Wearable devices for physiological parameters monitoring are gaining broad acceptance due to their ease of use, comfortability, and reliability. Among all human joints, the knee joint is the most involved in day-to-day activities. Monitoring the knee joint movements may allow outlining an optimized and patient-specific rehabilitation process and may perform a quantitative assessment of the improvements made. In this work, we propose a washable and reusable wearable system based on a conductive textile for knee flexion-extension monitoring. We performed a biomechanical analysis to guide the design of the sensing element, to perform its metrological characterization, and to optimize its integration into a wearable knee guard. We tested the developed system on 5 healthy volunteers performing 3 different rehabilitation exercises in terms of number of flexion-extension performed and of the knee angle. This assessment was performed using a motion capture system as a reference. The results are promising and in good agreement with the reference system and enable the system to be suitable for its application in rehabilitation and day-to-day monitoring.

Background: Stroke in childhood presents a serious rehabilitation challenge since it leads to physical, cognitive and psychosocial disability. The objective of our study was to describe the effectiveness of robot-mediated therapy (RMT) with Gloreha Sinfonia in addition to a conventional treatment in the recovery of the sensory-motor capabilities of the paretic hand and the quality of life in a ten-year-old child after a stroke. Methods: The girl was enrolled to undergo 10 sessions of RMT with Gloreha Sinfonia. She was evaluated with functional scales and with upper limb kinematic analysis at pre-treatment (T0) and at the end of treatment (T1). Outcome measures were Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Visual Analogic Scale (VAS) and Activities and Participation of Daily Life (ADL). In addition, a Force Assessment System based on Virtual Reality games was used to assess the force control and modulation capability at T0 and T1. Results: At the end of treatment, the patient improved in functional scales and in quality of life for greater involvement in some activity of daily living. Force control and modulation capability significantly increased after the treatment. Conclusions: This clinical case highlights possible positive effects of a combined (conventional plus robotic) rehabilitation treatment for the upper limb in pediatric stroke outcomes from both a sensorimotor and functional point of view, also improving the motivational and affective aspects of the patient and of family members. Further studies are needed to validate these results and to identify the most appropriate modalities and doses.

The central nervous system (CNS) is able to control a very high number of degrees of freedom to perform complex movements of both upper and lower limbs. However, what strategies the CNS adopts to perform complex tasks are not completely clear and are still being studied. Recent studies confirm that stroke subjects with mild and moderate impairment show altered upper limb muscle patterns, but the muscular patterns of the hand have not completely investigated, although the hand represents a paramount tool for performing activities of daily living (ADLs) and stroke can significantly alter the mobilization of this part of the body. In this context, this study aims at investigating hand muscular synergies in chronic stroke patients and evaluating some possible benefits in the robot-aided rehabilitation treatment of the hand in these subjects. Seven chronic stroke patients with mild-to-moderate impairment ($FM>30$) were involved in this study. They received a 5-week robot-aided rehabilitation treatment with the Gloreha hand exoskeleton, and muscle synergies of both the healthy and injured hand were evaluated at the beginning and at the end of the treatment. The performed analysis showed a very high degree of similarity of the involved synergies between the healthy and the injured limb both before and after the rehabilitation treatment (mean similarity index values: H-BR: $0.88\pm 0.03$, H-AR: $0.94\pm 0.03$, BR-AR: $0.89\pm 0.05$). The increasing similarity is regarded as an effect of the robot-aided rehabilitation treatment and future activities will be performed to increase the population involved in the study.

This systematic review of the literature aimed to highlight which criteria are described in the literature to define when a patient, after rotator cuff repair (RCR), is ready for return-to-play (RTP), which includes return to unrestricted activities, return to work, leisure, and sport activities. An online systematic search on the US National Library of Medicine (PubMed/MEDLINE), SCOPUS, Web of Science (WOS), and the Cochrane Database of Systematic Reviews, was performed with no data limit until December 2021. A total of 24 studies that reported at least one criterion after RCR were included. Nine criteria were identified and among these, the most reported criterion was the time from surgery, which was used by 78% of the studies; time from surgery was used as the only criterion by 54% of the studies, and in combination with other criteria, in 24% of the studies. Strength and ROM were the most reported criteria after time (25%). These results are in line with a previous systematic review that aimed to identify RTP criteria after surgical shoulder stabilization and with a recent scoping review that investigated RTP criteria among athletes after RCR and anterior shoulder stabilization. Compared to this latest scoping review, our study adds the methodological strength of being conducted according to the Prisma guidelines; furthermore, our study included both athletes and non-athletes to provide a comprehensive view of the criteria used after RCR; moreover, ten additional recent manuscripts were examined with respect to the scoping review.

Gait impairment is one of the most common disorders of patients with chronic stroke, which hugely affects the ability to carry out the activities of daily living and the quality of life. Recently, traditional rehabilitation techniques have been associated with non-invasive brain stimulation (NIBS) techniques, which enhance brain plasticity, with the aim of promoting recovery in patients with chronic stroke. NIBS effectiveness in improving gait parameters in patients with chronic stroke has been in several studies evaluated. Robotic devices are emerging as promising tools for the treatment of stroke-related disabilities by performing repetitive, intensive, and task-specific treatments and have been proved to be effective for the enhancement of motor recovery in patients with chronic stroke. To date, several studies have examined the combination of NIBS with robotic-assisted gait training, but the effectiveness of this approach is not yet well established. The main purpose of this systematic review is to clarify whether the combination of NIBS and robot-assisted gait training may improve walking function in patients with chronic stroke. Our systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies eligible for review were identified through PubMed/MEDLINE, Embase, Scopus, and PEDro from inception to March 15, 2021, and the outcomes considered were gait assessments. Seven studies were included in the qualitative analysis of this systematic review, with a total population of 186 patients with chronic stroke. All studies specified technical characteristics of robotic devices and NIBS used, with high heterogeneity of protocols. Methodological studies have shown a significantly greater improvement in walking capacity recorded with 6MWT. Finally, research studies have highlighted a positive effect on walking recovery by combination of robot-assisted gait training with non-invasive brain stimulation. Furthermore, future studies should identify the best characteristics of the combined therapeutic protocols. Systematic Review Registration: CRD42021244869.

Lower limb orthoses are frequently used in children suffering from cerebral palsy (CP) alongside rehabilitation. The aim of this study was to analyze the effectiveness of ankle–foot orthosis (AFO) and knee–ankle–foot orthosis (KAFO) in walking, balance maintenance, spasticity, and quality of life improvement during rehabilitation in children affected by CP. The hypothesis was that the use of orthoses could improve the parameters compared to non-use. A systematic review was conducted in the main databases, including English language RCTs published about the use of AFO and KAFO in combination or not with rehabilitation methods in children affected by CP and studies mentioning walking, balance, muscle length, and quality of life as outcomes. From an initial number of 1484 results, a final number of 11 RCTs were included, comprising a total number of 442 participants and showing an overall high risk of bias in 10 studies and some concerns in one study. Six studies investigated the domain of walking, four studies investigated the domain of balance, and two studies investigated how KAFO and AFO orthoses could improve and prevent muscle contractures. Using highly heterogeneous study designs, different kinds of orthoses and different assessment tools were used. Further studies conducted with higher methodological quality are needed to establish whether AFO and KAFO are useful or not in combination with rehabilitation in improving the investigated domains.