Journal of NeuroEngineering and Rehabilitation最新文献

{"title":"Exploration-based feedback for BCI training: a case study with an adolescent with paraplegia.","authors":"Nicolas Ivanov, Tom Chau","doi":"10.1186/s12984-026-02070-y","DOIUrl":"10.1186/s12984-026-02070-y","url":null,"abstract":"<p><strong>Purpose: </strong>Brain-computer interface (BCI) inefficiency limits clinical utilization of BCIs, as many users struggle to produce consistent machine-recognizable electroencephalography (EEG) patterns for reliable control. While training can improve BCI performance for most users, the required duration and intensity may hinder BCI accessibility. Prior BCI and motor learning research suggests that feedback enabling efficient exploration of different task strategies may enhance training.</p><p><strong>Methods: </strong>An eight-session BCI training case study was completed with an adolescent participant with paraplegia. To support training, a novel feedback system that visualized EEG signal pattern states identified via K-means clustering within the EEG covariance space. Unlike common classifier feedback, this interface presented the EEG signal patterns produced throughout each trial, allowing the participant to explore strategies that yielded task-specific pattern states.</p><p><strong>Results: </strong>The participant was initially a low-performing user and showed little progress across the first five sessions. After transitioning to a simplified feedback mode emphasizing deviation from resting state patterns in the sixth session, the participant displayed significant improvement in task-related physiological signal discriminability. Post-training analysis, however, revealed that this improvement was partially attributable to electromyography (EMG) activity from cranial muscles.</p><p><strong>Conclusion: </strong>Although the observed gains were not solely attributable to neuro-cortical signal modulation, the case study highlights the potential of simplified feedback to support task exploration in low-performing users and presents potential implications for hybrid EEG-EMG BCIs for relevant clinical populations.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of non-pharmacological interventions for lower limb motor impairment in post-stroke hemiplegia: a systematic review and Bayesian network meta-analysis.","authors":"Di Zhang, Yating Yang, Guixing Xu, Lu Wang, Guilin Zhang, Wanyi Song, Miaoyu Ye, Jian Luo, Dehua Li","doi":"10.1186/s12984-026-02081-9","DOIUrl":"10.1186/s12984-026-02081-9","url":null,"abstract":"<p><strong>Background: </strong>Stroke-related hemiplegia often results in significant lower limb dysfunction, severely affecting walking ability, balance, and daily activities. Although various non-pharmacological interventions have shown potential benefits, the optimal rehabilitation strategy remains unclear.</p><p><strong>Objective: </strong>To evaluate the efficacy and comparative ranking of non-pharmacological interventions in improving lower limb motor function, balance, walking ability, and activities of daily living in individuals with post-stroke hemiplegia.</p><p><strong>Methods: </strong>We conducted a search of PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) published from January 2010 to August 2025. The Cochrane Risk of Bias Tool and Review Manager 5.4 were used to assess study quality, and evidence was graded with GRADEPro. Using R Studio software, a NMA was carried out to evaluate the clinical efficacy of various treatments in improving lower limb motor function in patients with post-stroke hemiplegia, ranked by the surface under the cumulative ranking curve (SUCRA). The study was officially registered in PROSPERO under the number CRD420251169037.</p><p><strong>Results: </strong>A total of 82 RCTs involving 3514 participants and 16 non-pharmacological interventions were included. The results indicated that repetitive transcranial magnetic stimulation (rTMS) showed favorable effects on lower limb motor function measured by FMA-LE (MD = 3.7, 95% CI 2.5 to 4.9; SUCRA = 88.13%). rTMS also demonstrated positive effects on balance (MD = 8.5, 95% CrI: 5.1 to 11; SUCRA = 98.41%) and activities of daily living (MD = 14, 95% CrI: 11 to 16; SUCRA = 94.68%). For walking independence assessed by FAC, transcranial direct current stimulation (tDCS) showed considerable effects (MD = 1.5, 95% CrI: 0.41 to 2.5; SUCRA = 87.60%). Furthermore, virtual reality combined with robotic rehabilitation showed a relatively marked effect in reducing TUG time (MD = - 6.6, 95% CrI: - 8.9 to - 4.3; SUCRA = 95.27%).