Kristen L Jakubowski, Gregory S Sawicki, Lena H Ting
{"title":"Center of mass feedback for joint torque control during perturbed standing: a potential generalizable control approach for balance augmentation in wearable robots.","authors":"Kristen L Jakubowski, Gregory S Sawicki, Lena H Ting","doi":"10.1186/s12984-026-02035-1","DOIUrl":"10.1186/s12984-026-02035-1","url":null,"abstract":"<p><strong>Background: </strong>Exoskeletons have the potential to augment balance and decrease fall risk. However, existing balance-augmenting wearable robotic controllers have only been tested in single planes of motion during either standing or walking. Thus, it is unclear whether a single control scheme can generalize across perturbations with varying spatial properties or from standing to walking. Inspired by the nervous system's generalizable balance control strategy across perturbation types and conditions, we propose a novel torque control framework that modulates multi-joint reactive torques based on center of mass (CoM) deviation. We evaluated the generalizability of our delayed CoM feedback controller to predict multi-joint torque responses to perturbations of varying magnitudes, directions, and across movement contexts.</p><p><strong>Methods: </strong>In nine healthy young adults, we tested the ability of a delayed CoM feedback scheme to predict multi-joint torque responses to (1) ramp-and-hold support surface perturbations at three magnitudes in 8 directions, (2) a continuous sinusoidal movement, resulting in a cyclical movement of the CoM with similar periodic features as walking, and (3) a sinusoidal motion with random perturbations superimposed to mimic perturbations during cyclic tasks. We trained the model on single ramp-and-hold conditions and evaluated its ability to generalize across directions, magnitudes, movement contexts, and subjects.</p><p><strong>Results: </strong>The delayed CoM feedback controller trained on a single ramp-and-hold condition generalized to all ramp-and-hold perturbations for all joints, predicting the joint torques for perturbations of varying directions and magnitudes with high fidelity (average R<sup>2</sup> > 0.84 and RMSE < 0.08 Nm/kg). However, generalization from standing to cyclic movement only occurred for hip and knee flexion. The CoM feedback parameters from ramp-and-hold perturbations generalized to the continuous sinusoidal movement (cyclic movement) and the sinusoidal movement with superimposed perturbations (unexpected perturbations) for hip flexion and knee flexion (average R²>0.70 and RMSE < 0.13 Nm/kg), but not for ankle plantarflexion and hip adduction (R²>0.20 and RMSE < 0.22 Nm/kg).</p><p><strong>Conclusion: </strong>Our findings show that a physiologically-inspired CoM feedback controller can robustly predict balance-correcting torques appropriate for driving a hip or knee wearable robotic device during standing and movement, and an ankle device during standing only. The goodness-of-fit of joint torque is comparable to top machine learning algorithms, yet requires orders of magnitude less training data, enabling rapid implementation to reduce fall risk.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176058","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":"SR-FSL: Sample reconstruction enhanced few-shot learning for real-time motor unit identification from surface electromyogram.","authors":"Yunfei Liu, Zhaoyang Sheng, Dongfang Li, Xiang Chen, Ping Zhou, Xu Zhang","doi":"10.1186/s12984-026-02026-2","DOIUrl":"10.1186/s12984-026-02026-2","url":null,"abstract":"<p><strong>Background: </strong>Deep learning (DL) methods have demonstrated promising performance in online motor unit (MU) identification from high-density surface electromyogram (HD-sEMG). However, its dependency on larger amounts of data limits practicability.</p><p><strong>Methods: </strong>To address this issue, a novel few-shot learning method enhanced by sample reconstruction strategy is presented for online MU identification. In this method, a spatio-temporal neural network was first pre-trained based on the simulated HD-sEMG data and MU spike trains, endowing it with initial representational capabilities for MU features. Then, an innovative sample reconstruction strategy was employed to generate physiologically interpretable synthetic samples for model fine-tuning with minimal experimental data. These samples were intended to enhance the model's ability to characterize the spatiotemporal features of MUAP waveforms, thereby improving the online MU identification performance. Experimental HD-sEMG signals were collected from the abductor pollicis brevis muscles of ten subjects using an 8 × 8 electrode array.