This research examines the perceived age of Premier League basketball players as they near retirement, focusing on the complex interplay between players, fans, and the media in shaping perceptions of age and retirement. The study highlights the unique pressure on the basketball players to retire due to age-related expectations, rooted in the perception that athleticism is age dependent.The research methodology applied in this study involved conducting semi-structured interviews with a sample of 11 professional Israeli basketball players and two veteran players’ agents.Three themes emerged: (1) Feelings of betrayal and ingratitude; (2) A farewell tour toward disengagement from one’s professional career; and (3) The media’s role in shaping beliefs and attitudes. These themes illustrate how the sports environment portrays aging players, shaping fan opinions, both positively and negatively. Significantly, the findings emphasize the challenges that players must confront within an ageist environment.The study concludes by highlighting the cultural and social construction at work. The “coercion” to retire from professional sports is more pronounced here due to the common belief that sports success is time-bound and age-dependent, necessitating a “young body”. In this reality, the audience does not merely function as a backdrop for athletes’ performances, but has the power, at the collective and the individual level, to affect change on and off the court. The age of athletes plays a critical role in shaping not only how they are perceived by others but also in influencing their self-perception. This becomes increasingly evident as athletes approach retirement, their age becoming a central theme in both public discourse and professional discussions. One of the most pivotal aspects in this context is the dynamic relationship between fans and athletes. This relationship is heavily influenced by how fans perceive an athlete’s skills, expectations, and behaviors. As highlighted by Sports fandom is an exceptionally widespread, cross-national and cross-cultural phenomenon, considered unique in many respects, and has therefore captured extensive research attention in recent years. The fundamental presumption, which constitutes a solid foundation for research centered on sports fans’ behaviors and speech, is that sports function as authorization zones for fans , grantinMedia framing theory is considered one of the most well-known and influential theories in the study of media effects. The theory deals with the question of how the media mediates reality to the audience. The premise is that the media creates the nature of the discourse, and public opinion absorbs and internalizes it. Framing is defined as the way in which a media source defines, organizes, and structures the media information, so that the sequence of events covered receives broad context and meaning . FramingAccording to The genesis of Israeli sports and the affiliation of fans to their beloved clubs were initially rooted in deep political involvement . HoweverIt is common knowledge that a professional sports career is both contingent on and limited by one’s biological age, more so than in any other profession. While considerations of retirement in other professions are not necessarily considered to entail one’s body, retirement from professional sports is intuitively considered a “natural” process that occurs at relatively young ages.According to the stereotype embodiment theory, people internalize socially generated stereotypes about aging into their perceptions of their own aging which can lead to self-fulfilling prophecies that have a negative impact on their health . For athThe current study focuses on the specific social context of basketball players in Israel and explores the audiences’ role in professional basketball players’ retirement process.The study’s objective is to gain an understanding of how Premier League basketball players perceive age as they near retirement and to explore the role played by their fan base in this transitional process. Eleven professional Israeli-born basketball players participated in the current study and two veteran basketball players’ agents. Their mean age ranged from 30 to 40 years and playing experience ranged from 14 to 22 years. The first six interviewees were recruited by the first author, a former professional basketball player in Israel’s First (Premier) League, who was then referred to an additional five participants , Guy Pnini walked onto the court for the first time in that game. Guy is the former Maccabi Tel Aviv captain and one of the team’s most senior Israeli players in recent history. His participation in the game was not based on professional considerations but motivated by a desire to show him respect and give fans an opportunity to demonstrate their admiration and respect for him. Although the situation was obvious to all and is a well-known practice in the world of sports, it structures the specific social roles within the player-audience relationship. The audience is required to honor the player, but not for the performance, while the player understands that the audience’s adulation is granted for other periods of his career. The player senses that the final chord in their career is approaching, but, as the interviewees noted, the player typically believes that a summary of their career is premature.The two themes noted above are related to fan behavior toward older players. A question arises, however, regarding the process through which fans develop their attitudes toward the players. When do fans develop a belief that the retirement of an older player is approaching? Although this may be inferred from the length of a player’s time in the game  or a decline in the player’s performance (based on subjective and quantifiable measures), the findings of the current study confirm that the media play a decisive role in shaping fans’ options, in line with findings of previous studies e.g., . As artiOne example of how the media use stereotypes to construct a player’s profile, and to a large extent also the character of a team, occurred during a season hiatus, when the daily newspaper Ha’aretz published an article about Maccabi Ashdod, a team with two senior players over the age of 30, under the headline “Let the Veterans Play Before Us” . The headline is a paraphrase of the well-known biblical phrase, “Let the young men arise and play before us,” which expresses a disparaging attitude toward inexperienced people who try to engage in practices in which they are unskilled. Attributing the image of incompetency to the team’s older players implies that they are no longer able to perform in the tough league due to their age, and are no longer able to move, shoot baskets, or perform other roles that require dexterity, concentration, and physical contact, because their bodies are no longer young or agile. According to this article, “The team needs a mix of young people and responsible adults. Ashdod would be wise to put some new blood next to the older ones.” In the eyes of the media, if the team wishes to be successful it should sign young players, this would help the older players maintain their relevance and contribute added value to the team, and they would become the “responsible adults.” Another example that reproduces the “old player