1.1 s and the knee joint (approximately 140° movement) was achieved in 3.0, 2.0, and 0.6 s for slow, medium and fast modes, respectively. The trial-to-trial variation in commanded servo position remained below ±1° under the tested conditions. The results demonstrate the feasibility of generating repeatable commanded hip and knee joint motion under controlled laboratory conditions. However, further investigations involving quantitative load-bearing evaluation, safety assessment, user studies, and clinical trials are required before the system can be considered for practical rehabilitation applications.
Customized wheelchair components that are designed to fit the individual user and consider their preferences can greatly improve the user’s quality of life, but are often cost-prohibitive using traditional manufacturing methods. 3D printing technology is advancing rapidly and has been used to manufacture assistive devices, but there is limited research on whether these methods are viable for load-bearing structural components in wheelchairs. We designed a progressive anti-tipper, an anti-tipper that provides a spring-loaded response to backwards rotation of the wheelchair. This prototype avoids the hard impact of rigid anti-tippers, and also provides increased range of motion of up to 20° rearward tip, allowing the front casters to rise far enough to climb curbs. We 3D printed our prototype using four different 3D printing methods in five materials (PLA, ASA, Resin, Onyx (Nylon+carbon fiber composite), and stainless steel). We performed function tests, ISO 7176-8 strength tests, and UTM destructive tests. The Onyx and stainless steel 3D prints passed our function and strength requirements, indicating that 3D printed parts show potential for load bearing components in wheelchairs. Further fatigue, strength, and real-world use studies are warranted to explore the viability of this technology.
Background Historically, daily hours of wearing a cranial remolding orthosis (CRO) was not objectively assessed, and the compliance to the treatment plan was evaluated subjectively through questionnaires in previous studies. Objective To assess objective monitoring of the postoperative CRO in infants with single suture craniosynostosis. Study design Prospective comparative study. Methods Data collection regarding the number of hours that the CRO was worn was obtained from data recorded from the Orthotimer sensor and data recorded from the participants’ parents. Results A total of 21 individuals (11 boys and 10 girls) participated in the study. Among these 21 participants, 9 had scaphocephaly (sagittal craniosynostosis), 9 had trigonocephaly (metopic craniosynostosis), and 3 had unilateral coronal deformity (coronal craniosynostosis). A significant difference was observed in adherence to the CRO treatment between the objective and subjective methods (p<0.05). Accordingly, the compliance based on parental reports (subjective method) was significantly higher than the data recorded objectively (p<0.05). Conclusion It was found that parents tend to report higher estimates regarding the use and compliance of the CRO. Therefore, for a more accurate assessment of the hours spent wearing the CRO, the objective method is the preferred choice.
One of the most important factors affecting quality of life is recreation, due to its positive role in social and physical health. Adaptive recreation can be difficult to access, largely because market availability for adaptive equipment, outside of assistive devices for daily living tasks, is extremely limited. The purpose of this project is to develop an open-source repository of affordable Sport and Recreation Activity Assistive Technology in response to idea submissions from the disability community. Prototypes are developed using predominantly 3D printing coupled with commonly available assembly materials, a fabrication approach that allows for rapid and reasonably affordable development of custom solutions. Each prototype follows a defined project methodology: need identification, design (prototyping and evaluation), fabrication testing, and dissemination. To date, several devices have been designed and made available with full documentation, including swim paddles, an attachment for a miniature golf club, billiards stick handles, a game piece mover, a cornhole bag adaptation, an arm prosthetic vehicle shifter adaptor, and a curling stone push stick attachment. All device designs, part files, bills of materials, and assembly instructions are accessible through a publicly available repository so that end users or their support networks can download and fabricate the devices themselves.
Exercise and participation in sport can have physical, psychological, and social benefits to persons with disabilities. The high cost ($5,000 to $12,000 USD) and long lead times of sport wheelchairs, however, is a barrier to participation. The objective of this study was to develop an affordable kirigami inspired rugby wheelchair made from sheet metal instead of tubes. Three prototypes of varying seat widths were designed, fabricated, and evaluated by 11 participants. Participants performed common drills in the prototype that best matched their hip width, and each provided feedback via a structured interview. The participants reported overall favorable reviews and cited the adjustability, repairability, and implications of this wheelchair on decreasing the barrier of entry to sport as its best features. Participants also identified areas for improvement, such as seat material and caster size. Future study should examine safety, durability, and performance during training and competition scenarios.
