Accurately estimating knee joint angle during walking from surface electromyography (sEMG) signals can enable more natural control of wearable robotics like exoskeletons. However, challenges exist due to variability across individuals and sessions. This study evaluates an attention-based deep recurrent neural network combining gated recurrent units (GRUs) and an attention mechanism (AM) for knee angle estimation. Three experiments were conducted. First, the GRU-AM model was tested on four healthy adolescents, demonstrating improved estimation compared to GRU alone. A sensitivity analysis revealed that the key contributing muscles were the knee flexor and extensors, highlighting the ability of the AM to focus on the most salient inputs. Second, transfer learning was shown by pretraining the model on an open source dataset before additional training and testing on the four adolescents. Third, the model was progressively adapted over three sessions for one child with cerebral palsy (CP). The GRU-AM model demonstrated robust knee angle estimation across participants with healthy participants (mean RMSE 7 degrees) and participants with CP (RMSE 37 degrees). Further, estimation accuracy improved by 14 degrees on average across successive sessions of walking in the child with CP. These results demonstrate the feasibility of using attention-based deep networks for joint angle estimation in adolescents and clinical populations and support their further development for deployment in wearable robotics.

Hand-intensive work is strongly associated with work-related musculoskeletal disorders (WMSDs) of the hand/wrist and other upper body regions across diverse occupations, including office work, manufacturing, services, and healthcare. Addressing the prevalence of WMSDs requires reliable and practical exposure measurements. Traditional methods like electrogoniometry and optical motion capture, while reliable, are expensive and impractical for field use. In contrast, small inertial measurement units (IMUs) may provide a cost-effective, time-efficient, and user-friendly alternative for measuring hand/wrist posture during real work. This study compared six orientation algorithms for estimating wrist angles with an electrogoniometer, the current gold standard in field settings. Six participants performed five simulated hand-intensive work tasks (involving considerable wrist velocity and/or hand force) and one standardised hand movement. Three multiplicative Kalman filter algorithms with different smoothers and constraints showed the highest agreement with the goniometer. These algorithms exhibited median correlation coefficients of 0.75-0.78 for flexion/extension and 0.64 for radial/ulnar deviation across the six subjects and five tasks. They also ranked in the top three for the lowest mean absolute differences from the goniometer at the 10th, 50th, and 90th percentiles of wrist flexion/extension (9.3°, 2.9°, and 7.4°, respectively). Although the results of this study are not fully acceptable for practical field use, especially for some work tasks, they indicate that IMU-based wrist angle estimation may be useful in occupational risk assessments after further improvements.

BACKGROUND: Lumbar range of motion (ROM) is a critical component of spinal function and often affected by age and sex. This study aimed to evaluate the variations in lumbar ROM across different age groups in a healthy adult population and determine the influence of sex, height, weight, and body mass index.
METHODS: A total of 208 subjects (106 men, 102 women) were recruited and stratified into age groups from the 20s to 60s and older. Lumbar ROM was measured using the Wolfson modified Schober test. Data were analyzed for flexion, extension, and total ROM. Linear regression examined the predictors of lumbar ROM.
RESULTS: The study found a progressive decline in lumbar flexion and total ROM with age. Age was the only notable predictor of lumbar flexion, with no notable effect of weight and body mass index on ROM. Extension measurements were inconsistent and did not show a clear pattern across age groups.
CONCLUSIONS: Age-related changes in lumbar ROM were consistent with known physiological changes within the spine. Despite physical differences in height and weight, the lumbar spine ROM was similar between sexes, highlighting the influence of age over sex in lumbar motion. Lumbar ROM decreases with age, with flexion affected more than extension.