stereotype” is the question posed in the secondary headline: “Can a reduced ego and extensive experience compensate for a weakening body?.” In this manner, the media structure players’ retirement around stereotypes related to age and physical decline, which are framed as the sole cause of retirement from basketball .The interviewees in the current study describe a similar picture regarding the media’s role as a consciousness-shaping mechanism. All interviewees acknowledge the media’s power, their practices, and their use of rhetoric, and mentioned specific cases in which the media criticized them, specifically referencing their age. Yossi, an experienced agent explained:I talked to a player, and he says, “Tell me, how can that son of a bitch [from the media] say that I’m done? Come on, I still do 12 min in a game, did not you see how I guarded him?... It’s enough for two people from the media to say it for everyone to follow them… it has an effect on [other] teams’ views..” All day they think: “Enough, he’s at the end of his game. He cannot move his feet, enough, stop, stop, stop...so then you are considered a player who’s over the hill, and your financial offers will be accordingly..”Shlomi offered a similar description:The media…every time they broadcast a game, they talk about your performances, “He’s an old man, he’s old, he is not what he used to be….” Look, it’s natural that they try to push the young ones and look for the next stars… the next big thing… but somehow in that period, which is quality time for players… and they are at the peak of their performance mentally, and also physically, I think, they are at a very high standard at 30–32. Their physical [condition] is ideal. You know, [at that age] you know your body best of anyone, you know how to take care of it, you know how to train, you know when to stop training, you are in the best place you can be.The interviewees expressed their frustration for having the label of “aging basketball player” attached to them. Labeling affects the way a player’s image is presented to media viewers and readers . A uni-dThe tendency to criticize active players is reversed when a player announces their retirement. In Dennis’ case, for example, when he announced his decision to become a coach, the media’s response was generous and kind, exalting his achievements. The media’s support for this announcement illustrates its position as a key player in creating a player’s public image. After the media satisfied its own needs, they were able to glorify Dennis’ past and build up his image, catapulting him toward a new, more “respectful” and age-appropriate career. The following quote is taken from one of the dozen articles related to Dennis’ extensively covered retirement announcement:One looks at [his] list of achievements and it is obvious to us all that he is a star. Perhaps the only one who enjoys a consensus of love, including from his colleagues…his sacrifice, fighting spirit, winner mentality, talent, love of the game, and above all, enormous modesty. That’s the formula that the man we know as Dennis is made of .After a player retires, criticism and the focus on their aging body and advanced age transform into a slew of superlatives, support, and positive media coverage. From an oddity, the player suddenly becomes a star with heroic traits. Nonetheless, Dennis was relegated to public memory, he was “buried” in a glorified manner, is spoken of in the past tense, and the commemoration of his accomplishments became the material for what Hall and Gieben call “memory work” to build the self and its memory. These are the raw materials used in the construction of the player’s self-image. Through a retrospective review of the player’s achievements, the media establishes a new “self” for the player, one that is consistent with the social order, and these ultimately affect the self-image of the retiring player.Self-image is a set of beliefs and opinions about oneself, one’s values, competencies, and social status. It is one of the main factors that affects a person’s behavior. Self-image is dynamic, and is affected by changes in a person’s physical, mental, social, and cognitive condition. Researchers’ attention to elite athletes’ retirement has typically focused on the athletes themselves and the process they experience on their path to retirement. Studies have also examined the professional, emotional, financial, and other challenges that athletes encounter in adapting to their new situation. The current study focuses on the fans’ role and their contribution to the retirement decision. Sports fans are considered a significant factor in modern sports, and this is certainly the case in popular fields of sport where their impact on the sport in general, and specifically on the players, is dramatic.This study offers a new perspective on the audience’s role in shaping athletes’ retirement trajectories. Findings point to three main themes: the media’s influence on public opinion and public discourse; the audience’s effect on athletes; and the athletes’ self-image development process through the compliments and taunts directed at them. These themes shed light on a process that has thus far gained limited attention in academic and professional literature. Research on fans’ behaviors and impact are typically examined at the team level, with respect to the team’s accomplishments. The novelty of the current research is its analysis of the audience’s effect on athletes’ attitudes and beliefs and how these shape retirement-related decisions. The findings of the current study indicate that the audience does not merely function as a backdrop for athletes’ performances, but has the power, at the collective and the individual level, to affect change on and off the court. Significantly, the findings emphasize the challenges that players must confront within an ageist environment. In this context, it becomes evident that the aging process of professional basketball players is, to a great extent, influenced by social constructs.The current study offers a preliminary focused examination of the phenomenon under investigation. Participants are all elite basketball players with a history in Israel’s premier league. It is therefore important to examine the effect of the audience’s conduct on the retirement of players in other fields. Due to cultural and social differences related to the audience’s size and conduct, future studies on additional fields or sport and levels of competition can help shed light on the differences and similarities of these cases. Furthermore, attention should also be directed to gender and cultural factors and to how the social and cultural environment in which athletes and the audience function affect the dynamics of their interrelationship.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The study was conducted in accordance with all ethical standards set by Haifa University, Israel, and received approval from the Ethical Committee for Research Studies in Master’s Degree programs. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.AL: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Writing – original draft, Writing – review & editing. OL: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing. IT: Conceptualization, Formal analysis, Writing – original draft, Writing – review & editing.