</p><p><strong>Results: </strong>The results demonstrated that the proposed method can achieve a matching rate of approximately 93% in online MU identification stage, with only 6 s of experimental data for offline model fine-tuning, significantly outperforming the comparison methods.</p><p><strong>Conclusions: </strong>This work provides a novel solution for efficient real-time MU identification, and the findings are expected to advance the widespread application of DL-based real-time HD-sEMG decomposition in developing advanced neural-machine interfaces towards robotic motor control and rehabilitation medicine.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163428","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}
Yifang Lin, Mingfen Li, Yajuan Su, Hewei Wang, Jie Jia
{"title":"EEG biomarkers for assessment, prognosis, and monitoring of natural upper limb recovery after stroke: a systematic review.","authors":"Yifang Lin, Mingfen Li, Yajuan Su, Hewei Wang, Jie Jia","doi":"10.1186/s12984-026-02028-0","DOIUrl":"10.1186/s12984-026-02028-0","url":null,"abstract":"<p><strong>Background: </strong>Persistent upper limb deficits after stroke necessitate reliable candidate biomarkers to support precision rehabilitation. While electroencephalogram (EEG) provides a highly accessible tool to characterize post-stroke neurophysiology, its clinical translation is hindered by fragmented evidence. This systematical review critically synthesizes the directional associations between EEG biomarkers and upper limb outcomes, and introduces a novel functional framework to classify these biomarkers into assessment, prognostic, and monitoring roles for natural upper limb recovery under conventional rehabilitation.</p><p><strong>Methods: </strong>A systematic search was conducted in MEDLINE, SCOPUS, EMBASE, EBSCO CINAHL, and IEEE Xplore up to March 10, 2026. Studies investigating associations between quantitative EEG measures and upper limb motor outcomes in stroke adults were included. Two reviewers independently screened studies and assessed risk of bias. Data extraction classified EEG biomarkers by assessment, prognosis, and monitoring roles.</p><p><strong>Results: </strong>Forty-two studies were included, comprising 23 cross-sectional and 19 longitudinal designs. We categorized the evidence into three biomarker roles: (i) assessment, where measures like the brain symmetry index (BSI), β-band interhemispheric connectivity, and network efficiency correlated with impairment severity; (ii) prognostic, where baseline asymmetry and functional connectivity showed predictive potential; and (iii) monitoring, where longitudinal changes in oscillatory power, connectivity, and network topology paralleled functional gains. Across roles, the BSI emerged as one of the most frequently reported candidate metrics.</p><p><strong>Conclusion: </strong>EEG-derived metrics, particularly the BSI, serve as frequently reported candidate biomarkers for potential clinical application in stroke rehabilitation. However, their immediate clinical translation is currently limited by the predominantly fair methodological quality of the underlying evidence. Our proposed framework helps to bridge the gap between current observational findings and future clinical utility. Future progress hinges on standardizing protocols and validating these biomarkers in large-scale rehabilitation trials to facilitate their transition toward potentially clinically useful tools.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156928","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":"Correction: A decade of Cybathlon: impact on public visibility, scientific dissemination and technology transfer.","authors":"Robert Riener, Luca Vassella, Peter Wolf","doi":"10.1186/s12984-026-02034-2","DOIUrl":"10.1186/s12984-026-02034-2","url":null,"abstract":"","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"23 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156945","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}
Muslim Khan, Ayman Abdullah Alhammad, Mshari Alghadier, Saeed Mufleh Alnasser, Abdullah Basheer Alanazi, Hasan Ali Abdullah AlAidarous, Engy BadrEldin S Moustafa, Mohammad Ahmad Sharahily, Mohammed Ibrahim Amri, Edward Muteesasira