Background:Medial knee osteoarthritis (KOA) is a prevalent degenerative joint disease causing pain and functional impairment. Off-loading knee braces reduce pain but may decrease muscle activity, leading to weakness. Integrating local muscle vibration (LMV) into off-loading braces may enhance muscle activation and clinical outcomes. Objective:To design a portable LMV system synchronized with gait phases and compare its efficacy to a conventional off-loading brace in patients with medial KOA. Methods:In this randomized clinical trial, 16 patients with medial KOA were assigned to either an LMV-equipped off-loading brace group or a conventional brace group for 4 weeks. Clinical outcomes (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], Visual Analog Scale [VAS]) and biomechanical parameters (knee adduction moment [KAM1, KAM2], impulse, range of motion [ROM], cadence, stride length) were assessed pre- and post-intervention using validated questionnaires and a motion analysis system. Results:The LMV-equipped brace group demonstrated a significantly greater reduction in KAM impulse (-24.79% vs. -7.68%, p=0.050) and improved knee ROM (p=0.048) compared to the conventional brace group. Significant improvements in WOMAC (p=0.001) and VAS (p=0.011) scores were observed in the LMV group, indicating enhanced functional status and pain relief. Conclusion:The LMV-equipped off-loading brace provides superior biomechanical (KAM impulse, ROM) and clinical outcomes compared to conventional braces, offering a promising intervention for medial KOA.
This study aimed to characterize the anthropometric, muscle power, and kinematic profiles of visually impaired sprinters (AVI) and their guides (GA) during the 100-meter dash. Three male guide pairs participated, all with national and international experience: Pair 1: AVI (T12); Pair 2: AVI (T11); Pair 3: (T11). Assessments included: (a) anthropometry, (b) lower-limb muscle power via countermovement jump (CMJ), and (c) kinematic analysis during an official 100-meter race using a global positioning system (GPS). GAs generally exhibited greater height, body mass, and longer lower limbs compared to AVIs. Except for Pair 3, GAs demonstrated superior CMJ performance and lower-limb power output. Peak running velocity (PV) was comparable across pairs, but AVI in Pair 1 and 2 achieved PV faster than their GAs. Pair 3 displayed pronounced asymmetries in instantaneous velocity and acceleration between AVI and GA during the race. The synchronization is influenced by experience duration, anthropometric compatibility, and muscle power disparities.
Introduction This study compared fixed and individualized speed zone methods for quantifying external match load (EML) across classification and playing levels in women’s wheelchair basketball (WB) and examined their relationship with internal match load (IML) measures. Methods EML of 31 well trained female players (age: 28 ± 7 years, experience: 11 ± 5 years, weekly training: 12 ± 4 h) were quantified across 13 international (INT) and 5 Women’s Premier League (WPL) games using two inertial measurement units. A linear mixed model compared the percentage time in fixed and individualized speed zones and correlations with IML (eTRIMP, sRPE) using Pearson and Spearman Rho. Results Individualized zones recorded more time (10%) in low speed (Z3) and less time (0.3–5.9%) in moderate to very high-speed zones (Z4-Z6) versus fixed ( p < 0.0001). Differences and effect sizes were greater in INT games (+0.8-1.1 pp) and highest classifications (+9.5 pp). Both methods correlated poorly with IML, except weak Z3 correlations at the INT level ( p ≤ 0.020). Conclusions Speed zone method influences high-intensity movement assessments, varying by playing level and classification. Neither method optimally related to IML, highlighting the need for calibrated, consistent thresholds.
