Abstract Background Schroth therapy is one of the conservative methods used to treat scoliosis. It includes not only therapeutic exercises in physiotherapy facilities but also concepts for independent training at home. Consistent and correct performance of this training has a major impact on the success of the therapy. However, without guidance and supervision by a therapist, patient motivation may decline. In addition, incorrect training techniques may be used, which can have a negative impact on the success of the therapy. Objective This study aimed to develop a digitally assisted training system for home-based scoliosis therapy and to verify it technically on a laboratory scale. Methods On the basis of training devices used in Schroth therapy, such as mirrors, balance boards, wall bars, and exercise sticks, we developed a concept for a modular, digitally assisted scoliosis training system (iScoolio). The development process included a requirements specification, iterative design drafts, and the transfer of the concepts into a functional demonstrator. Finally, a theoretical evaluation of the use cases and a technical verification of the measurement functions were carried out using specifically developed test scenarios. Results A demonstrator with tracking, training, and modification functions was developed, consisting of 4 modules. Technical verification of the integrated measurement functions showed that the angle measurement in motion tracking (n=50) had a mean deviation of 2.29° (SD 1.66°) compared to the ARAMIS 3D optical reference system. Respiration tracking enabled the detection of all simulated respiratory cycles (n=40) and the significant distinction between shallow and deep breathing ( t 39 =−27.4; P <.001). The investigation of the 2 force sensor concepts in the handles ( χ ² 2 =80.0; P <.001) and supporting feet ( χ ² 2 =50.0; P <.001) showed a significant differentiation between 3 force levels, but approximately linear drift behavior in each case. When tracking the stance width (n=50), the mean value was 15.4 (SD 0.54) cm. Verification of the center of pressure measurement function (n=50) showed that 48% of the measurements had a deviation of ≤10 mm, and 82% of the measurements had a deviation of ≤20 mm. Conclusions In this paper, we have presented the iScoolio concept, which has the potential to support home-based scoliosis therapy through adaptable devices and tracking elements. Integrated sensors enable monitoring of movements, breathing, forces, and pressure distribution during training. An associated web application visualizes the recorded data and serves as a guide for performing the exercises. Technical verification indicates that the integrated tracking methods are functional; however, there is still room for optimization in terms of hardware and software. Further validation is required before conducting clinical trials under real-world conditions.
BackgroundThe UGO lower limb exoskeleton rehabilitation robot is designed for patients with lower limb motor dysfunction, and it can be used to assess the peak torque of hip and knee flexors and extensors. ObjectiveThe primary aim of this study was to establish the concurrent validity of peak isokinetic torque using the UGO exoskeleton and Humac Norm dynamometers in healthy young adults. MethodsTwenty healthy young adults were enrolled in this study. All participants underwent isokinetic muscle strength tests using both the UGO exoskeleton and the Humac Norm dynamometers. Peak torque (Nm) of the hip and knee flexors and extensors was measured. The Pearson correlation coefficient was used to determine concurrent validity. Bland-Altman analysis was used to assess the agreement between the 2 devices. ResultsAt the knee, peak torque of the extensors measured by the UGO exoskeleton correlated strongly with that measured by the Humac Norm dynamometer (right: r=0.662; P=.001; left: r=0.768; P<.001), with 95% limits of agreement (LoA) ranging from −22.89 to 82.21 Nm and from −24.60 to 75.65 Nm, respectively; the right knee flexors showed a moderate correlation (r=0.547; P=.01), with 95% LoA ranging from −26.27 to 36.01 Nm, whereas the left knee flexors showed no significant association (r=0.347; P=.12), with 95% LoA ranging from −2.40 to 75.02 Nm. At the hip, peak torque of the flexors correlated strongly on the right (r=0.615; P=.003) and moderately on the left (r=0.443; P=.04), with 95% LoA ranging from −15.52 to 86.57 Nm and from −12.53 to 98.50 Nm, respectively, whereas the bilateral hip extensors showed no significant association (right: r=0.337; P=.14; left: r=0.391; P=.20), with 95% LoA ranging from −51.57 to 76.80 Nm and from −28.19 to 79.59 Nm, respectively. ConclusionsIn healthy young adults, the UGO exoskeleton demonstrated moderate to strong concurrent validity for peak torque of the bilateral knee extensors and hip flexors, but not for the nondominant knee flexors or bilateral hip extensors. The device may serve as a convenient torque assessment tool for selected muscle actions, but systematic overestimation and posture-related differences must be considered, and validation in the intended clinical population of patients with neurological conditions is required in further studies.