</p><p><strong>Conclusion: </strong>Different non-pharmacological interventions may provide distinct benefits for lower limb rehabilitation after stroke. rTMS appears favorable for improving motor function, balance, and daily living ability; tDCS may help enhance walking independence; and virtual reality combined with robotic rehabilitation may be beneficial for functional mobility. Further large-scale, multicenter, standardized RCTs with longer follow-up are needed to confirm these findings.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online modulation of neural drive to lower motor neurons with high-definition transcranial alternating current stimulation (HD-tACS).","authors":"Michael Houston, Hao Meng, Nicholas Dias, Yingchun Zhang, Sheng Li","doi":"10.1186/s12984-026-02058-8","DOIUrl":"10.1186/s12984-026-02058-8","url":null,"abstract":"<p><strong>Background: </strong>Transcranial alternating current stimulation (tACS) is a form of non-invasive brain stimulation that entrains cortical neuronal activity through exogenously delivered sinusoidal currents. However, it remains unclear whether tACS can effectively modulate the common input to lower motor neurons. This study aims to address this gap by applying high-definition tACS (HD-tACS) at varying stimulation frequencies (11 Hz, 21 Hz, 40 Hz, and Sham) and intensities (1 mA and 2 mA).</p><p><strong>Materials and methods: </strong>Fifteen healthy, young adults produced 10% maximal voluntary contraction (MVC) isometric forces for 100 s with their flexor digitorum superficialis (FDS) while HD-tACS was applied to the motor hotspot of FDS during the initial 60 s. High-definition surface electromyography (HD-sEMG) was decomposed into motor unit (MU) spike trains. The number of identified MUs, amplitude, firing rate, and MU connectivity (MUC) were assessed during the 60-s HD-tACS period. Cortico-muscular connectivity (CMC) of the FDS motor hotspot and FDS was quantified during the 40 s post-HD-tACS period.</p><p><strong>Results: </strong>HD-tACS delivered at 2 mA versus 1 mA elicited significantly greater delta-band (δ: 1-4 Hz) MUC (p = 0.033). Additionally, when HD-tACS was applied at 21 Hz and 2 mA, both δ MUC (p = 0.003) and α MUC (p = 0.015) were greater in magnitude than during Sham. However, no significant differences to CMC after HD-tACS were identified (p = 0.135).</p><p><strong>Conclusion: </strong>HD-tACS delivered at 21 Hz and 2 mA can produce online modulation of the corticospinal inputs to lower motor neurons. However, 60 s of online HD-tACS may not be ample time for corticospinal entrainment to persist post-stimulation.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous spinal cord stimulation for motor function and functional independence in patients with spinal cord injury: a systematic review.","authors":"Jingjing Liu, Yinxu Wang, Xin Chen, Bangqiang Hou, Jingyi Lin, Danlei Long, Wei Song, Yulei Xie","doi":"10.1186/s12984-026-02086-4","DOIUrl":"10.1186/s12984-026-02086-4","url":null,"abstract":"<p><strong>Background: </strong>Spinal cord injury (SCI) can lead to severe impairments in motor, sensory, and autonomic functions, significantly affecting patients' functional independence and quality of life. Transcutaneous spinal cord stimulation (tSCS), as an emerging non-invasive neuromodulation technique, has shown potential in improving motor function. However, existing studies demonstrate substantial heterogeneity, and its clinical efficacy remains unclear.</p><p><strong>Objective: </strong>To systematically evaluate the effects of tSCS on motor function and functional independence in individuals with SCI, and to explore the potential influence of patient characteristics and stimulation parameters on treatment outcomes.</p><p><strong>Methods: </strong>A systematic search of PubMed, Web of Science, Cochrane Library, Embase, and Scopus was conducted from database inception to March 23, 2026. Eligible studies included randomized controlled trials (RCTs), non-randomized studies, and case series. Methodological quality was assessed using the revised Cochrane Risk of Bias tool (RoB 2) for RCTs, the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool, and the Joanna Briggs Institute (JBI) critical appraisal checklist for case series. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence. This review was registered in PROSPERO (registration number: CRD420251106919).