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Dynamic loads have short and long-term effects in the rehabilitation of lower limb joints. However, an effective exercise program for lower limb rehabilitation has been debated for a long time. Cycling ergometers were instrumented and used as a tool to mechanically load the lower limbs and track the joint mechano-physiological response in rehabilitation programs. Current cycling ergometers apply symmetrical loading to the limbs, which may not reflect the actual load-bearing capacity of each limb, as in Parkinson’s and Multiple Sclerosis diseases. Therefore, the present study aimed to develop a new cycling ergometer capable of applying asymmetric loads to the limbs and validate its function using human tests. The instrumented force sensor and crank position sensing system recorded the kinetics and kinematics of pedaling. This information was used to apply an asymmetric assistive torque only to the target leg using an electric motor. The performance of the proposed cycling ergometer was studied during a cycling task at three different intensities. It was shown that the proposed device reduced the pedaling force of the target leg by 19% to 40%, depending on the exercise intensity. This reduction in pedal force caused a significant reduction in the muscle activity of the target leg (p < 0.001), without affecting the muscle activity of the non-target leg. These results demonstrated that the proposed cycling ergometer device is capable of applying asymmetric loading to lower limbs, and thus has the potential to improve the outcome of exercise interventions in patients with asymmetric function in lower limbs.

Monitoring biophysical signals such as body or organ movements and other physical phenomena is necessary for patient rehabilitation. However, stretchable flexible pressure sensors with high sensitivity and a broad range that can meet these requirements are still lacking. Herein, we successfully monitored various vital biophysical features and implemented in-sensor dynamic deep learning for knee rehabilitation using an ultrabroad linear range and high-sensitivity stretchable iontronic pressure sensor (SIPS). We optimized the topological structure and material composition of the electrode to build a fully stretching on-skin sensor. The high sensitivity (12.43 kPa−1), ultrabroad linear sensing range (1 MPa), high pressure resolution (6.4 Pa), long-term durability (no decay after 12000 cycles), and excellent stretchability (up to 20%) allow the sensor to maintain operating stability, even in emergency cases with a high sudden impact force (near 1 MPa) applied to the sensor. As a practical demonstration, the SIPS can positively track biophysical signals such as pulse waves, muscle movements, and plantar pressure. Importantly, with the help of a neuro-inspired fully convolutional network algorithm, the SIPS can accurately predict knee joint postures for better rehabilitation after orthopedic surgery. Our SIPS has potential as a promising candidate for wearable electronics and artificial intelligent medical engineering owing to its unique high signal-to-noise ratio and ultrabroad linear range. An ultrabroad-linear range (1 MPa) iontronic pressure sensor with superior sensitivity (12.43 kPa-1) and stretchability (up to 20%) was proposed for biophysical monitoring and deep learning-based knee-rehabilitation training.

Purpose: Digital technologies, including mobile applications, websites, and wearable devices, like smartwatches are among the newest approaches in prevention, care, and treatment studies; they could provide public access to high-quality rehabilitation services. The current review study aimed to evaluate the effects of digital technologies for enhancing physical activity, as well as improving and managing pain in individuals with knee injuries and pain. Methods: The keywords “digital care program”, “e-health”, “physical activity”, and “knee pain” were used to search the studies in the PubMed, Scopus, and Google Scholar databases. In total, 734 articles were found. Then, studies published in languages other than English; the articles with completely similar results; the studies on diseases other than knee problems, and those investigating children or adolescents were excluded. Thus, valid articles indexed in these databases that digital technologies were an except original in the intervention; databases that investigated the impact of digital technologies on osteoarthritis and total knee arthroplasty knee improvement, and the randomized controlled trials were included in this research. Eventually, 8 articles were evaluated in this study. The methodological quality of the studies was assessed using the PEDro score. Results: The overall outcome of the explored studies indicated that digital technologies significantly impact pain relief, and improve mobility, quality of life, and self-care in patients with osteoarthritis and total knee arthroplasty. Conclusion: Digital technologies increase the effectiveness of rehabilitation programs and play an essential role in creating a self-care culture. These technologies have resulted in savings in medical, commuting, pharmacotherapy, and surgery costs by communicating between patient and therapist at any time in any place.

Research objective The research aims to identify the effect of using Bose Ball exercises on the level of functional efficiency in people with a torn cruciate ligament. Research hypotheses - There are statistically significant differences between the averages of the pre and post measurements in the level of functional efficiency in those with a torn cruciate ligament in the experimental research group. - There are statistically significant differences between the averages of the pre and post measurements in the level of functional efficiency in those with torn cruciate ligament control research group. - There are statistically significant differences between the two averages post measurements of both the experimental and control research groups in the level of functional efficiency of those with torn cruciate ligament and in favor of the experimental research group. Some terms in the research Bose Ball It is a training device for balance, strength, ability, and improvement of the heart and blood vessels. It is a hemisphere on a flat base with a diameter of 55 cm. It is used on both sides, whether the hemispherical hemisphere or the flat face and equipped with two Resistance Ropes on the two sides of its base, its length is 60 cm, and at its maximum tension, its length becomes 120 cm, the equivalent weight of 7 kg (Operative Definition

Knee injuries such as ACL tears commonly occur and there is a high re-injury rate after primary ACL reconstruction with figures estimated at 25%-33%. Clinicians often use hip strengthening as a key component of knee rehabilitation. Evidence suggests that adopting a "regional" or "proximal" approach to rehabilitation can increase hip strength, but motor control often remains unchanged, particularly during more complex tasks such as running and jumping. It has been previously suggested that the current approach to "regional/proximal" rehabilitation is too basic and is constrained by a reductionist philosophy. This clinical commentary provides the clinician a framework for optimizing knee rehabilitation, underpinned by a more global approach. Although this approach remains hip-focused, it can be easily adapted to modify exercise complexity and key loading variables (speed, direction, flight), which will help the clinician to better replicate the sport specific demands on the knee. Level of evidence 5.