BACKGROUND: Evaluating muscle spasticity in children with cerebral palsy (CP) is essential for determining the most effective treatment strategies. This scoping review assesses the current methods used to evaluate muscle spasticity, highlighting both traditional and innovative technologies, and their respective advantages and limitations.
METHODS: A search (to April 2024) used keywords such as muscle spasticity, cerebral palsy, and assessment methods. Selection criteria included articles involving CP children, assessing spasticity objectively/subjectively, comparing methods, or evaluating method effectiveness.
RESULTS: From an initial pool of 1971 articles, 30 met our inclusion criteria. These studies collectively appraised a variety of techniques ranging from well-established clinical scales like the modified Ashworth Scale and Tardieu Scale, to cutting-edge technologies such as real-time sonoelastography and inertial sensors. Notably, innovative methods such as the dynamic evaluation of range of motion scale and the stiffness tool were highlighted for their potential to provide more nuanced and precise assessments of spasticity. The review unveiled a critical insight: while traditional methods are convenient and widely used, they often fall short in reliability and objectivity.
CONCLUSIONS: The review discussed the strengths and limitations of each method and concluded that more reliable methods are needed to measure the level of muscle spasticity more accurately.

METHODS: We present a 67-year-old woman with long finger extrinsic extensor tightness and a 56-year-old man with limited index finger flexion due to extrinsic extensor tightness secondary to tendon transfers for radial nerve palsy. Both patients underwent prior surgical procedures that led to limited range of motion (ROM). Subsequently, they elected for central tendon tenotomy (CTT), which demonstrated postoperative ROM improvement and satisfactory patient outcomes.
CONCLUSIONS: Surgical management of extrinsic extensor tendon tightness of the hand is generally addressed by performing tenolysis to improve tendon excursion. We present a novel and simple technique of CTT with pertinent anatomy, descriptive cases, and a cadaveric video.

OBJECTIVE: To compare whole-body kinematics, leg muscle activity, and discomfort while performing a 10-min carrying task with and without a passive upper-body exoskeleton (CarrySuitⓇ), for both males and females.
BACKGROUND: Diverse commercial passive exoskeletons have appeared on the market claiming to assist lifting or carrying task. However, evidence of their impact on kinematics, muscle activity, and discomfort while performing these tasks are necessary to determine their benefits and/or limitations.
METHODS: Sixteen females and fourteen males carried a 15kg load with and without a passive exoskeleton during 10-min over a round trip route, in two non-consecutive days. Whole-body kinematics and leg muscle activity were evaluated for each condition. In addition, leg discomfort ratings were quantified before and immediately after the task.
RESULTS: The gastrocnemius and vastus lateralis muscle activity remained constant over the task with the exoskeleton. Without the exoskeleton a small decrease of gastrocnemius median activation was observed regardless of sex, and a small increase in static vastus lateralis activation was observed only for females. Several differences in sagittal, frontal, and transverse movements\' ranges of motion were found between conditions and over the task. With the exoskeleton, ROM in the sagittal plane increased over time for the right ankle and pelvis for both sexes, and knees for males only. Thorax ROMs in the three planes were higher for females only when using the exoskeleton. Leg discomfort was lower with the exoskeleton than without.
CONCLUSIONS: The results revealed a positive impact on range of motion, leg muscle activity, and discomfort of the tested exoskeleton.

Patella alta is a clinical condition where the patella is positioned too proximal in relation to the femoral trochlea. Such an abnormality may cause patellar instability and predispose to recurrent patellofemoral dislocations and patellofemoral pain. There are no conclusive guidelines for determining a threshold for too high positioned patella, as several different methods have been described to measure patellar height. As a surgical solution, distalising tibial tubercle osteotomy has been described to correct excessive patellar height. In the early phase of the distalising tibial tubercle osteotomy postoperative protocol, weightbearing and knee flexion are limited with a brace commonly for 4-8 weeks to avoid potential implant failure leading to displacement of the osteotomy or non-union. The potential risks for adverse effects associated with the limitation rehabilitation protocol include a delay in regaining knee range of motion, stiffness and muscle weakness. As a result, recovery from surgery is delayed and may lead to additional procedures and long-term morbidity in knee function. This is a prospective, randomised, controlled, single-blinded, single centre trial comparing a novel accelerated rehabilitation protocol with the traditional, motion restricting rehabilitation protocol. All skeletally mature patients aged 35 years and younger, referred to as the distalising tibial tubercle osteotomy procedure group, are eligible for inclusion in the study. Patients will be randomised to either the fast rehabilitation group or the traditional rehabilitation group. Patients with patellar instability will be additionally treated with medial patellofemoral ligament reconstruction. The hypothesis of the trial is that the novel accelerated rehabilitation protocol will lead to faster recovery and improved functional outcome at 6, 12 and 24 weeks compared with the conservative rehabilitation protocol. A secondary hypothesis is that the complication rate will be similar in both groups. The study will document short-term recovery and the planned follow-up will be 3 years. After the 1-year follow-up, the trial results will be disseminated in a major peer-reviewed orthopaedic publication. Protocol version 3.6, date 28/11/2023.