This case is a unique pediatric presentation of a surfer’s myelopathy, now referred to as acute hyperextension-induced myelopathy (AHIM), that provides an optimistic rehabilitation outcome. A 13-year-old boy presented to the emergency department with back pain, paraplegia, urinary retention, and dysesthesia following his first surfing lesson while visiting Hawaii. MRI of the thoracic spine without contrast showed a significant T2 hyperintense signal in the T9-T12 distal thoracic cord, consistent with AHIM. He completed a 10-day inpatient rehabilitation program and experienced exceptional improvement in functional mobility. AHIM is a rare phenomenon that is triggered by repetitive spinal hyperextension. While there are studies describing this clinical syndrome in detail, the literature lacks information about rehabilitation outcomes for these patients. Following the diagnosis and acute management of AHIM, a comprehensive inpatient rehabilitation program is recommended to maximize functional improvement. This report presents the case of a young boy who was diagnosed with surfer’s myelopathy after his first surfing lesson. Surfer’s myelopathy, more recently described as acute hyperextension-induced myelopathy (AHIM), is a rare phenomenon triggered by repetitive spinal hyperextension -3. The tThe child described is a Chinese-American boy with a medical history of hypothyroidism. At baseline, he was athletic, played multiple sports, and had normal development . During his first surfing lesson, he developed lower back pain after approximately 30 minutes. One hour after completing the lesson, the child’s pain became severe, and he developed lower extremity weakness and dysesthesia. He did not recall any particular traumatic event during or preceding the lesson. In the emergency room two hours later, he exhibited substantial lower extremity paresis with only minimal bilateral hip flexion . He presented with severe lower back pain, described as “tingling” with radiation to both lower extremities, along with significant urinary retention requiring a Foley catheter. Patellar reflexes were absent, but Achilles reflexes were preserved. A Babinski test revealed bilateral upgoing toes. The sensation was preserved at the T10 level but was impaired in the bilateral lower extremities. MRI of the thoracic spine without contrast showed a significant T2 hyperintense signal in the T9-T12 distal thoracic cord  was not completed, but his documented physical exam upon presentation was most consistent with T10 AIS B. He was administered six milligrams of intravenous dexamethasone and transported to the pediatric intensive care unit. Although there is a lack of a clear guideline-directed protocol, the patient was treated with blood pressure augmentation. To maintain a mean arterial pressure goal of 70-85 mmHg, he received intravenous dopamine and phenylephrine for three days for induced hypertension. He showed clinical improvement over the subsequent days, including notable improvement in hip flexion to at least anti-gravity, the return of normal thigh sensation, and intact patellar reflexes. For pain management, he initially required morphine but eventually transitioned to acetaminophen only. Polyethylene glycol was also initiated due to concern for the neurogenic bowel. The child was stabilized, taught self-catheterization, and took commercial travel home for rehabilitation.Upon admission to inpatient rehabilitation, the child exhibited poor eccentric control and ambulatory dysfunction. Using the Functional Independence Measures scale from complete independence to total assistance, the patient's function was subjectively graded by trained rehabilitation therapists throughout his stay. He initially required moderate assistance to perform transfers, including sit-to-stand, stand-to-sit, and stand pivot transfers. He could walk 56.7 feet with minimal assistance using a rolling walker for upper-extremity support and required maximal assistance for toileting. He completed a 10-day inpatient rehabilitation program and experienced exceptional improvement in functional mobility. Physical therapy focused primarily on lower extremity strengthening exercises, stretching, gait training, stair climbing, and aquatic therapy. Occupational therapy specifically focuses on standing balance, coordination exercises, household transfers, and improving independence for activities of daily living. Upon discharge, he had progressed to ambulating 1000 feet with contact guard assistance and supervision with a gait belt and had transferred independently. All activities of daily living were performed at a modified, independent level. Urinary retention improved with the use of a timed voiding schedule. Ten months after the initial injury, the patient had completed outpatient therapy for multiple sessions weekly and returned to participation in sports.Data pertaining to long-term rehabilitation outcomes after AHIM are limited. In a 2022 retrospective systematic review of 104 patients with suspected AHIM, Alva-Diaz et al. proposed diagnostic criteria . Chang eIn 2013, Takakura et al. reported the disastrous consequences of three surfers who developed complete paraplegia from AHIM . DespiteAoki et al. (2013) studied the long-term rehabilitation course of a 26-year-old male diagnosed with AHIM classified as T12 AIS A given complete paraplegia [Given the rarity of AHIM and emerging research on this condition, there is limited data regarding rehabilitation outcomes. Though this study pertains to only one subject, this pediatric case of incomplete spinal cord injury provides an optimistic result and emphasizes the importance of early rehabilitation. Following the diagnosis and acute management of AHIM, a comprehensive inpatient rehabilitation program is recommended to maximize functional improvement. In the future, research studying larger cohorts is required for improved understanding regarding prognosis and rehabilitation outcomes in patients with this condition.