The aim of the study was to compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis.This study used a two-phase sequential design. Twenty-seven participants with unilateral knee osteoarthritis completed two separate treadmill walking sessions: (1) continuous 45-min walking exercise and (2) three 15-min bouts of walking exercise separated by 1-hr rest periods for a total of 45 mins in an interval format. Participants reported their knee pain using the numeric pain rating scale and serum levels of biomarkers associated with tissue turnover (cartilage oligomeric matrix protein), inflammation (tumor necrosis factor α), and pain (neuropeptide Y) were evaluated at baseline and every 15 mins for both conditions.Continuous walking resulted in a cumulative increase in cartilage oligomeric matrix protein concentration up to 45 mins, whereas interval walking was associated with return of cartilage oligomeric matrix protein concentrations back to baseline at 45 mins. There were no significant changes in tumor necrosis factor α and neuropeptide Y concentration during walking. There was a significant increase in pain compared with baseline in the continuous walking regimen only.Incorporating rest breaks in walking regimens may affect the potential deleterious effects of longer continuous bouts on the knee joint as well as limit pain during exercise.

Three-dimensional human motion analysis provides in-depth understanding in order to optimize sports performance or rehabilitation following disease or injury. Recent developments of statistical methods for functional data allow for novel ways to analyze often complex biomechanical data. Even so, for such methods as well as for traditional well-established statistical methods, the interpretations of the results may be influenced by analysis choices made prior to the analysis. We evaluated the consequences of three such choices when comparing one-leg vertical hop (OLVH) performance in individuals who had ruptured their anterior cruciate ligament (ACL), to that of asymptomatic controls, and also athletes. Kinematic data were analyzed using a statistical approach for functional data, targeting entire curve data. This was done not only for one joint at a time but also for multiple lower limb joints and movement planes simultaneously using a multi-aspect methodology, testing for group differences while also accounting for covariates. We present the results of when an individual representative curve out of three available was either: (1) a mean curve (Mean), (2) a curve from the highest hop (Max), or (3) a curve describing the variability (Var), as a representation of performance stability. We also evaluated choice of sample leg comparison; e.g., ACL-injured leg compared to either the dominant or non-dominant leg of asymptomatic groups. Finally, we explored potential outcome effects of different combinations of included joints. There were slightly more pronounced group differences when using Mean compared to Max, while the specifics of the observed differences depended on the outcome variable. For Var there were less significant group differences. Generally, there were more disparities throughout the hop movement when comparing the injured leg to the dominant leg of controls, resulting in e.g., group differences for trunk and ankle kinematics, for both Mean and Max. When the injured leg was instead compared to the non-dominant leg of controls, there were trunk, hip and knee joint differences. For a more stringent comparison, we suggest considering to compare the injured leg to the non-dominant leg. Finally, the multiple-joint analyses were coherent with the single-joint analyses. The direct effects of analysis choices can be explored interactively by the reader in the Supplementary Material. To summarize, the choices definitively have an impact on the interpretation of a hop test results commonly used in rehabilitation following knee injuries. We therefore strongly recommend well-documented methodological analysis choices with regards to comparisons and representative values of the measures of interests.

Wearable devices for knee rehabilitation have been studied extensively in the past few years, with particular applications in tackling ageing problems all over the world. Such devices were firstly created 40 years ago. Although numerous solutions have been proposed since then, many challenges still exist, like high energy consumption compared to their short battery lifetime, low portability and incompatibility anthropomorphic mechanisms. Recently, these issues are resolved with different methods, including the development of better-designed actuators and artificial muscles, and the improvement of gait models. However, there are questions associated with each of these methods such as the self-weight of actuators and muscles which decrease the portability of the devices, while increased complexity is associated with more accurate models. The resulting device from this thesis aims to overcome the difficulties mentioned above and acts as lightweight and functional wearable devices/joints. The device consists of two rings fixed on the femur and tibia, respectively, connected with two crossing flexural shells. The design concept comes from the anatomy and physiology of the human knees concluded in the bio-joint model. Two designs, cross-spring pivot and the crossing four-bar linkage, are studied in this thesis. The kinetostatic models of the two designs are established for the intended bionic characteristics. After optimizing the two designs by using the analytical models, it shows that the crossing four-bar linkage is much better than the cross-spring pivot for matching the bio-joint. A comparison between analytical model and FEA for each design is implemented, showing acceptable agreement. A prototype is fabricated, and preliminarily static experiment tests are conducted.