</p><p><strong>Results: </strong>A total of 25 studies (n = 353) were included, comprising 9 RCTs, 10 non-randomized studies, and 6 case series. Due to substantial heterogeneity in study design, patient characteristics, and intervention parameters, a qualitative synthesis was performed. The findings suggest that tSCS may have beneficial effects on upper limb motor function as well as balance and postural control. However, no consistent or stable improvements were observed in lower limb motor function, walking ability, functional independence, spasticity, or quality of life. According to the GRADE assessment, the overall certainty of evidence was very low. In terms of safety, tSCS was well tolerated, with no serious adverse events reported.</p><p><strong>Conclusion: </strong>Current evidence is insufficient to support the definitive efficacy of tSCS in individuals with SCI. Although potential benefits have been observed in certain functional domains, the robustness of the evidence is limited by small sample sizes, methodological limitations, and substantial heterogeneity across studies. High-quality randomized controlled trials are needed to further establish its clinical effectiveness.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Towards routine biomechanical data collection in stroke rehabilitation: a usability comparison of IMU and markerless motion capture systems for functional upper-limb assessments.","authors":"Tim Unger, Xin Yao, Anna Schmitt, Lea Cebulla, Chris Easthope Awai","doi":"10.1186/s12984-026-02075-7","DOIUrl":"10.1186/s12984-026-02075-7","url":null,"abstract":"<p><p>Objective measurement of upper-limb movement quality based on biomechanical data collected in clinical routine has the potential to enable precision neurorehabilitation at scale. However, integrating biomechanical data collection into daily clinical workflows remains challenging. In this exploratory study, we evaluated the usability of two technologies for routine kinematic data collection: an IMU-based version of the instrumented Action Research Arm Test (iARAT-IMU) and a MMC markerless motion capture (MMC) system. First, five physiotherapists independently operated the iARAT-IMU across seven clinical routine assessment sessions at a rehabilitation clinic in Switzerland to quantify learning curves, setup times, and usability. Second, we conducted a preference study in which the same therapists used both, the IMU- and MMC-system, during a standardized drinking task and completed quantitative and qualitative usability assessments focusing on system preference and underlying reasons. Results show that therapists rapidly learned to operate the tablet application for scoring the iARAT; however, the IMU system added approximately 11 min of setup time and sometimes required assistance. In contrast, the MMC workflow required approximately 2 min of additional time - well within the 5-minute maximum indicated a priori by therapists as acceptable for clinical routine and received consistently higher usability ratings. Most therapists preferred this approach due to greater efficiency and reduced patient burden. These findings highlight important design considerations for future digital assessment tools and indicate that MMC systems may offer a more feasible pathway toward routine biomechanical data collection for upper-limb assessments in clinical neurorehabilitation.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625311/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eye-tracking phenotypes reveal clinically meaningful heterogeneity of attention and executive control dysfunction after stroke.","authors":"Xiao Fei, Ying Tang, Yue Shi, Yi Zhang","doi":"10.1186/s12984-026-02079-3","DOIUrl":"10.1186/s12984-026-02079-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Post-stroke impairments in attention and executive control are common and clinically relevant, whereas conventional neuropsychological tests mainly capture task outcomes and provide limited information about process-level task behavior. Eye tracking can quantify fixation behavior, saccadic activity, and visual sampling, but whether integrated eye-tracking features can reveal clinically interpretable heterogeneity after stroke remains insufficiently defined.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;This study examined whether integrated multi-paradigm eye-tracking features could identify exploratory eye-movement phenotypes in individuals with stroke and whether these phenotypes were associated with behavioral, clinical, lesion-related, and functional characteristics.