UK hospices often provide outpatient rehabilitation services for people with advanced progressive illness. However, some people are unable to travel, leading to inequity in rehabilitation access.The Living Well at Home Team (LWAHT) at St Christopher's Hospice aimed to evaluate whether using volunteers to support rehabilitation in peoples’ homes improved the reach of rehabilitation for people living in underserved localities and if it supported people to optimise their functional independence.This service improvement project evaluated hospice rehabilitation uptake during the implementation of volunteer-supported community rehabilitation. Following assessment by an LWAHT therapist, eligible people were matched with a trained volunteer who supported four to eight rehabilitation sessions in the person's home. The evaluation assessed uptake of the rehabilitation sessions. Mobility, wellbeing, and goal attainment outcomes were assessed by the Life-Space Assessment (LSA), General Health Questionnaire (GHQ), and Goal Attainment Scale (GAS), respectively.In the first year, 183 patients were referred to the LWAHT; 123 were assessed and 96 received rehabilitation including 56 who were matched with a volunteer. Following volunteer support, patients reported significant improvements in mobility [LSA median 20 ], general health [GHQ −2 (−5.25 to 0)], and achievement of goals [GAS T-score +8 (0–18.4)].It was feasible to support community rehabilitation using hospice volunteers for people with advanced progressive illness. The LWAHT service also increased the uptake of hospice centre-based rehabilitation. Further work should test efficacy and identify patients requiring additional professional input.This is the first known study reporting on the use of trained rehabilitation volunteers to extend the reach of hospice rehabilitation services. People with limited access to the hospice, because of geographical location or personal circumstances, valued and benefited from tailored rehabilitation supported by the volunteers in their own homes. People with advanced progressive conditions often prioritise functional independence and maintaining usual roles and routines for as long as possible –4. A higSt Christopher's Hospice, a charitable trust in southeast London, provides specialist palliative care and support to over 5,000 adults each year. People referred to the hospice have access to rehabilitation and wellbeing services, including gym classes  and funcExpanding services to a larger cohort of people living in the community would increase reach and access to rehabilitation, but requires additional staffing resource. There is early evidence that volunteers can support rehabilitation delivered in the home setting . VolunteThis service development project aimed to expand the provision of rehabilitation to people not able to access hospice outpatient services. It modelled a rehabilitative palliative approach using innovative roles for volunteers, to reach people in their home environment who would otherwise be unable to access rehabilitation. This provides the rationale for the working practices, service evaluation processes, and outcomes data.We followed The Model for Service Improvement . FollowiThe LWAHT aimed to optimise function and wellbeing by providing a practical rehabilitation service in the homes for people unable to access the hospice buildings. The objectives were to enable patients and carers to achieve personal goals, self-manage symptoms using non-pharmacological strategies, and remain as independent as possible within the limitations of illness.The LWAHT consisted of a Team Lead , 0.4 full-time equivalent (FTE), and a Senior Rehabilitation Assistant Practitioner (Band 4-trained support worker), 0.8 FTE. Hospice volunteer and finance services supported recruitment, training of volunteers, and reimbursement of travel expenses. Volunteers were recruited from the existing cohort of patient-facing volunteers and had completed a comprehensive patient-facing training programme. This included scope of role and responsibilities, confidentiality, infection control, and skills for communicating with patients and family members. Additional training specific to the LWAHT programme included training in the rehabilitation intervention components, including supporting and progressing exercises, strategies to support mobility and functioning in activities of daily living, use of walking aids, and non-pharmacological symptom self-management strategies for breathlessness and pain. Training ensured volunteers could conduct a basic risk assessment at the start of each session see . This waPatients under the current care of St Christopher's could be referred to the LWAHT. Members of the multi-disciplinary team (MDT) were encouraged to refer people, through the existing Electronic Patient Record system, if they had a rehabilitation goal and were unable to attend outpatient services. Each referral was reviewed and, if accepted, the physiotherapist contacted patients via telephone to assess their understanding of the service, functional goals, and home environment and potential risks.For suitable patients, a home visit was arranged during which an LWAHT physiotherapist completed a comprehensive assessment and devised a collaborative rehabilitation plan based on agreed goals (including relatives and/or