Effectiveness of Telerehabilitation Programs in Elderly with Hip or Knee Arthroplasty: A Systematic Review.

Background: Lower limb osteoarthritis (OA) often generates musculoskeletal pain causing functional impairment and decreasing mobility, autonomy, and quality of life. Patients with OA are commonly prescribed specific care for total hip arthroplasty or total knee arthroplasty (THA or TKA), when patients present symptoms that are refractory to nondrug treatments. Currently, when patients are discharged from orthopedic surgery, they are either referred to a rehabilitation department, or sent directly home with assistance such as remote monitoring by teleconsultation or a mobile application. In recent years, there has been an evolution in digital health and in particular telerehabilitation. To determine utility and effectiveness, the aim of this systematic review was to highlight and evaluate different telerehabilitation programs using new information and communication technologies. Methods: Five databases, ScienceDirect, PubMed, Web of Sciences, Scopus, and Google scholar, were searched until 30 June 30, 2023. All studies written in English and meeting our inclusion criteria were included. Databases were screened for "Total Hip Arthroplasty," "Total Knee Arthroplasty," "Total Hip Replacement," "Total Knee Replacement," "Rehabilitation," "Physical Activity," "Physiotherapy," "Telerehabilitation," "Telecommunication*," "Senior*," and "Elderly" in accordance with PRISMA-ScR guideline. Results: Fourteen articles were selected according to inclusion criteria. Telerehabilitation was offered in seven different ways (video call, applications smartphones, website, etc.). Assessments included were mainly quality of life questionnaires, perceived effort after exercises, field surveys on the tool experience, and physical tests to assess motor functions. Conclusion: This review highlights the importance and relevance of evaluating the contributions and limits of new health technologies to improve patient monitoring and thus enable better remote clinical care.

Upper limb motor dysfunction is associated with fragmented kinetics after brain injury.

BACKGROUND: Characterization of motor deficits after brain injury is important for rehabilitation personalization. While studies reported abnormalities in the kinematics of paretic and non-paretic elbow extension for patients with brain injuries, kinematic analysis is not sufficient to explore how patients deal with musculoskeletal redundancy and the energetic aspect of movement execution. Conversely, interarticular coordination and movement kinetics can reflect patients' motor strategies. This study investigates motor strategies of paretic and non-paretic upper limb after brain injury to highlight motor deficits or compensation strategies. METHODS: 26 brain-injured hemiplegic patients and 24 healthy controls performed active elbow extensions in the horizontal plane, with both upper limbs for patients and, with the dominant upper limb for controls. Elbow and shoulder kinematics, interarticular coordination, net joint kinetics were quantified. FINDINGS: Results show alterations in kinematics, and a strong correlation between elbow and shoulder angles, as well as time to reach elbow and shoulder peak angular velocity in both upper limbs of patients. Net joint kinetics were lower for paretic limb and highlighted a fragmented motor strategy with increased number of transitions between concentric and eccentric phases. INTERPRETATION: In complement to kinematic results, our kinetic results confirmed patients' difficulties to manage both spatially and temporally the joint degrees of freedom redundancy but revealed a fragmented compensatory motor strategy allowing patients upper limb extension despite quality alteration and decrease in energy efficiency. Motor rehabilitation should improve the management of this fragmentation strategy to improve the performance and the efficiency of active movement after brain injury.

Gait-Oriented Post-Stroke Rehabilitation Tasks Online Trajectory Generation for 1-DOF Hip Lower-Limb Exoskeleton.

In the field of gait rehabilitation lower limb exoskeletons have received a lot of interest. An increasing number of them are revised to be adapted for post-stroke rehabilitation. These exoskeletons mostly work in complement of conventional physiotherapy in the subacute phase to practice gait training. For this gait training the reference trajectory generation is one of the main issues. This is why it usually consists in reproducing some averaged healthy patient's gait pattern. This paper's purpose is to display the online trajectory generation (OTG) algorithm developed to provide reference trajectories applied to gait-oriented tasks designed based on conventional physiotherapy. This OTG algorithm is made to reproduce trajectories similar to the ones a therapist would follow during the same tasks. In addition, experiments are presented in this paper to compare the trajectories generated with the OTG algorithm for two rehabilitation tasks with the trajectories followed by a therapist in the same conditions. During these experiments the OTG is implemented in a runtime system with a 500µs cycle time on a bench able to emulate late and early patients' interaction. These experiments results assess that the OTG can work at a 500µs cycle time to reproduce a similar trajectory as the one followed by the therapist during the two rehabilitation tasks implemented.

Biomechanical modeling for the estimation of muscle forces: toward a common language in biomechanics, medical engineering, and neurosciences.