The rapid expansion of virtual reality (VR) technology has led to the development of low-friction, slip-style omnidirectional treadmills (OTs), which have great promise for implementation into VR-based gait rehabilitation protocols. However, previous work indicates that use of these treadmills leads to unique gait patterns that may differ from overground gait, and there is a lack of research examining how OT gait differs from a conventional, belt-driven treadmill (CT). Thus, the purpose of this study was to characterize spatiotemporal and electromyographic gait patterns on an OT and to compare them with overground and CT walking. Fourteen healthy participants walked in these three conditions in both the real-world and in VR, as well as at fixed and preferred paces. Results indicate that use of the CT promoted significantly longer stride lengths (mean = 1.838 m) and reduced variability (coefficient of variation (CV) = 14.7%) compared to overground walking (mean = 1.578 m, CV = 21.4%). Moreover, the use of CT in VR at a fixed pace led to reduced biceps femoris (CV = 20.4%) and medial gastrocnemius (CV = 14.9%) variability compared to overground walking (biceps femoris CV = 26.4%, medial gastrocnemius CV = 22.2%), while use of the OT demonstrated variability similar to that of overground walking across measures. These results indicate that the user-driven aspect of OTs may elicit gait patterns more similar to overground walking than traditional belt-driven treadmills.
Background and AimThe study investigated the present state of awareness, unmet needs, and barriers faced by participants using wheelchairs in a tertiary care hospital in India.MethodsThis sequential explanatory mixed-method study explored the participants' experiences in two parts. Part one presents the result analysis of user experience and wheelchair service provision using rATA (n=100). Part two presents a thematic analysis of 100 in-depth semi-structured interviews.ResultThe study and interviews define barriers to wheelchair access provision, including assessment, prescription, customization, training, wheelchair maintenance, and follow-up. The study reported that most participants procured their wheelchairs from the private sector (35%) while 10% received them from the public sector. The main reasons for not having the appropriate wheelchair were affordability (78%), lack of support (64%), and lack of awareness (41%), while road/transport accessibility (63%) and home accessibility (53%) were the main obstacles for the wheelchair non-use.ConclusionThe study provided insights into wheelchair provision and user satisfaction within healthcare delivery system. Integration of Wheelchair service and delivery into the health care system can strengthen the rehabilitation health system per the WHO guidelines.
Air cell cushions are widely used in wheelchair seating and medical support surfaces to reduce interface pressure and prevent pressure injuries. Their effectiveness depends on maintaining proper internal air pressure, which can fluctuate with environmental changes such as temperature and atmospheric pressure. These fluctuations pose a risk in clinical and transport settings where cushions may be exposed to extreme conditions. This study examines the behavior of air cell cushions made from silicone, polyurethane, and TPU-coated fabric under different environmental conditions. Using a proportional–integral–derivative (PID) control algorithm, we regulated the internal air-cell pressure to remain constant under changing temperature (15–35 °C) and atmospheric pressure (101–75 kPa) conditions. Results indicate that the cushion material significantly influences pressure stability, with TPU-coated fabric being the most sensitive to environmental changes. Applying the closed-loop control algorithm, it is possible to maintain the set pressure within ±0.05 kPa regardless of the cushion material, loading conditions, and environmental variations.
The ability to grasp objects has a significant impact on the independence of individuals following a stroke, a spinal cord injury, or for those who are living with amyotrophic lateral sclerosis. In most cases, physical rehabilitation is not sufficient to regain the hand function necessary for day-to-day life. Hand orthoses capable of providing grasping assistance in activities of daily living are therefore crucial to a more independent lifestyle. However, most available options struggle to offer an acceptable balance between cost, size, weight and functionality, resulting in limited use in practice. This article presents a low-cost, 3D-printed hand orthosis that relies solely on mechanical elements to aid in finger flexion. An underactuated, flexible design for the fingers with nylon strips as spring blades was used to achieve a design that costs only 27% of the price of comparable commercially available options, as well as being very lightweight and easily customizable. It was also demonstrated that rigid thumb supports allowed the orthosis to be used in the majority of daily grasping tasks. Finally, the use of the proposed mechanism was shown to be able to provide up to 4 N of flexion assistance to the finger when using a medium wrap grip.