carers when the patient desired). As indicated, the physiotherapist addressed immediate concerns and short-term goals during the first visit, referred to another rehabilitation service, and/or advised matching with a volunteer.The LWAHT rehabilitation assistant matched patients with a volunteer, considering availability and ease of travel. Once matched, a joint home visit with the volunteer and a member of the LWAHT was arranged to discuss the patient's goal(s) and rehabilitation plan. Components of the plan to be supported during volunteer visits, including any exercises, techniques, or advice, were practised and clarified.The programme typically involved four to eight visits on a weekly basis, with flexibility regarding visit frequency and intervals, to accommodate patient needs and preferences . AppointThe volunteer worked with the patient to complete the rehabilitation programme, monitoring the patient throughout. If concerns arose, they were advised to stop the session and to contact the LWAHT physiotherapist, following the lone working policy.Following completion of the agreed number of visits, or sooner if the goal was achieved early, the volunteer and physiotherapist visited the patient together to review outcomes.Routine hospice data were collected according to usual hospice practice, including Phase of Illness , Australt-test or Wilcoxon signed-rank test as appropriate. P-values <0.05 were deemed statistically significant.Participant baseline clinical and demographic characteristics were summarised using descriptive statistics. Paired data for the LSA, GHQ, and GAS were analysed using Student’s Over 1 year from January 2017, 1,189 referrals were made to the rehabilitation services. Of these, 183 (16%) people were referred to the LWAHT service . Most peOf the 183 people preferred to the LWAHT programme, four (2%) were redirected for outpatient rehabilitation at the hospice site, nine (5%) declined rehabilitation services, and 47 (26%) deteriorated or died prior to the physiotherapist assessment.Of the 123 who were assessed, 56 (45%) were matched with a volunteer and 35 completed the LWAHT programme in full. Deterioration in condition prevented 16 people from completing the programme and five did not complete as they declined further input.Sixty-one patients did not require matching with a volunteer. Five (4%) were redirected to outpatient rehabilitation services, 25 (20%) achieved their goals within one to two visits with the LWAHT physiotherapist and/or rehabilitation assistant, and 13 (10%) did not need matching with a volunteer following provision of equipment to support mobility and/or activities of daily living. A further 18 patients received one to two sessions of rehabilitation with the LWAHT but deteriorated or died before being matched with a volunteer.Following referral to the LWAHT, patients accessing rehabilitation identified goals corresponding with second-level domains of the WHO-International Classification of Function Disability and Health (WHO-ICF) . Goals pW = 16, p < 0.02), median decrease of −2  in GHQ , and increases in GAS T-score with a median increase of 8.2  . Group and individual data are shown in Thirty-five patients completed the LWAHT programme. Paired LSA, GHQ, and GAS were obtained for 19, 20, and 32 patients, respectively. Significant improvements were seen with a median increase of 20  in the LSA (n = 18) reported that the LWAHT therapist and volunteer gave good explanations and that they understood what was important to them. All respondents strongly agreed that they “had confidence in [their] physiotherapist and/or volunteer” and 16/18 “would strongly recommend the service to others” and “would choose to participate in the LWAHT programme again.” Most patients felt that they could say the things that were important to them to the LWAHT staff; however, 2/18 selected “yes, but not as much as I wanted.”Patients matched with a volunteer who provided feedback (People with reduced functional capacity and geographical and transport barriers had limited access to rehabilitation provided by St Christopher's Hospice, London. A service development project was planned, delivered, and evaluated to improve access to rehabilitation for people living in underserved localities. A volunteer-led rehabilitation outreach programme was designed for people with advanced progressive illness, to be delivered in their own homes and communities. The findings demonstrate that people not previously known to the hospice had increased access to rehabilitation services following referral to the LWAHT programme. While some people's needs were met with one or two contacts with LWAHT clinicians or referral to existing rehabilitation services, just under one-third of those referred were matched with a volunteer, and of these, more than half completed the programme. People who completed the programme showed an improvement in mobility, wellbeing, and made progress towards achieving their goals as measured by LSA, GHQ-12, and GAS, respectively. Feedback from patients was excellent and all recommended the programme to others.This study is novel for two reasons. First, it is the first known study to report on the use of hospice volunteers to support home rehabilitation to patients receiving care from a hospice. Second, this study demonstrates the efficacy of extending