{"title":"Targeted ankle proprioceptive training improves balance, gait, and functional mobility in chronic stroke survivors: a multicenter randomized controlled trial with longitudinal follow-up.","authors":"Muslim Khan, Ayman Abdullah Alhammad, Mshari Alghadier, Saeed Mufleh Alnasser, Abdullah Basheer Alanazi, Hasan Ali Abdullah AlAidarous, Engy BadrEldin S Moustafa, Mohammad Ahmad Sharahily, Mohammed Ibrahim Amri, Edward Muteesasira","doi":"10.1186/s12984-026-02031-5","DOIUrl":"10.1186/s12984-026-02031-5","url":null,"abstract":"<p><strong>Background: </strong>One of the most common predictors of post-stroke balance and gait problems is ankle proprioceptive impairment. Previous cross-sectional studies have shown strong links, especially with inversion proprioception, but causality, progression over time, and effectiveness in severe cases has not been proven.</p><p><strong>Objective: </strong>To determine the causal effects of ankle proprioceptive training on balance, gait, and mobility in moderate-to-severe and non-ambulatory chronic stroke survivors, and to examine the long-term impact of proprioception training across different stroke stages.</p><p><strong>Methods: </strong>A total of 132 participants (mean age 58.4 ± 11.2 years; 18 to 72 months post stroke) completed the 12 weeks of intervention and immediate post-intervention assessments, (68 were randomly assigned to the intervention group(proprioceptive ankle training) while 64 to the control group(standard rehabilitation)).The primary outcome was weight-bearing ankle proprioception, assessed with the Active Movement Extent Discrimination Apparatus (AMEDA) while the secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go Test (TUG), 10-meter walk test (10-MWT), Fugl-Meyer Lower Extremity Test (FM-LE), and Functional Ambulation Category(FAC). An assessment from acute to chronic stages was conducted on a longitudinal subsample (n = 42).</p><p><strong>Results: </strong>The intervention led to significant and clinically meaningful improvements in proprioception (inversion Δ = 0.21), balance(BBS + 12.4 points), gait speed (+ 0.32 m/s)(TUG), and mobility(10-MWT, FM-LE, FAC), which were sustained at 6-month follow-up (all p < 0.001). Benefits were evenly observed in severe/non-ambulatory individuals who experienced a stroke. This was supported by mediation analysis showing that 72% of the functional gains in severe/non-ambulatory chronic stroke participants were influenced by improved inversion proprioception. Longitudinal data indicated a progressive bilateral decline, with the earliest and steepest drop occurring in inversion.</p><p><strong>Conclusion: </strong>Targeted proprioceptive exercises are causally efficacious in enhancing functional recovery across all levels of severity in post stroke populations and it therefore compliments routine clinical practice. Trial registration This study was retrospectively registered at Clinical Trials.gov (Registration Number NCT07420608) on 18th February,2026.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055052","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}
Andrea Demofonti, Beniamino Brunetti, Marco Germanotta, Marco Morelli Coppola, Francesca Falchini, Alice Valeri, Stefania Tenna, Sergio Valeri, Irene Giovanna Aprile
{"title":"Correction: Effects of a tailored rehabilitation treatment in lower limb Soft Tissue Sarcomas reconstruction: a case series.","authors":"Andrea Demofonti, Beniamino Brunetti, Marco Germanotta, Marco Morelli Coppola, Francesca Falchini, Alice Valeri, Stefania Tenna, Sergio Valeri, Irene Giovanna Aprile","doi":"10.1186/s12984-026-02019-1","DOIUrl":"10.1186/s12984-026-02019-1","url":null,"abstract":"","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":"23 1","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148055112","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}
Julien Rossato, Elodie Hinnekens, Daniele Borzelli, Sergio Gurgone, Denise Jennifer Berger, Andrea d'Avella