Background:The global prevalence of dementia is increasing, necessitating effective non-pharmacological interventions due to the limitations and side effects of pharmacological treatments. Digital health interventions, including Virtual Reality (VR), offer promising alternatives. This study assessed the feasibility, safety, and potential side effects of interactive computer-generated VR (CGVR) for individuals with dementia (IwD), focusing on reaction tests of varying complexity. Methods:In the feasibility study recruited 32 participants with mild to moderate dementia, assessed by the Mini-Mental-State-Examination (MMSE). Participants underwent a single CGVR session involving virtual reaction wall tasks of varying difficulty. Pre- and post-exposure assessments, alongside feedback forms, evaluated cognitive and motor functions, mood, anxiety, and balance (paired t-test). Results:Of the 32 participants, 29 completed the study (9% drop-out). Observational data indicated high levels of engagement and enjoyment. No adverse effects on cognitive or motor functions were observed, with slight non-significant improvements across most parameters. MMSE scores correlated significantly with task feasibility and reaction/motor times, highlighting the influence of cognitive status on performance. Conclusions:CGVR demonstrated high feasibility and acceptability among IwD, with no adverse effects and potential to enhance cognitive and motor skills. Further research is required to explore long-term efficacy and optimize therapeutic applications.
Introduction: This study aimed to assess women Veterans' satisfaction with their primary mobility device and the related services they received. Methods: Women Veterans who received a mobility device in the past 5 years from the Veterans Health Administration (VHA) completed an online survey containing the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) about their primary mobility device. Scores were analyzed using descriptive statistics while open-ended comments were analyzed using inductive thematic analysis. Results: 571 out of 4078 (14%) invited women completed a sufficient portion (>75%) of the QUEST. They reported high levels of satisfaction with their devices and services received (>4 out of 5 indicating 'quite' to 'very' satisfied). Despite this finding around 80% of the women left comments related to discontent with their device. Main and sub-themes that were consistent across all devices included equipment issues (mechanical design, lack of features or customizability, poor quality components/material), physical and psychological impacts of the device, usability issues, and unmet service needs (lack of efficiency, lack of quality, issues with service providers and lack of access). Discussion: Women-centered design and delivery of mobility devices should be prioritized. Opportunities exist for VHA to make improvements within several areas in the service and provision process.
Background:Anti-gravity exosuits supporting hip and knee extension have emerged for overground training. This study investigated their effect on kinematics in individuals with incomplete spinal cord injury (iSCI) compared to regular walking and to walking with an overground BWS system. Methods:Fourteen individuals with iSCI were tested during overground walking in three conditions: regular, exosuit, and BWS. Kinematics were assessed using the Xsens MVN motion capture system. Results:Maximum hip extension was larger for exosuit compared to regular walking (Δ4.7°, 95% CI [1.4, 7.9]), but was not different compared to BWS. Mean knee flexion was smaller for exosuit compared to regular walking (Δ-1.7°, 95% CI [-3.0, -0.4]) and compared to BWS (Δ-3.5°, 95% CI [-5.4, -1.6]). Most secondary outcome measures (e.g. walking speed, stride length, step width, ML COM excursion) showed no differences between exosuit and regular walking. Comparing exosuit to BWS, most secondary outcome measures (e.g., walking speed, stride length, stride time, trunk inclination) favored BWS. Conclusions:An anti-gravity exosuit resulted in increased hip and knee extension, but did not translate into other gait improvements. Given the more favorable outcomes of the BWS system compared to the exosuit, exosuit design improvements are needed to be effectively implemented in gait rehabilitation after iSCI.
Objective:The objective of this study was to carry out a systematic review and meta-analysis of available literature on the relationships between spasticity, proprioception and motor function of the upper limb post-stroke. Methods:Using the terms: stroke; movement; proprioception; spasticity; rehabilitation; and upper limb, a systematic search was conducted on Scopus, PubMed and Web of Science from database inception to November 2023. A study must have assessed two of spasticity, proprioception, or motor function of the upper limb post-stroke to be included. Random-effects meta-analyses were conducted to investigate changes in time and strength of correlations between variables. Results:Fifty-two studies were included. Over time, spasticity increased (OR = 0.5, p = 0.0475); proprioception and motor function impairments decreased (OR = 3.15, p < 0.0001; OR = 3.21, p < 0.0001, respectively). The correlation between spasticity and proprioception was weak (r = 0.33, p = 0.0283); between proprioception and motor function was moderate (r = 0.45, p < 0.0001); and between spasticity and motor function was moderate (r = 0.55, p < 0.0001). Conclusion:Despite the limitation of heterogeneity in the available evidence, relationships between variables were illustrated. Moderate correlations between proprioception and both spasticity and motor function suggest proprioception should be an important target for personalised rehabilitation interventions.