OBJECTIVE: To compare the clinical outcomes between nonsurgical and surgical treatment of distal radius fracture.
METHODS: We performed a systematic literature search by using multiple databases, including Medline, PubMed, and Cochrane. All databases were searched from the earliest records through February 2023. The study compared nonsurgical versus surgical treatment of distal radius fractures and included only randomized controlled trials (RCTS).
RESULTS: There were seventeen randomized controlled trials retrieved. A total of 1730 patients were included: 862 in the nonsurgical group and 868 in the surgical group. The results showed a significant reduction in DASH score with surgical treatment (WMD 3.98, 95% CI (2.00, 5.95), P < 0.001). And in grip strength (%), the results showed a significant improvement in surgical treatment compared with non-surgical treatment (WMD - 6.60, 95% CI (-11.61, -1.60), P = 0.01). There was significant difference in radial inclination, radial length, volar title, range of wrist pronation, range of wrist supination. However, no difference in radial deviation, ulnar deviation, ulnar variance, range of wrist extension and range of wrist flexion was observed.
CONCLUSIONS: The results of this meta-analysis suggest that some patients with surgical treatment of distal radius fractures not only improved the grip strength (%), decreased the DASH score, but also improved the range of wrist pronation and the range of wrist supination compared with nonsurgical treatment. Based on the present meta-analysis, we suggest that some patients with surgical treatment might be more effective in patients with distal radius fracture.

We propose a compact wearable glove capable of estimating both the finger bone lengths and the joint angles of the wearer with a simple stretch-based sensing mechanism. The soft sensing glove is designed to easily stretch and to be one-size-fits-all, both measuring the size of the hand and estimating the finger joint motions of the thumb, index, and middle fingers. The system was calibrated and evaluated using comprehensive hand motion data that reflect the extensive range of natural human hand motions and various anatomical structures. The data were collected with a custom motion-capture setup and transformed into the joint angles through our post-processing method. The glove system is capable of reconstructing arbitrary and even unconventional hand poses with accuracy and robustness, confirmed by evaluations on the estimation of bone lengths (mean error: 2.1 mm), joint angles (mean error: 4.16°), and fingertip positions (mean 3D error: 4.02 mm), and on overall hand pose reconstructions in various applications. The proposed glove allows us to take advantage of the dexterity of the human hand with potential applications, including but not limited to teleoperation of anthropomorphic robot hands or surgical robots, virtual and augmented reality, and collection of human motion data.

The flexion-relaxation phenomenon (FRP) is frequently absent among non-specific chronic low back pain (NSCLBP) patients. However, it is unknown whether this absence is intrinsic to their pathology or merely a consequence of reduced trunk flexion. Immersive virtual reality (IVR) can create a patient avatar whose range of motion can be modulated to differ from the real movement. The present study enrolled 15 NSCLBP patients and 15 asymptomatic participants with similar characteristics to disentangle the relationship between range of motion and the FRP in NSCLBP using IVR. Trunk kinematics and lumbar muscle electromyography were assessed. The IVR environment was combined with a motion capture system to create avatars that moved like each participant. The IVR display showed a closed room and a mirror reflecting the subject\'s avatar with a target line to be reached by trunk flexion. The avatar\'s trunk movements were modulated from reality, leading the participants to flex their trunk more than their voluntary maximum trunk flexion. Under IVR conditions, NSCLBP patients significantly increased their trunk flexion angle, which was coupled with a significant improvement in the FRP. The absence of the FRP among the NSCLBP population appeared to be primarily related to reduced trunk flexion.