BackgroundBoth ankle-foot orthoses (AFOs) and footwear adaptations are used to improve gait across a broad range of neuromuscular disorders. AFOs and footwear can each independently influence gait through the manipulation of certain design parameters, such as AFO footplate stiffness or the use of a forefoot rocker. While the effects of design parameters from AFOs and footwear on gait have been investigated independently, how these parameters interact to influence walking biomechanics remains poorly understood. ObjectiveThis systematic literature review aims to provide an overview of the interacting effects between AFOs and footwear on gait biomechanics from both a theoretical standpoint and through the synthesis of existing literature. MethodsA search of existing literature was conducted across 4 major databases. Studies were eligible if they included adult participants from healthy or patient populations. Studies included should have investigated biomechanical gait outcomes recorded during walking with an AFO and at least two different footwear conditions. Quality assessment was performed using the Downs and Black checklist and AFO reporting guidelines. ResultsA total of 14 studies were included in this review. Across these 14 studies, a total of 204 participants (108 healthy, 84 patients after stroke, and 12 unilateral ankle weakness or pain) were included. The majority of these studies were within-subjects designs. Footwear adaptations were primarily changes to the heel-sole differential (HSD; 7/14), followed by forefoot rockers (5/14), with some studies on changes to heel shape and hardness (3/14), and a study on mediolateral wedging. These adaptations were used in combination with primarily rigid AFOs (10/14), with studies also using dorsiflexion-free and frontal plane restrictive AFOs. ConclusionsIncreasing the HSD can be used to increase knee flexion across the stance phase in rigid AFO users, including in the third rocker when HSD is manipulated between the shoe and AFO. Beyond changing the HSD, there is a lack of well-designed experimental studies exploring footwear adaptations. Detailed reporting of both AFO and footwear design choices is necessary for future work in order to make informed statements on biomechanics.
Abstract Background Many stroke survivors experience chronic cognitive deficits that, together with motor impairments, negatively impact well-being and daily function. Critically, poststroke cognitive deficits can interfere with successful engagement in rehabilitation programs aimed at improving participation in home and community activities. To address this issue, we developed a new telehealth intervention that integrates brief, functional cognitive rehabilitation (COG) into an existing upper extremity-focused, activity-based occupational therapy (OT) telerehabilitation program. Objective To describe the development and specification of a telehealth intervention (COG+OT) that integrates functional cognitive rehabilitation into activity-based stroke telerehabilitation. Methods COG+OT was developed using a multi-disciplinary, theory-informed process guided by principles of functional cognitive rehabilitation. It is reported according to the Template for Intervention Description and Replication checklist for rehabilitation (TIDieR-Rehab). The intervention was developed by a team with expertise in stroke rehabilitation from the fields of OT, neuropsychology, clinical psychology, and speech-language pathology. Cognitive rehabilitation content was adapted from an evidence-based compensatory strategy program and condensed into a brief “primer” format. The COG component was iteratively integrated into an existing upper-extremity, activity-based OT telerehabilitation program to support engagement and transfer of strategies to real-world functional tasks. In this paper, we describe the intervention structure, content, delivery, and tailoring procedures. Results COG+OT is an 8-week, 13-session telehealth intervention delivered in three phases: (1) cognitive strategy training (“primer”; sessions 1-4), (2) review and guided application of strategies within OT activities (sessions 5‐10), and (3) integration of strategies to support generalization to everyday contexts (sessions 11-13). The intervention combines individualized, strategy-based cognitive rehabilitation with goal-oriented OT using a titrated approach. Patient-facing materials, structured session workflows, and therapist-guided metacognitive strategies support tailoring and real-world application. Conclusions COG+OT is a theory-informed, user-centered intervention that provides a structured approach for integrating functional cognitive rehabilitation into stroke telerehabilitation. This work establishes a well-specified, replicable intervention model and supports future feasibility, effectiveness, and implementation studies.