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this single-center exploratory case-control study, 72 subacute stroke participants (14-90 days post-onset) and 36 matched healthy controls completed five tasks of attention and executive control and six eye-tracking paradigms. Group differences in behavioral and eye-tracking measures were examined with false discovery rate correction. Within the stroke group, K-means clustering was performed using four nonredundant integrated eye-tracking features: total fixation duration, first-fixation duration, number of fixations, and total saccade distance. Cluster stability and sensitivity analyses were conducted using bootstrap resampling, alternative feature sets, and combined clustering with healthy controls. Post-clustering comparisons and exploratory regression analyses were used to evaluate the clinical relevance of the identified phenotypes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Compared with healthy controls, participants with stroke showed lower performance across attention/executive-control tasks and altered eye-tracking metrics across paradigms. The most consistent eye-movement pattern was shorter total fixation duration and a higher number of fixations across the six paradigms, whereas total saccade distance differed most clearly during the antisaccade task. K-means clustering identified two exploratory eye-movement phenotypes: a High-Fixation/Low-Saccade phenotype and a Low-Fixation/High-Saccade phenotype. The two-cluster solution remained stable across bootstrap and sensitivity analyses. The Low-Fixation/High-Saccade phenotype showed poorer cognitive performance, greater neurological and functional impairment, higher emotional symptom burden, and more frequent frontal involvement and bilateral or multifocal involvement. In exploratory hierarchical regression, eye-movement phenotype explained additional variance in Barthel Index scores beyond demographic variables, post-stroke timing, neurological severity, and conventional attention/executive-control performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Integrated multi-paradigm eye-tracking features identified two exploratory eye-movement phenotypes in individuals with subacute stro","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148396906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immediate changes during dysesthesia-matched transcutaneous electrical nerve stimulation in refractory neuropathic pain: a retrospective observational case series.","authors":"Kentaro Kawamura, Seiji Etoh, Makoto Ueno, Rintaro Ohama, Takashi Hoei, Shintaro Hagihara, Kei Enohata, Megumi Shimodozono","doi":"10.1186/s12984-026-02084-6","DOIUrl":"10.1186/s12984-026-02084-6","url":null,"abstract":"<p><strong>Background: </strong>Dysesthesia-such as tingling and numbness-remains refractory to pharmacological treatment and poses therapeutic challenges within neuropathic pain. Dysesthesia-matched transcutaneous electrical nerve stimulation (DM-TENS) is a perceptually guided neuromodulation approach in which stimulation parameters are iteratively adjusted to synchronize with the perceived temporal patterns and intensity of the patient's abnormal sensory experience. However, immediate responses to DM-TENS across heterogeneous neuropathic pain conditions, as well as the feasibility of both direct and indirect (remote-site) stimulation approaches have not been described.</p><p><strong>Methods: </strong>This retrospective observational case series included consecutive patients with refractory neuropathic pain referred from the pain clinic to the rehabilitation department at our university hospital between December 2024 and August 2025. Dysesthesia intensity was assessed before and during stimulation using the Numerical Rating Scale (NRS), and pain quality was evaluated using the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2) as an exploratory measure. Within-session changes were examined using session-level linear mixed-effects models, with aggregated non-parametric analyses performed as sensitivity analyses. As an exploratory analysis, within-patient consistency of stimulation parameters (frequency, pulse width, and intensity) across repeated sessions was evaluated using intraclass correlation coefficients (ICCs).</p><p><strong>Results: </strong>DM-TENS was well tolerated in all participants, with no stimulation-related adverse events requiring session termination. Fifteen patients underwent 66 DM-TENS sessions, of which 64 provided NRS data. A session-level linear mixed-effects model showed significantly lower NRS scores during stimulation (p < 1 × 10⁻⁸). Aggregated sensitivity analyses showed a median NRS change of - 2.0 (interquartile range - 2.75 to - 1.43). Indirect stimulation was applied only in trigeminal neuropathic presentations; lower within-session symptom scores were observed during palm stimulation, and these findings should be considered exploratory. SF-MPQ-2 total scores were also significantly lower during stimulation (p = 0.002). Stimulation parameters showed good to excellent within-patient consistency across repeated sessions (ICC range 0.78-0.85).