{"title":"Structured modulations in high-density EMG patterns from a single muscle enable simultaneous control of natural and extra degrees of freedom.","authors":"Julien Rossato, Elodie Hinnekens, Daniele Borzelli, Sergio Gurgone, Denise Jennifer Berger, Andrea d'Avella","doi":"10.1186/s12984-026-02029-z","DOIUrl":"10.1186/s12984-026-02029-z","url":null,"abstract":"<p><strong>Background: </strong>Identifying and exploiting independent neural inputs within a single muscle is a key step toward improving neuromuscular interfaces for motor augmentation and rehabilitation. Recent evidence suggests that motor neurons within the same pool can receive multiple, independent inputs, allowing flexible modulation of muscle activity. Harnessing this neural flexibility could enable the control of supplementary degrees of freedom (SuDoF) without interfering with the performance of natural motor tasks. However, current methods rely on motor unit decomposition, which is technically challenging and impractical for daily-life applications. This study introduces a decomposition-free approach to detect and quantify distinct neural inputs directly from high-density surface electromyography (HDsEMG) and assesses the feasibility of extracting from the modulation of these neural inputs a signal for simultaneous control of natural and SuDoF.</p><p><strong>Methods: </strong>Fifteen participants performed reaching and orienting tasks in a virtual environment moving a cursor by generating isometric force at the hand (force control) and rotating the cursor by modulating the pattern of HDsEMG signals recorded using a 64-channel grid from the biceps brachii (SuDoF control). HDsEMG signals were represented as vectors in a multidimensional EMG space, and its deviation from a reference vector associated with pure force control was used to control the cursor orientation. Participants reached eight planar targets with a circular cursor using only force control and reached and matched the orientation of eight elliptical targets with an elliptical cursor using force and SuDoF control. Performance across conditions was analyzed using linear mixed-effects models.</p><p><strong>Results: </strong>Participants successfully reached targets in 89 ± 10% of force and SuDoF control trials, with cursor rotations exceeding those observed in force-only trials in 84 ± 31% of cases. Participants primarily modulated contraction amplitude but maintained distinct directional shifts in HDsEMG patterns, compatible with the modulation of different neural inputs within the motor neuron pool. However, these modulations may also partly reflect changes in overall muscle activation and recruitment.</p><p><strong>Conclusions: </strong>This study presents a decomposition-free method to detect structured modulations in HDsEMG patterns within a single muscle. The observed modulations are compatible with the presence of distinct neural inputs and enabled concurrent control of natural and SuDoF, advancing neuromuscular interface design for assistive and rehabilitative technologies.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13465195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148042684","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}
Stefano Nuzzo, Sophia Taddei, Eligia Alfio, Rossana Lovecchio, Menthy Denayer, Stijn Hamelryckx, Elias Thiery, Stijn Kindt, María Alejandra Díaz, Louis Flynn, Kevin De Pauw, Tom Verstraten
{"title":"Cyberlegs X-Leg at CYBATHLON 2024: insights on the control development of an active transfemoral prosthesis.","authors":"Stefano Nuzzo, Sophia Taddei, Eligia Alfio, Rossana Lovecchio, Menthy Denayer, Stijn Hamelryckx, Elias Thiery, Stijn Kindt, María Alejandra Díaz, Louis Flynn, Kevin De Pauw, Tom Verstraten","doi":"10.1186/s12984-026-02018-2","DOIUrl":"10.1186/s12984-026-02018-2","url":null,"abstract":"<p><p>Powered lower-limb prostheses aim to enhance the mobility of people with amputations in daily life. The CYBATHLON competition offers an opportunity to evaluate these devices' performance across 10 tasks inspired by everyday activities, such as sitting and standing, avoiding obstacles, walking on uneven terrain and slopes, and climbing stairs. This study reports on the development and deployment of the CYBERLEGs X-Leg, a powered knee-ankle prosthesis equipped with a hierarchical control architecture and task-specific finite state machines (FSMs) during the CYBATHLON 2024 leg prosthesis race. The pilot, an individual with a transfemoral amputation, was trained for approximately 46 h, attempted eight tasks during the competition, and completed three. Overall, the pilot successfully controlled the prosthesis's behavior to execute multiple tasks. The prosthesis delivered stable knee-swing flexion during walking ([Formula: see text]), obstacle-clearance trajectories driven by thigh kinematics, and knee-extension assistance during sit-to-stand ([Formula: see text] Nm). The control design and competition experience underlined the importance of initiating control co-design at earlier development stages and revealed the extensive tuning effort required for a multitask FSM-based system. Performance analysis identified reliance on manual locomotion mode selection, sensitivity in threshold-based FSM transitions, and user discomfort at higher torque levels as key areas for improvement. The competition highlighted both the feasibility and the limitations of FSM-based control when deployed across diverse functional activities. These findings motivate future work on autonomous task recognition, smoother inter-state control blending, the integration of enriched sensing modalities, and human-in-the-loop optimization for user-specific personalization.