Walking and running at different speeds are common in daily life. This study investigated 6 degrees of freedom (DOF) kinematics of normal knees of Chinese during walking and running. Forty healthy participants were investigated in 4 conditions: comfortable walking, normal walking, slow running and ordinary running. The range of motion (ROM) and peak values in 6 DOF kinematics were analysed. As the speed increased, a general increase in flexion, lateral and proximal translations occurred. Significant increases of ROM in flexion/extension, axial rotation and medial/lateral translations were observed. The ROM of adduction/abduction, anterior/posterior and proximal/distal translations were greatest during normal walking. The maximum and minimum flexion/extension, maximum internal rotation and tibial lateral translations increased with the increase of speed. The maximum and minimum tibial proximal translations in running were found being greater than walking. A phenomenon between walking and running was observed: both tibial proximal/distal and medial/lateral translations increased when changed from walking to running. Non-linear transition exists in 6 DOF kinematics during walking to running. Discoveries in this study may have potential clinical values to serve as references of normal walking and running in the management of knee injury and knee rehabilitation.

Rehabilitation engineering, as one of the active research areas in biomedical science, needs further investigations and improvements. The process of rehabilitation, whether after a stroke, ligament, or accident-related injuries, is commonly based on clinical assessment tools, which can be executed, either by self-reported (home-based) treatment or through observer-rated therapy. However, people with reduced mobility (e.g., stroke, surgical, and ligament patients) can benefit from rehabilitation programs only if effective and appropriate assistive tools are provided. In this paper, a new internet of things (IoT)-based telemonitoring system is introduced for knee injuries’ rehabilitation (Knee-Rehab). The proposed system is a real-time rehabilitation and monitoring framework designed to be a portable, home-based, and online-based instrument comprised of bio-mechanical, bio-instrumentation and IoT-based elements. The system helps patients to rest at home after surgeries or physical treatment, do their rehab-exercises, and receive suggestions form their advisors, which gain the ability to monitor the situation over the exercising time and propose necessary medication/activities to be followed by the patients accordingly, based on their current status. The experimental measurements show the high accuracy achieved by the developed system in terms of monitored knee joint angle, where the maximum error is 3.5° compared to manual goniometer measurements.

U ovom radu osmišljen je koncept interaktivne rehabilitacije koljena primjenom igrifikacije u sustavu biološke povratne veze. Navedeni koncept je implementiran za mobilne Android platforme koristeći razvojnu okolinu Android Studio i Unity Engine. Kao izvor signala korištena je sklopovska platforma KneEMG koja mjeri, prikuplja i Bluetooth bežičnom vezom šalje elektromiografske signale mišića kvadricepsa te signale inercijskog senzorskog sustava koji daju podatak o kretanju potkoljenice. Za razvijenu aplikaciju izrađena je popratna dokumentacija s uputama za instalaciju i konfiguraciju sustava. Aplikacija pod nazivom BlueBird je igrica zabavnog i uzbudljivog karaktera u kojoj korisnik pravilnom izvedbom rehabilitacijskih vježbi osvaja dodatne bodove i ispunjava svoj dnevni zadatak. In this thesis, the concept of interactive rehabilitation was used to apply games in the biological feedback system. This concept has been implemented for Android mobile platforms using Android Studio and Unity Engine. The KneEMG hardware platform was used as the signal source, which measures, collects, and sends electromyographic signals from the muscles of the quadriceps and signals from the inertial sensor system via Bluetooth connection to provide information about the movement of the lower leg. Supporting documentation for system installation and configuration has been created for the developed application. The app called BlueBird is a game with fun and excitng character where the user with correctly performed rehabilitation exercises wins additional points and completes a daily task.

espanolIntroduccion. Multiples estudios de procesamiento de senales han reportado la aplicacion de las senales de electromiografia de superficie (sEMG) en robotica y en procesos de rehabilitacion motora. Objetivo. Realizar una revision de la literatura sobre el uso de senales de sEMG como alternativa para la estimacion del par de rodilla con el fin de medir objetivamente el progreso de los pacientes en las diferentes etapas de rehabilitacion de lesiones de rodilla. Materiales y metodos. Se realizo una revision de la literatura publicada entre 1986 y 2018, sin limites geograficos, en las bases de datos Engineering Village, IEEE Xplore, ScienceDirect, Web of Science, Scopus y PubMed mediante la combinacion de 8 terminos de busqueda. Resultados. Al finalizar la busqueda inicial se obtuvieron 355 registros. Luego de realizar la remocion de duplicados esta cifra descendio a 308, los cuales fueron analizados para determinar si cumplian con los criterios de inclusion. Finalmente se incluyeron 18 estudios que describen de forma comparativa como estimar el par a partir de senales de sEMG. Conclusion. El uso de senales de sEMG para calcular el par en una articulacion es una herramienta alternativa que permite al terapeuta acceder a parametros cuantitativos y, de esta forma, valorar el progreso de los pacientes durante el proceso de rehabilitacion de rodilla. EnglishIntroduction: Multiple signal processing studies have reported the application of surface electromyography (sEMG) signals in robotics and motor rehabilitation processes. Objective: To conduct a literature review on the use of sEMG signals as an alternative method for knee torque estimation in order to objectively measure the progress of patients at different stages of knee injury rehabilitation. Materials and methods: A literature review of studies published between 1986 and 2018, without geographical limits, was carried out in the Engineering Village, IEEE Xplore, Science- Direct, Web of Science, Scopus, and PubMed databases by combining 8 search terms. Results: After completing the initial search, 355 records were retrieved. Duplicated publications were eliminated, and 308 articles were analyzed to determine if they met the inclusion criteria. Finally, 18 studies describing, in a comparative way, how to estimate torque based on sEMG signals were included. Conclusion: The use of sEMG signals to calculate joint torque is an alternative method that allows therapists to obtain quantitative parameters and assess the progress of patients undergoing knee rehabilitation processes.