</p><p><strong>Conclusions: </strong>In this retrospective observational case series, lower within-session symptom scores were observed during DM-TENS across heterogeneous neuropathic pain conditions, including trigeminal, spinal, and peripheral presentations. These findings raise the hypothesis that individualized, perceptually guided adjustment of stimulation parameters warrants prospective evaluation.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sensor-derived heel pressure metrics capture reversible gait dysfunction beyond conventional gait measures in normal pressure hydrocephalus.","authors":"Seongmin Hong, Wonhee Lee, Seung-Ick Choi, Hui Woo Yang, Seok Jong Chung, Jun Kyu Hwang, Na Young Kim","doi":"10.1186/s12984-026-02087-3","DOIUrl":"10.1186/s12984-026-02087-3","url":null,"abstract":"<p><strong>Background: </strong>The response to the cerebrospinal fluid (CSF) tap test helps determine the surgical eligibility of individuals with idiopathic normal pressure hydrocephalus (iNPH); however, conventional gait assessments have limited specificity and low negative predictive value. We investigated whether commercially available, low-cost sensor-embedded insoles could offer sensitive gait biomarkers for detecting changes in gait following the CSF tap test.</p><p><strong>Methods: </strong>Seventy-seven individuals with iNPH were prospectively enrolled. Participants performed conventional gait assessments, including the 10-m walking test (10MWT), wearing insoles with pressure sensors and an accelerometer before and after the CSF tap test. Spatiotemporal and plantar pressure parameters were compared between individuals with iNPH and control participants without iNPH and between responders and non-responders to the CSF tap test, defined by subjective and objective symptom improvements. Decision curve analysis evaluated clinical utility.</p><p><strong>Results: </strong>Individuals with iNPH exhibited significantly impaired gait and balance, reduced heel and toe pressures, and increased pressure variability compared with control participants. Responders (n = 48) demonstrated a significant post-tap increase in right heel pressure and decreased variability (p < 0.001 and p = 0.002, respectively), with sustained improvements at the 3-month follow-up in 19 participants who subsequently underwent surgical intervention. Decision curve analysis showed that models incorporating plantar pressure metrics in combination with the 10MWT yielded higher net benefit than the 10MWT model alone, with the greatest average Δnet benefit observed when multiple plantar pressure metrics were combined (+ 0.093).</p><p><strong>Conclusion: </strong>Sensor-derived heel pressure metrics represent a digitally quantifiable biomarker that enhances decision-analytic evaluation of CSF tap test response and may improve early treatment stratification in iNPH. Trial registration The project was retrospectively registered at ClinicalTrials.gov (NCT06722768) on December 9, 2024.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13617829/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of cut-off points for the Move4 accelerometer and assessment of energy expenditure in children and adolescents aged 6-16 years using manual wheelchairs: a validation and calibration study.","authors":"Selina Seemüller, Anne Kerstin Reimers, Benedikt Meixner, Florian Engel, Franziska Beck","doi":"10.1186/s12984-026-02085-5","DOIUrl":"10.1186/s12984-026-02085-5","url":null,"abstract":"<p><strong>Background: </strong>The present study aimed to determine activity intensity and validate the Move4 accelerometer and derive cut-off points to accurately classify wheelchair-based physical activity (PA) in children and adolescents.</p><p><strong>Methods: </strong>A calibration and validation study with a test-retest design was performed in 24 children and adolescents (mean age 9.9 ± 3.2 years; 50% girls) using manual wheelchairs. Participants used a manual wheelchair as their primary mode of mobility and were able propelling the wheelchair independently. Participants completed standardized activities while wearing Move4 sensors at the wrist, upper arm, and chest. In a subsample of 7 children and adolescents, energy expenditure was recorded using portable metabolic cart. Mean Amplitude Deviation (MAD) and Movement Acceleration Intensity (MAI) were processed to derive cut-off points for sedentary, light, moderate, and vigorous PA using CART models, and validity was assessed via Metabolic Equivalent (MET) and heart-rate responses.