Different research fields, such as biomechanics, medical engineering or neurosciences take part in the development of biomechanical models allowing for the estimation of individual muscle forces involved in motor action. The heterogeneity of the terminology used to describe these models according to the research field is a source of confusion and can hamper collaboration between the different fields. This paper proposes a common language based on lexical disambiguation and a synthesis of the terms used in the literature in order to facilitate the understanding of the different elements of biomechanical modeling for force estimation, without questioning the relevance of the terms used in each field or the different model components or their interest. We suggest that the description should start with an indication of whether the muscle force estimation problem is solved following the physiological movement control (from the nervous drive to the muscle force production) or in the opposite direction. Next, the suitability of the model for force production estimation at a given time or for monitoring over time should be specified. Authors should pay particular attention to the method description used to find solutions, specifying whether this is done during or after data collection, with possible method adaptations during processing. Finally, the presence of additional data must be specified by indicating whether they are used to drive, assist, or calibrate the model. Describing and classifying models in this way will facilitate the use and application in all fields where the estimation of muscle forces is of real, direct, and concrete interest.

Design and Prototyping of a Serious Game on Interactive Tabletop with Tangible Objects for Disability Awareness in Companies.

This paper presents elements of user-centered design and prototyping of a serious game. Produced within the framework of the SG-HANDI project, the serious game aims to raise awareness about integration, prevention of professional displacement and job retention of people with disabilities. This serious game is developed on an interactive RFID tabletop with tangible objects. It is intended to be used in a collective context involving one or more facilitators specialized in employment and disability, as well as the company's stakeholders to be made aware of the issue.

Sensorimotor Time Delay Estimation by EMG Signal Processing in People Living with Spinal Cord Injury.

Neuro mechanical time delay is inevitable in the sensorimotor control of the body due to sensory, transmission, signal processing and muscle activation delays. In essence, time delay reduces stabilization efficiency, leading to system instability (e.g., falls). For this reason, estimation of time delay in patients such as people living with spinal cord injury (SCI) can help therapists and biomechanics to design more appropriate exercise or assistive technologies in the rehabilitation procedure. In this study, we aim to estimate the muscle onset activation in SCI people by four strategies on EMG data. Seven complete SCI individuals participated in this study, and they maintained their stability during seated balance after a mechanical perturbation exerting at the level of the third thoracic vertebra between the scapulas. EMG activity of eight upper limb muscles were recorded during the stability. Two strategies based on the simple filtering (first strategy) approach and TKEO technique (second strategy) in the time domain and two other approaches of cepstral analysis (third strategy) and power spectrum (fourth strategy) in the time-frequency domain were performed in order to estimate the muscle onset. The results demonstrated that the TKEO technique could efficiently remove the electrocardiogram (ECG) and motion artifacts compared with the simple classical filtering approach. However, the first and second strategies failed to find muscle onset in several trials, which shows the weakness of these two strategies. The time-frequency techniques (cepstral analysis and power spectrum) estimated longer activation onset compared with the other two strategies in the time domain, which we associate with lower-frequency movement in the maintaining of sitting stability. In addition, no correlation was found for the muscle activation sequence nor for the estimated delay value, which is most likely caused by motion redundancy and different stabilization strategies in each participant. The estimated time delay can be used in developing a sensory motor control model of the body. It not only can help therapists and biomechanics to understand the underlying mechanisms of body, but also can be useful in developing assistive technologies based on their stability mechanism.

Inter and intra-individual differences in steering wheel hand positions during a simulated driving task.

This paper describes an experimental study focusing onto the way drivers use the steering wheel while performing a 2D tracking task. The stimulus during this task was a steering wheel angle signal recorded in real situations involving turns and straight lines performed at about 30 km/h. The hand positions of 20 volunteers were recorded in 6 steering scenarios involving 7 road geometries using a 3D motion capture system. The hand movement data were analysed via a descriptive/inferential procedure: each hand was considered using nine indicators - eight membership value averages linked to eight fuzzy angle windows and a frequency value related to the off steering wheel position - while the indicators were investigated using multiple correspondence analysis and non-parametric global and post-hoc tests. Results showed that inter-individual differences were larger than intra-individual differences. Considering 2 × 9 = 18 windows, the inter-individual differences mainly appeared during two main kinds of steering hand strategies: with versus without crossing hands, the latter being the most often used (17 among 20 participants). The intra-individual data showed that some drivers maintained a nearly identical strategy for all road geometries, while other drivers changed their hand position with the direction and/or maximum angle value of the turn. Practitioner Summary: Understanding hand position strategy could be used to design steering wheel assistance in relation to a driver's physical resources with a view to adapting the steering wheel to disabled drivers.