Zusammenfassung Ziel Ziel der Untersuchung war es, Prädiktoren für das Rehabilitationssetting (ambulant vs. stationär) nach Akutaufenthalt zu bestimmen, um Hinweise auf die Bedeutung der Fallschwere beim Zugang zu einer bestimmten Rehabilitationsform zu erhalten. Methode Für die Auswertungen wurden Patienten2 ausgewählt, bei denen zwischen 2005 und 2010 eine Totalendoprothese (TEP) an Hüfte oder Kniegelenk implantiert oder eine Bandscheibenoperation vorgenommen wurde. Anhand anonymisierter Routinedaten der AOK Baden-Württemberg sowie der Deutschen Rentenversicherungen Bund und Baden-Württemberg wurde mittels logistischer Regression die Wahrscheinlichkeit modelliert, eine stationäre Anschlussrehabilitation (AR) durchzuführen. Ergebnisse Über alle 3 Operationsgruppen hinweg führten Patienten, die unmittelbar nach dem Akutaufenthalt zur AR kamen, eher eine stationäre Maßnahme durch, als Patienten, die nach einer häuslichen Übergangszeit zur Rehabilitation kamen. Mit zunehmendem Alter sowie bei Komorbiditäten wurde häufiger eine stationäre AR in Anspruch genommen. Die Wahrscheinlichkeit einer stationären Durchführung nahm im Zeitraum zwischen 2005 und 2009 ab. Schlussfolgerung Neben der Fallschwere scheinen Kontextfaktoren für das Setting der AR eine Rolle zu spielen. Bei der bedarfsorientierten Zugangssteuerung zu einer bestimmten Rehabilitationsform sind individuelle Rahmenbedingungen, wie bspw. die Versorgung durch das familiäre Umfeld bzw. die Erreichbarkeit therapeutischer, pflegerischer und medizinischer Angebote, und medizinische Parameter, d. h. die Erkrankungsschwere, gegeneinander abzuwägen.

This research aims to design and implement a novel task-based knee rehabilitation strategy through kinematic synthesis, assist-as-needed control strategy, and recovery tracking system. Experimental kinematic data collected through motion capture system are utilized as an input to the mechanism synthesis procedure. Parallel mechanisms with single degree-of-freedom are considered to generate the complex three-dimensional (3D) motions of the lower leg. An exact workspace synthesis approach is utilized, in which the implicit description of the workspace is made to be a function of the structural parameters of the serial chains of the parallel mechanism, making it easy to relate those parameters to the desired trajectory from the motion capture. The synthesis procedure resulted an exoskeleton which can guide the complex motion of the human knee without the need of mimicking the joint by the exoskeleton counterpart. This can potentially reduce the improper alignment problems arising due to the constantly varying axis of rotation of human joint, which is often very difficult to predict. An assist-as-needed control and recovery tracking strategy is outlined based on an electromyography (EMG) signals and force sensing resistors (FSRs) mounted on the user and exoskeleton, respectively. The EMG signal is captured from the user leg and FSRs are applied at the attachment area of the exoskeleton and the leg, this helps to get the amount of force applied by the exoskeleton to the leg as well as for the recovery tracking. The assist-as-needed controller eliminates the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process. Similarly, the real-time progress tracking system will motivate and actively engage users

For total knee replacement (TKR) patients, rehabilitation after the surgery is key to regaining mobility. This study proposes a sensor-based system for effectively monitoring rehabilitation progress after TKR. The system comprises a hardware module consisting of the triaxial accelerometer and gyroscope, a microcontroller, and a Bluetooth module, and a software app for monitoring the motion of the knee joint. Three indices, namely the number of swings, the maximum knee flexion angle, and the duration of practice each time, were used as metrics to measure the knee rehabilitation progress. The proposed sensor device has advantages such as usability without spatiotemporal constraints and accuracy in monitoring the rehabilitation progress. The performance of the proposed system was compared with the measured range of motion of the Cybex isokinetic dynamometer (or Cybex) professional rehabilitation equipment, and the results revealed that the average absolute errors of the measured angles were between 1.65° and 3.27° for the TKR subjects, depending on the swing speed. Experimental results verified that the proposed system is effective and comparable with the professional equipment.

An important milestone in the recovery following total knee replacement (TKR) is the ability to return to driving. With advances in pain control and the widespread introduction of rapid rehab programs, we hypothesized that the ability to drive would also return sooner than had been traditionally observed. In our group of consecutive right TKR patients, using a driving simulator, we showed that at the 2-week mark, 36 of the 40 patients tested had returned to their preoperative driving capabilities and the other 4 had reached baseline at 3 weeks. While the eventual decision to return to driving is complex and dependent on many factors, we conclude that one of the benefits of enhanced pain and rehab protocols is that patients undergoing right TKR can return to driving in most instances at the 2-week mark rather than the traditional 6-week mark.

Objective: To assess the effects of early self-managed focal sensorimotor training compared to functional exercise training after total knee replacement on functional mobility and sensorimotor function. Design: A single-blind controlled clinical trial. Setting: University Hospital of Rion, Greece. Subjects: A total of 52 participants following total knee replacement. Outcome measures: The primary outcome was the Timed Up and Go Test and the secondary outcomes were balance, joint position error, the Knee Outcome Survey Activities of Daily Living Scale, and pain. Patients were assessed on three separate occasions (presurgery, 8 weeks post surgery, and 14 weeks post surgery). Intervention: Participants were randomized to either focal sensorimotor exercise training (experimental group) or functional exercise training (control group). Both groups received a 12-week home-based programme prescribed for 3–5 sessions/week (35–45 minutes). Results: Consistently greater improvements ( F2,98 = 4.3 to 24.8; P Conclusions: Overall, the magnitude of improvements in functional mobility and sensorimotor function endorses using focal sensorimotor training as an effective mode of rehabilitation following knee replacement.