</p><p><strong>Results: </strong>Both MAD and MAI values increased systematically across activity intensities, supporting good criterion validity. MET values showed progression from sedentary to vigorous tasks. Intensity-specific cut-off points were successfully established for all sensor placements, with consistently higher thresholds for MAI. Sensitivity and specificity analyses indicated the most balanced performance for the upper arm (MAD) and chest (MAI). Test-retest comparisons showed greater variability for MAD-based cut-offs, whereas MAI thresholds demonstrated higher stability, with deviations of approximately 4-5%.</p><p><strong>Conclusions: </strong>While both MAD and MAI validly reflected PA intensity, MAI showed greater temporal stability and test-retest robustness. These findings support the use of accelerometery for classifying PA in children and adolescents using wheelchairs and underscore the importance of selecting appropriate metrics and sensor positions.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"23 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13330353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety, feasibility and preliminary effects of Atalante exoskeleton-assisted gait training in amyotrophic lateral sclerosis: a prospective ABA pilot study.","authors":"Ghida Trad, Timothée Lenglet, Isabelle Ledoux, Giorgia Querin, Sophie Blancho, Véronique Marchand-Pauvert, Jean-Yves Hogrel, Pierre-François Pradat","doi":"10.1186/s12984-026-02046-y","DOIUrl":"10.1186/s12984-026-02046-y","url":null,"abstract":"<p><strong>Background: </strong>In amyotrophic lateral sclerosis (ALS), progressive weakness makes walking practice increasingly unsafe and difficult, accelerating loss of mobility and autonomy. Lower-limb exoskeletons could preserve task-specific stepping in a controlled setting, but evidence in ALS remains scarce. This study evaluated the safety of an intensive Atalante exoskeleton gait-training program and explored its effects on walking and related clinical outcomes.</p><p><strong>Methods: </strong>In this prospective, monocentric ABA pilot study, 10 ambulatory persons with ALS underwent three consecutive 6-week phases over 18 weeks: A1 (baseline, usual care), B (intervention: Atalante exoskeleton gait training added to usual care; 18 sessions, 3 times/week), and A2 (withdrawal, usual care), with repeated assessments every 3 weeks. The primary endpoint was safety, assessed by adverse events (AE). Secondary endpoints included ALS Functional Rating Scale-Revised, forced vital capacity, standardized walking tests (6-minute walk test, 10-meter walk test, Timed Up and Go test), Berg Balance Scale, postural control on a force platform, lower-limb strength with dynamometry, spasticity with isokinetic dynamometer, Fatigue Severity Scale, Modified Fatigue Impact Scale, ALS Assessment Questionnaire-40, and Hospital Anxiety and Depression Scale. Exoskeleton-specific patient-reported outcomes (PROs) included intrinsic motivation, participants' attitudes toward the intervention, perceived subjective impact of the training, perceived efficacy and interactivity of the exoskeleton. The results were analyzed with linear mixed-effects models.</p><p><strong>Results: </strong>No serious AE occurred, and one mild AE was certainly related to the intervention. No outcome showed significant phase-specific slopes or slope contrasts, although several measures displayed directionally consistent trends compatible with attenuated decline during phase B and a return toward a less favorable trajectory after withdrawal. Exoskeleton-specific PROs indicated high intrinsic motivation and acceptability (usefulness for standing, perceived safety, ease of participation, and ease of installation/uninstallation rated very highly), with perceived gait-training efficacy generally positive. Participants frequently reported reduced immobility and increased accomplishment (80% each) and postural improvement (70%), and the Net Promoter Score of recommendation was + 40.</p><p><strong>Conclusions: </strong>Atalante exoskeleton gait training was safe and feasible in ambulatory ALS. These pilot data can guide the optimization of future studies to test whether it preserves function. Trial registration ClinicalTrials.gov, NCT06199284. Registered on 29/12/2023.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}