rehabilitation services into the home for people with advanced progressive disease unable to access outpatient rehabilitation services.In England, two-thirds of hospices are managed in the voluntary sector. Hospices receive between 20% and 50% of total income from statutory funding, relying on charitable donations to cover the remaining costs . VoluntePeople enrolled on the LWAHT programme were unable to access hospice outpatient rehabilitation services due to practical, emotional, or financial reasons, and most were housebound. Community rehabilitation provided by local services has long waiting times, which are incompatible with having an advanced progressive illness. The LWAHT programme provides a model for the provision of rehabilitation for housebound people living in the community, without significant extra cost. In addition, this approach is in line with peoples’ preference for home-based rehabilitation and exercise programmes –29.When evaluating feasibility, consideration of clinical service flow is paramount. This study reports that of 183 people referred to the service, around two-third were assessed. Of these, just under half were accepted onto the LWAHT programme and matched with a volunteer. However, this number does not fully capture the cohort of patients who benefited from the LWAHT service. A proportion of people who were not matched had their goals achieved within one or two visits, or had equipment delivered to them before they deteriorated or died. Therefore, around three-quarters of people who were assessed received rehabilitation. Unlike exercise interventions such as pulmonary rehabilitation for COPD, where completion of the full 8 weeks has strong evidence as a meaningful marker of benefit derived , the LWAThe service development and evaluation demonstrate that the LWAHT extended the reach of the hospice rehabilitation services. Tailored rehabilitation is now provided to patients where geographical location or personal circumstances limited access to existing rehabilitation at the hospice.Lessons were learned from this service development and evaluation project. Collecting outcomes data in addition to routinely collected assessment data was challenging. LSA, GHQ, and GAS were incomplete for some patients who completed the LWAHT programme. The novel use of volunteers rather than qualified clinicians raises questions regarding the quality of the rehabilitation delivered. The results from this study suggest that volunteers under close supervision of clinicians can support effective rehabilitation to this cohort of patients. Given the complexity of patient care and outcomes, regular communication to create an in-depth understanding between clinicians and volunteers is paramount. Further research and evaluation should be conducted to help determine which rehabilitation tasks can be delivered by volunteers and which patients may require rehabilitation from paid healthcare professionals to achieve benefit.The service was planned and evaluated prior to the COVID-19 pandemic and was sustained after the evaluation with ongoing involvement of 18 volunteers. The COVID-19 pandemic impacted the delivery of rehabilitation in palliative care setting  and the In conclusion, this study demonstrates the feasibility and efficacy of using volunteers to support community rehabilitation to patients with advanced progressive illness who were unable to access hospice outpatient services. The LWAHT adds value as part of a broader rehabilitation offering. Following initial assessment and during ongoing access to support, people can choose to receive care from the hospice rehabilitation service that best suits their needs and preferences.Further research investigating volunteer-delivered home-based rehabilitation in patients with advanced progressive illness is required, specifically validating the efficacy of volunteers and identifying the limitations of using volunteers compared to paid professionals in certain groups of patients.


Biomolecular interaction assays revealed ASR-600 binds to the N-terminal domain of AR, which was further confirmed by immunoblot and subcellular localization studies. Molecular studies suggested that ASR-600 promotes the ubiquitination of AR and AR-V7 resulting in the inhibition of AR signaling. Microsomal and plasma stability studies suggest that ASR-600 is stable, and its oral administration inhibits tumor growth in CRPC xenografted castrated and non-castrated mice. In conclusion, our data suggest that ASR-600 enhances AR ubiquitination in both AR+ and AR-V7 CRPC cells and inhibits their growth in vitro and in vivo models.We investigated the efficacy of a small molecule ASR-600, an analog of Urolithin A (Uro A), on blocking androgen receptor (AR) and its splice variant AR-variant 7 (AR-V7) signaling in castration-resistant prostate cancer (CRPC). ASR-600 effectively suppressed the growth of AR Androgen receptor (AR) signaling plays a key role in prostate cancer (CaP) pathogenesis . AndrogeThe truncated AR protein encoded by AR splice variants (AR-Vs) lacks the LBD domain while retaining the transactivating NTD domain. This results in ligand-independent activation and resistance to ADTs . The AR Recently, more attention was paid to post-translational regulation of AR activation, either by ubiquitination or lysosome degradation. Currently, three