Zusammenfassung Hintergrund Nach der Akutbehandlung bei Implantation einer Hüft- oder Knietotalendoprothese (TEP) erfolgt meist eine sich daran anschließende Rehabilitationsmaßnahme, entweder unmittelbar im Anschluss oder nach vorangegangener häuslicher Übergangszeit. Aber auch eine ausschließlich ambulante Nachbehandlung ohne Rehabilitation ist möglich. Ziel der Arbeit war die Analyse von personen- und behandlungsbezogenen Faktoren auf die Inanspruchnahme der jeweiligen Nachbehandlung. Methode Auf Basis eines verknüpften Datensatzes bestehend aus Routinedaten der AOK Baden-Württemberg sowie der Deutschen Rentenversicherung Bund und der Deutschen Rentenversicherung Baden-Württemberg erfolgte eine sektorenübergreifende Analyse des Versorgungsgeschehens. Mittels 2 logistischer Regressionsmodelle (Backward-Selektion) wurden Prädiktoren der Inanspruchnahme einer Anschlussrehabilitation (AR) sowie einer häuslichen Übergangszeit getrennt für Hüft- und Knie-TEP-Patienten ermittelt. Ergebnisse Von 9 232 Hüft-TEP-Patienten nahmen 82,6% eine AR entweder direkt nach dem Akutaufenthalt (58,7%) oder nach häuslicher Übergangszeit (23,9%) in Anspruch. Jüngere, männliche und nicht-deutsche Hüft-TEP-Patienten gingen dabei deutlich seltener zur AR. Von den insgesamt 7 656 Knie-TEP-Patienten nahmen 83,9% eine AR in Anspruch, 59,7% direkt und 24,2% mit Übergangszeit. Dabei waren ebenfalls soziodemografische Merkmale für die Inanspruchnahme prognostisch bedeutsam. Die Analyse zeigte, dass die Inanspruchnahme einer AR sowohl von Alter, Geschlecht und Staatsangehörigkeit, als auch von Komorbiditäten, Behandlungen sowie Medikamentenverordnungen beeinflusst wird. Schlussfolgerung Die Ergebnisse liefern Hinweise auf eine höhere Fallschwere von direkt verlegten Patienten, was für eine bedarfsorientierte Inanspruchnahme einer Rehabilitation spricht. Dennoch lassen einige Anhaltspunkte für bestimmte Patientengruppen eine Unterinanspruchnahme vermuten.

In this paper a novel knee joint rehabilitation device made for controlled active motion (CAM) therapy is presented and tested. More precisely, the system is a redesign of an originally passive CAM device, called CAMOped. Instead of a break, the adjustable resistance, which is needed for CAM therapy, is now provided via a torque-controlled pneumatic-muscle-actuator-driven joint. These actuators are inherently compliant and can produce both a variable restistance and, by co-contraction, a variable stiffness. It will be shown that, by measuring the foot contact forces and using them as feedback information, the foot load can be adjusted very precisely up to 100 N. Furthermore, it will be demonstrated that, in contrast to passive systems, the presented active systems is capable of varying the resistance while the device is in use. This facilitates adapting the resistance to the patient’s needs in real time and to use joint-angle- or foot-position-dependent resistance curves.

The posterolateral tibial plateau fracture was not easy to be exposed and fixed with usual techniques. The aim of this study was to investigate the biomechanical stability and clinical outcome of the isolated posterolateral tibial plateau fracture fixed with a single horizontal belt plate through the anterolateral supra-fibular-head approach. Fracture models were created by 18 synthetic tibias and fixed with three different fixation modes. Each group was fixed and tested on the loading machine, and final vertical displacement of the fragment was detected and calculated. Clinically, a retrospective analysis of 12 cases of posterolateral tibial plateau fracture from January 2013 to December 2017 was performed. There were 8 males and 4 females, aged 33-72 years, with an average age of 49.6 years. Isolated posterolateral tibial plateau fractures were identified according to preoperative X-ray and computed tomography scan. Through the modified anterolateral supra-fibular-head approach, the fracture was reduced and fixed by a prebending T-shaped distal radius plate and rafting screws, with bone substitute grafting or autogenous iliac bone implantation. Patients were followed up to a minimum one year of time period, and the outcome was evaluated clinically and radiologically. The biomechanical study shows that horizontal belt plate fixation for the isolated PL tibial plateau fracture can provide sufficient stability, allowing early knee functional exercise and partial weight bearing. For clinical case series, the average operation time in this group was 73.3 ± 10.2 mins (range: 55-90), and the average duration of hospitalization was 9.1 ± 3.3 days (range: 5-16). Patients were followed up for 12-24 months with an average of 16.5 months, and all patients achieved radiological fracture union after an average of 13.7 weeks. At one year after operation, the average knee score of the Hospital for Special Surgery (HSS) scale was 93.2 ± 4.2 points(range: 90-98), the average score of SMFA was 21.1 ± 5.6 points (range: 14-31), and the average knee range of motion (ROM) was 121.48 ° ± 8.88 ° (range: 105°-135°). There were 8 cases that were very satisfied and 3 cases that were satisfied with the operation. For an isolated posterolateral tibial plateau fracture, the supra-fibular-head approach can fully expose the fracture site; the horizontal belt plate fixation of the fracture is stable and reliable to allow for early-stage knee rehabilitation, and the outcome of medium-term clinical follow-up was satisfactory.