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031744","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}
Martin Schmoll, Anna Pataraia, Quang Nguyen, Bernhard Rosenauer, Erik Kornfellner, Renske S de Boer, Thomas P A Rijnbeek, Emilia Ambrosini, Nicole Sanna, Efe Anil Aksöz, Roberto de Souza Baptista, Henrique Resende Martins, Matheus Marcondes de Oliveira, Jozsef Laczko, Amelita Fodor, Winfried Mayr, Richard Crevenna
{"title":"FES-Cycling at the Cybathlon 2024: assessing accuracy of power-pedals for low power output in a virtual race scenario.","authors":"Martin Schmoll, Anna Pataraia, Quang Nguyen, Bernhard Rosenauer, Erik Kornfellner, Renske S de Boer, Thomas P A Rijnbeek, Emilia Ambrosini, Nicole Sanna, Efe Anil Aksöz, Roberto de Souza Baptista, Henrique Resende Martins, Matheus Marcondes de Oliveira, Jozsef Laczko, Amelita Fodor, Winfried Mayr, Richard Crevenna","doi":"10.1186/s12984-026-02025-3","DOIUrl":"10.1186/s12984-026-02025-3","url":null,"abstract":"<p><strong>Background: </strong>The Cybathlon is a unique international competition platform for evaluating assistive technologies under real-life conditions. In the most recent edition, the FES-Cycling discipline was conducted on stationary smart trainers (Wahoo Kickr) within a virtual race environment. Participants could use either the smart trainer or a pedal-based power meter as the primary power source. As both systems were not specifically designed for the very low power outputs typically generated during FES-Cycling, the outcomes of the competition require careful interpretation.</p><p><strong>Methods: </strong>This work summarizes the FES-Cycling competition at the Cybathlon 2024 and evaluates the accuracy of pedal-based power meters used in the virtual race. Race performance data from ten pilots representing eight international teams were analyzed. Pedal-based power measurements were compared against a validated smart trainer during the competition. In addition, an assessment in a controlled environment was conducted to quantify pedal accuracy in the low-power range (< 25 W) using a crank-based power meter as reference. The influence of pedal mounting torque, ankle-orthosis mounting position, and crank-length compensation was systematically investigated.</p><p><strong>Results: </strong>Four of the ten pilots completed the full virtual race distance of 1960 m within the 8-min time limit. Mean cycling speeds (7.8-19.5 km/h) exceeded those reported for the over-ground Cybathlon 2016 race. Analysis of valid race segments revealed substantial overestimation of pedal-based power relative to the smart trainer, with relative errors ranging from 14.7 to 66.6%. Additional accuracy measurements confirmed that pedal-based power was sensitive to mounting torque and particularly to ankle-orthosis position, with lateral displacement of the foot causing pronounced overestimation. Crank-length compensation reduced systematic bias, but residual errors and increased variability persisted at higher cadences.</p><p><strong>Conclusion: </strong>Commercially available pedal-based power meters and stationary smart trainers are currently not well suited for reliable performance assessment in low-power FES-Cycling competitions within virtual race environments. While virtual formats offer clear logistical advantages, engaging training opportunities and rich performance data, traditional race formats should be reconsidered to better align with the functional goals of FES-Cycling. Future competitions should prioritize over-ground cycling, assessing externally observable outcomes such as distance and time, which may further enhance pilot motivation and public visibility.</p>","PeriodicalId":16384,"journal":{"name":"Journal of NeuroEngineering and Rehabilitation","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148031712","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}