Precision and transient performance of trajectory tracking has practical significance for rehabilitation robot. A robust finite-time convergence control (RFTCC) strategy was developed for improving control accuracy and transient performance of knee rehabilitation robot in this paper. Firstly, uncertainties of dynamic model of knee rehabilitation robot were analyzed. Secondly, a RFTCC was developed to guarantee the robustness and accuracy of trajectory tracking with model uncertainties, unknown load, and external disturbances. Finally, simulation and experiment were performed on the knee rehabilitation robot. Simulations and experiments demonstrated that this new control method can provide robust and accurate control.

Completing a set of therapeutic exercises correctly and regularly is essential for early and safe recovery from knee reconstructive surgery. We propose EXTRA, a platform for monitoring and improving the quality of therapeutic exercises that the patients need to perform during the recovery. The data acquisition framework obtains observations of the knee movement using an embedded flex sensor in a hinged knee brace. A connected Android application transmits the data to the database real-time. We evaluated the accuracy of the knee joint angle measurement and the usability in a study with young healthy adults. The mean absolute error of the knee angle measurements was 13.31 degrees. The high score of the usability questionnaire indicates that EXTRA provides a user-friendly interface to motivate therapeutic exercises. EXTRA maintains high standards in accurately monitoring and interpreting the exercises. Our proposed platform has the potential to provide effective guidelines and improve the rehabilitation process for orthopedic professionals and patients.

IntroductionTelerehabilitation programmes have been attracting increasing attention as a potential alternative to conventional rehabilitation. Video conferencing can facilitate communication between healthcare professionals and patients. However, in certain cases, video conferencing may face practical limitations. As an alternative to real-time conferencing, sensor-based technologies can transmit the acquired data to healthcare providers. This study aimed to design and develop a sensor-based telerehabilitation programme and to outline the corresponding requirements for such a system.DevelopmentThe development of the sensor-based telerehabilitation programme was carried out based on user needs. The programme includes a portable platform for the patient as well as a web-based platform for the healthcare professional, thus allowing for an individualised rehabilitation programme. Communication, training, reporting, and information services were provided for the patients. Moreover, the portability and usability of the programme were enhanced by utilising the system in offline mode as well.ApplicationThe programme is currently being tested in the North Denmark Region to assess the feasibility and acceptance of a telerehabilitation programme as an alternative solution to the self-training programme for patients who have been discharged from knee surgery. The preliminary results of our assessment showed a high level of acceptance among the users.DiscussionIn this study, a semi-online sensor-based telerehabilitation programme was tested. It is argued that a similar sensor-based telerehabilitation programme can be utilised as an alternative solution for self-training rehabilitation in the future; however; further studies and development are required to ensure the quality and reliability of sensor-based services.

Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults.The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative.Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline-to-2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score.Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability.Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.

Neuromuscular electrical stimulation (NMES) involves the application of preprogrammed trains of stimuli to superficial skeletal muscles—by means of surface electrodes placed over the muscle belly—with the ultimate goal to evoke visible tetanic contractions. Unlike other electrical stimulation

Demand for hip and knee arthroplasty in the United States is rising rapidly. This is creating considerable strain on healthcare systems' institutional resources and finances. To reduce this strain, Spectrum Health in Grand Rapids, MI, developed a strategy to decrease length of stay for most primary hip and knee joint replacement patients. Four specific interventions were undertaken concurrently: (1) communication with providers, (2) modification of patient communications, (3) standardized risk assessment and prediction, and (4) physical therapy on POD (postoperative day) 0 (i.e., the day of surgery). Length of stay was reduced an average of 0.5 days per patient for primary hip and knee joint replacement surgeries, creating a positive financial outcome without negatively affecting quality and patient satisfaction. This demonstrated the ability of a large, high-volume joint replacement center to transform organizational culture and generate rapid, measureable change.

Context:Distinct exercises have been proposed for knee rehabilitation after anterior cruciate ligament (ACL) reconstruction. There is a need to understand ACL strain behavior during different rehabilitation exercises to protect the graft from excessive strain that could interfere with its healing process.Objective:To critically review studies that directly measured normal ACL strain in vivo during different movements, conditions, or exercises to gain insight into which of them may produce more strain on the ligament or the ligament graft in the case of reconstructed knees.Data Sources:A literature search of PubMed, CINAHL, SPORTDiscus, and PEDro databases was conducted. Keywords included a nterior cruciate ligament, strain, stress, deformation, transducer, rehabilitation, rehabilitation exercise, physical therapy, and physiotherapy.Study Selection:Inclusion criteria were (1) peer-reviewed studies published in English or Spanish, (2) research conducted on adult human subjects with normal ACLs and healthy knees, and (3) ACL strain directly measured during different movements, conditions, or exercises by using a transducer.Study Design:Systematic review.Level of Evidence:Level 4.Data Extraction:Specific data were abstracted from the selected studies, including isometric quadriceps and hamstrings activity, active and passive flexion-extension of the knee, closed kinetic chain exercises, and application of joint compressive load.Results:A total of 10 studies met all criteria and were included in the final analysis. The strain values produced by closed kinetic chain and open kinetic chain exercises were similar. However, closed kinetic chain exercises appear to attenuate the strain increase that occurs in open kinetic chain exercises when increasing resistance.Conclusion:These data may be relevant to develop rehabilitation exercises or programs that do not endanger the healing ACL graft and to provide a basis for future clinical trials.

Supplemental digital content is available in the text., Objective The objective of this study was to evaluate the clinical efficacy of mudpack therapy for the treatment of knee osteoarthritis and identify the likely factors associated with the high heterogeneity of combined studies. Design The Medline, Embase, and Cochrane Library databases were systematically searched for randomized controlled trials in which mudpack therapy was used to treat knee osteoarthritis. Results Ten publications that reported the results from a total of 1010 subjects were included in this meta-analysis. Meta-analysis of improvement in joint function at the final follow-up visit suggested, given that the follow-up time was less than 4 mos, that the combined effect size of four studies was −0.30 (−0.62 to 0.02) and the difference did not reach the level of statistical significance. When the follow-up time reached 4 mos, the combined effect size was −1.10 (−2.07 to −0.14) and the difference was significant. The I2 values of the two groups were 21.4% and 93.8%. Conclusion Functional improvement of the knee joint in patients treated with mudpack therapy was not significantly different from that of control subjects at the end of the 4-mo follow-up. The quality of current publications was a factor causing heterogeneity.

Background and Aims: Adductor canal block (ACB), though an effective procedure for postoperative analgesia in total knee arthroplasty (TKA), does not provide analgesia to the posterior articular aspect of the knee joint. Infiltration between the popliteal artery and the capsule of the knee (IPACK block) and sensory posterior articular nerves of the knee (SPANK block) are two single injection techniques that have been shown to provide effective analgesia in posterior knee pain. This study aims to compare the effect of IPACK block and SPANK block when combined with ACB for analgesia and postoperative rehabilitation in TKA. Methods: A total of 82 patients were randomised into two groups: (1) ACB combined with IPACK, (2) ACB combined with SPANK block. The primary outcome was the pain scores from 6 h to 48 h after surgery and the duration of postoperative analgesia. The secondary outcome measures were 24 h opioid consumption, ambulation parameters like mobilisation ability, quadriceps muscle strength and patient satisfaction score at discharge. Results: Numerical rating scale (NRS) scores at rest and on movement, duration of analgesia, total opioid consumption, and patient satisfaction were significantly better (P < 0.05%) in the IPACK group than in the SPANK block. There were no significant differences in the knee rehabilitation parameters between the blocks. Conclusion: ACB with IPACK block offers better analgesia, less opioid consumption and better patient satisfaction with comparable knee rehabilitation parameters in the immediate postoperative period after TKA compared to ACB with SPANK block.

This article analyzes different trajectories that different patients take when performing knee rehabilitation movements, which are flexion-extension movements in the supine position, analyzing the trajectory taking the patient’s ankle as a reference point, aiming to design a mechanism that can offer a solution to the following more than one trajectory issue, which will allow it to be used for more than one movement, in more than one patient.

Study aim: There are currently limited methods available to access dynamic knee range of motion (ROM) during free-living activities. This type of method would be valuable for monitoring and progressing knee rehabilitation. Therefore, the aim of this study was to evaluate the functioning of stretch sensors for the measurement of knee ROM and to assess the level of the measurement error. Material and methods: Nine healthy participants were included in the study. Three stretch sensors (StretchSense™, Auckland, NZ) were attached on the participants’ right knees by Kinesiotape®. A Cybex dynamometer was used to standardise movement speed of the knee joint. Data was recorded through the StretchSense™ BLE application. Knee angles were obtained from the video clips recorded during the testing and were analysed by MaxTraq® 2D motion analysis software. The knee angles were then synchronised with the sensor capacitance through R programme. Results: Seven out of the nine participants presented with high coefficient of determination (R2) (>0.98) and low root mean square error (RMSE) (5°). The equations generated from these 7 participants’ data were used individually to predict knee angles. Conclusions: The stretch sensors can be used to measure knee ROM in healthy adults during a passive, non-weight-bearing movement with a clinically acceptable level of error. Further research is needed to establish the validity and reliability of the methodology under different conditions before considered within a clinical setting.

Rehabilitation following knee injury or surgery is critical for recovery of function and independence. However, patient non-adherence remains a significant barrier to success. Remote rehabilitation using mobile health (mHealth) technologies have potential for improving adherence to and execution of home exercise. We developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). However, in order to translate interACTION into the clinical setting, it was first necessary to verify the efficacy of measuring knee motion during rehabilitation exercises for physical therapy and determine if visual feedback significantly improves the participant&rsquo, s ability to perform the exercises correctly. Therefore, the aim of this study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data. A convenience sample of ten healthy control participants were recruited for an IRB-approved protocol. Using the interACTION application in a controlled laboratory environment, participants performed ten repetitions of three knee rehabilitation exercises: heel slides, short arc quadriceps contractions, and sit-to-stand. The heel slide exercise was completed without feedback from the mobile application, then all exercises were performed with visual feedback. Exercises were recorded simultaneously by the IMU motion tracking sensors and a video-based motion tracking system. Validation showed moderate to good agreement between the two systems for all exercises and accuracy was within three degrees. Based on custom usability survey results, interACTION was well received. Overall, this study demonstrated the potential of interACTION to measure range of motion during rehabilitation exercises for physical therapy and visual feedback significantly improved the participant&rsquo, s ability to perform the exercises correctly.

This research aims to design and implement an assist-as-needed controller and patient recovery tracking system into a novel task based knee rehabilitation exoskeleton device. The level of support from the exoskeleton is measured through the force sensing resistors (FSR) placed in the interface of lower- leg and the exoskeleton. The signal from the FSR is used as a feedback to control the actuator torque. The intent of the user to start, stop, move left, and right are associated with muscle activities, surface electromyography (sEMG) signals in the upper-leg. The preliminary results have shown that the system has provided the user a visual display of the amount of recovery and history while providing full autonomy to control the exoskeleton device. The successful implementation of these features can eliminate the need of constant supervision, and hence saves time and reduces cost of the rehabilitation process; which can also be used in a home-based or telerehabilitation settings.

Knee injuries are common in people of all ages, due to physical activity and other reasons. In all cases, physical therapy is prescribed but it will depend on the type of injury suffered. Latest research in robotics has developed assistive devices to contribute to improving the patient’s quality of life. In this paper, we propose a five-bars-linkage knee rehabilitation device, which is reconfigurable according to the patient’s height. We present the kinematic modeling of the device to show that it can reproduce certain exercises or routines prescribed at physiotherapy during the knee rehabilitation according to a processor developed. For this, we show the corresponding workspace and the required mechanical configuration of the five-bars-linkage system. To validate the functionality of the processor and of the mechanism, we implement a real case routine performed by a healthy subject. We use the hip and knee angular positions to process them and show the feasibility of the system, obtaining and comparing the corresponding workspaces.

Background: Knee joint is a common site for injury among younger people, the purpose of this study is to measure the skeletal muscle endurance and strength on people with prior knee reconstruction surgery. Methods: Young healthy female subjects were tested who reported having knee reconstruction surgery of over one year prior to testing. The skeletal muscle endurance index of the hamstring and quadriceps muscles was determined as the decline in the specific muscle acceleration in response to 2, 4, and 6 Hz electrical stimulation. Maximal isometric muscle strength (MVC) was measured in the hamstring and quadriceps muscles. Results: The hamstring muscles in the affected leg had less endurance than the non-affected leg at 6 Hz stimulation (55.5 ± 13.2% versus 78.0 ± 13.3%, P = 0.01). Muscle endurance was not reduced in the quadriceps muscles in the affected leg compared to the non-affected leg at 6 Hz stimulation (78.0 ± 13.3% versus 80.3 ± 10.0%, P = 0.69). There were no differences in MVC between the affected and non-affected legs for either the hamstring (P= 0.20) or quadriceps muscles (p = 0.67). Conclusions: Muscle endurance is reduced in the hamstring muscles at least one-year post injury, while hamstring strength is not. Reduced hamstring muscle endurance could be a result of a lack of focus on muscle endurance during rehabilitation after injury and may contribute to re-injury in the particular muscle even in people who have recovered muscle strength.&nbsp

Knee injuries are frequent in people of all ages. In all cases, physical therapy is prescribed to recover strength, and range of motion. Robotic assistive devices are gaining the attention of the community and aim to improve the patients’ quality of life. In this paper, we propose a 5-bars-linkage knee rehabilitation device. We are interested in obtaining the complete dynamic model of the proposed rehabilitation system, in order to develop and evaluate adequate control strategies in future work. With this purpose, we present the kinematics formulation of the device and then, we derive the dynamics using two approaches, in order to validate the model; i.e. we obtain the motion equation using Lagrange approach and an algebraic method which simplifies the modeling. These models are simulated and compared with the physical behavior of the system, showing the functionality of the system and the validity of the models when performing a rehabilitation routine.

[EN] Rehabilitation robots are increasingly being developed in order to be used by injured people to perform exercise and training. As these exercises do not need wide range movements, some parallel robots with lower mobility architecture can be an ideal solution for this purpose. This paper presents the design of a new four degree-of-freedom (DOF) parallel robot for knee rehabilitation. The required four DOFs are two translations in a vertical plane and two rotations, one of them around an axis perpendicular to the vertical plane and the other one with respect to a vector normal to the instantaneous orientation of the mobile platform. These four DOFs are reached by means of two RPRR limbs and two UPS limbs linked to an articulated mobile platform with an internal DOF. Kinematics of the new mechanism are solved and the direct Jacobian is calculated. A singularity analysis is carried out and the gained DOFs of the direct singularities are calculated. Some of the singularities can be avoided by selecting suitable values of the geometric parameters of the robot. Moreover, among the found singularities, one of them can be used in order to fold up the mechanism for its transportation. it is concluded that the proposed mechanism reaches the desired output movements in order to carry out rehabilitation maneuvers in a singularity-free portion of its workspace., This work was funded by the Plan Nacional de I + D, Comision Interministerial de Ciencia y Tecnologia (FEDER-CICYT) under the projects DPI2013-44227-R and DPI2017-84201-R.

In this paper is present a new type of a rehabilitation system for both knee and ankle that integrate two treatment types. The system allows a continuous passive motion consisting of two rotations of the leg segments, one of the knee articulation and one of the ankle joint, allowing the functional rehabilitation of the individuals that have an impairment of walking due to a disease or an accident. This is one novelty of the system because all the system that are on the market now consider to one articulation that can be knee or the ankle. In addition, the system allows the application of a mechanical vibration at the lower level of the leg, which have a beneficial action on the bones, muscle, and nerves, which is a well-known treatment.