ubiquitination sites have been identified: K845 and K847 at the ligand-binding C-terminal  and anot+ CRPC growth in both in vitro and in vivo models compared to AR− CRPC growth , a dietary gut microbiota-derived metabolite of ellagic acid, has been shown to exert anti-cancer effects on many cancer types . InteresC growth . UroA wa+ CaP and enzalutamide resistant cells in both in vitro and in vivo models.We synthesized several O-methylated amino acids (tryptophan) and sulfonamide-/sulfoxide-conjugated analogs of UroA and tested their therapeutic effect on CRPC cell lines. Through structure-activity relationship (SAR) studies, we identified ASR-600 , normal prostate epithelial (RWPE-1), and HEK-293T cell lines were purchased from the American Type Culture Collection . C4-2B cells were obtained from ViroMed Laboratories . The cells were grown on a specified medium, as described previously . Dihydro1H NMR, Bruker Avance 500 MHz)) and mass spectrometry  and its purity (≥98%) was determined by high-performance liquid chromatography (HPLC). 1H NMR , 1.40 , 3.17–3.29 , 4.45–4.49 , 6.77–6.85 , 6.85–6.87 , 7.01 , 7.10 , 7.37–7.41 , 7.57–7.61 , 7.75–7.76 , 8.15 , 8.26 , 8.30 , 10.38 , 10.93 . MS m/z 457.92 [M+ (514.17) - t-butyl]. Melting point, 200°C–202°C.ASR-600 was synthesized from Urolithin A according to a synthetic strategy recently developed in our laboratory. Briefly, Urolithin A  was reacted with Nα-Boc-tryptophan  in the presence of coupling agents 1-ethyl-3-(3-dimethyl aminopropyl) carbodiimide hydrochloride , hydroxy benzotriazole , and triethylamine  in acetonitrile at room temperature to afford ASR-600 as the major product. The compound was purified by silica gel column chromatography to yield ASR-600 as an off-white solid and characterized by proton nuclear magnetic resonance (RWPE-1 and CaP cell lines were treated with vehicle control (DMSO) or different ASR-600 concentrations (200 nM–30 µM) for 24 h and then subjected to cell viability (MTT) assays as described before .ser473 (CST #4060), pmTORSer2481(CST #5536), mTOR (CST #2972), ERα (CST#8644), PR (CST#3176), Ubiquitin (CST#3933), and Lamin A. β-Actin was used as the loading control  of CaP cells were prepared following treatment for 24 h in a 6-well plate. Immunoblots were performed as described previously  for the 50 concentrations of ASR-600 and AR expression was assessed using immunoblots and IP.PC-3 and HEK-29 cells were seeded on 6-well plates in a respective medium supplemented with 10%FBS and were allowed to attach overnight. They were then transfected with either a control vector or AF-FL plasmid, using Lipofectamine-2000 reagent in Opti-MEM medium. After 24 h, these cells were treated with ASR-600 at different time points. Finally, the cells were lysed, protein was extracted, and AR expression was assessed using immunoblot and IP. Briefly, the transfected cells were treated with ICRNA was extracted from control and ASR600-treated cells using the RNAeasy Mini Kit . This was followed by reverse transcription using the iScript DNA Synthesis Kit . RT-PCR using SYBR Green PCR Master Mix  with specific AR and PSA primers as per the protocol described previously . β-actinImmunofluorescence analysis for AR and AR-V7 was performed on control, ASR-600, DHT or ASR-600 + DHT, MG132 or MG132+ASR-600 treated cells as described previously . ImmunohProteasomal activity of control and ASR-600 treated C4-2B cells was measured using a Proteasome activity assay kit (BioVision) per the manufacturer’s protocol. MG132 was used as the positive control.ab initio modeling to decipher its 3D structure. We submitted the FASTA sequence of NTD to the I-TASSER (Iterative Threading ASSEmbly Refinement) server  server , which u) server  for 6 × cs tools , and thecs tools .d6) in 500 µL of 20 mM phosphate buffer made up of 100% deuterium oxide. The NMR saturation transfer difference (STD) experiment was carried out with a standard pulse program from the Bruker pulse library. Two parallel experiments: the reference  and one with selective saturation on the AR protein  were executed. The peak intensity differences are shown by spectra C (green spectrum). The binding affinity was measured based on the peak intensity by the different spectra.The proton NMR experiment was carried out with Bruker Avance 600 MHz NEO NMR equipped with the TCI cyroprobe. The purified NTD protein (5 μM/L) was mixed with ASR-600 , purchased from the Jackson Laboratory , with either 22Rv1 or C4-2B cells. ASR-600 first dissolved in DMSO was diluted in PBS to make a 0.1% solution. Mice bearing 22Rv1 and C4-2B xenografts were then randomized into control (placebo) and treatment  groups. All mice were euthanized via CO2 asphyxiation after 4 weeks of treatment, and the xenograft tumors were removed and fixed in 10% formalin for histopathological studies. All experimental animals were approved by the University of Louisville’s ethical committee and maintained following Institutional Animal Care and Use Committee approved-protocols.The in vitro intrinsic clearance was calculated (detailed procedure was given in Pooled mouse liver microsomes were procured from BioIVT (USA). The ASR-600 metabolic stability was analyzed using previously established protocol . A detait-tests and one-way ANOVA analysis were performed for two-group and multiple group comparisons, respectively. p-values <0.05 were considered statistically significant and values were presented as either mean ± SD.All statistical analyses were performed using GraphPad Prism 8.0a software . Unpaired two-tailed Student’s O-methylated and amino acid- and sulfonamide-/sulfoxide-conjugated analogs were synthesized. SAR studies based on cytotoxicity towards CaP cells led to the identification of ASR-600  and normal prostate epithelial cells (RWPE1) was assessed by MTT assay. ASR-600 treatment inhibited the viability of C4-2B (IC50: 824 nM), LnCaP (811 nM), 22Rv1 (IC50: 919 nM) and VCaP (IC50: 923 nM) cells in a concentration-dependent manner at 24 h. Similarly, treatment with ASR-600 for 24 h also significantly inhibited the viability of enzalutamide resistant C4-2B cells (IC50: 815 nM). However, IC50 of AR-null CaP cell lines PC-3 (18 µM) and DU-145 (19.5 µM) are higher than AR-null CRPC cells. Interestingly, the RWPE1 cells remained unaffected (IC50: 37 µM) with ASR-600 treatment , was seen in a panel of CaP  cell lines after treatment with their respective IC50 concentrations of ASR-600 , and Progesterone receptor (PR) expressions in prostate and breast cancer cell lines. No significant changes in the expressions pAKTser243 were observed in the ASR-600 treated PC-3 cells . Similar45 cells . Moreove45 cells . As expe45 cells , which sab initio modeling to decipher the 3D structure of AR-NTD and used molecular docking studies to assess the binding affinity of ASR-600 to the NTD domain of AR. Visual inspection of the NTD-ASR-600 docked structures revealed compact binding between the ligand and NTD  and human hepatocytes, are the best models to predict a drug’s hepatic clearance  with a half-life (t½) of <1.4 min  (learance . At a co773 min) .in vitro t½  was also calculated based on the vitro t½  so the Catropine . The higin vivo using castrated and non-castrated CRPC xenograft mouse models. ASR-600 treatment was highly effective in reducing tumor volumes of both 22Rv1 and C4-2B xenograft models  was administered by oral gavage throughout the experiment period. ASR-600 significantly inhibited the growth of 22RV1 tumors and decreased the tumor weights of treated mice . IHC anavia ubiquitin-mediated pathway. NMR and ITC studies revealed that ASR-600 binds to the AR-NTD domain and enhances ubiquitin-mediated degradation of both AR-FL and AR-V7 without inhibiting proteasome activity.We show here that ASR-600, an analog of UroA, is more potent than its parent compound and that it specifically targets and causes AR-FL and AR-V7 degradation in CRPC and enzalutamide resistant CaP cells Upregulation or reactivation of AR signaling is a hallmark of CaP progression to CRPC , which r® drug that uses an E3 ligase to tag and degrades “clinically relevant mutated AR proteins”, has been introduced in a limited Phase-I dose escalation for patients with metastatic CRPC. Hence, as of now, enzalutamide, abiraterone, and apalutamide are the US FDA-approved agents for treating CRPC. Considering that CRPC is the leading cause of 30,000 CaP-related mortalities every year in the US  was terminated because it achieved a minor decline in serum PSA levels (a surrogate marker of disease progression) (4–29%), and only 3 out of 21 patients with metastatic CRPC . Anothern the US , there i50:35 µM) concentrations ]. Considering that the MTD of the oral dose of ASR-600 in mice was >500 mg/kg of body weight, it is safe to assume that oral dose can be increased without any concerns of ASR-600 being systemically toxic.Results assessing ASR-600 In conclusion, despite progress in this field, many second-generation anti-androgens have limited clinical success owing to their inability to block AR-V7 signaling in CRPC. Thus, to develop more efficient and target-specific treatments, a greater understanding of the regulatory mechanisms of AR-V7, its upstream and downstream effectors, and target genes is essential. Our findings highlight the importance of targeting AR-Vs, particularly AR-V7 in CRPC, and provides mechanistic insight into how UroA analog ASR-600 can target both AR-FL and AR-V7 in CRPC.


Our first goal is to understand the research status and popularity of telerehabilitation research for stroke survivors since 2012; the second goal is to analyze the research trends and frontiers in this field, and provide a scientific basis for the future application of telerehabilitation technology in patients with poststroke functional defects. We searched the Web of Science Core Collection (WoSCC) for literature on telerehabilitation for stroke survivors published from 2012 to 2022. The included articles were visually analyzed using CiteSpace6.1.6R (64-bit). In total, 968 eligible articles were included in this study. In the past 10 years, the number of papers published on telerehabilitation after stroke has been increasing annually, with the largest number of papers published in the United States and Australia, with 101 papers published by Chinese scholars. Some subsets of cooperative networks have been formed among major research institutions and their authors, but the scale remains small, and academic exchanges and cooperation need to be strengthened further. Research on virtual reality (VR) technology and rehabilitation robot technology is popular, and the choice of time and intensity of rehabilitation exercises, patients’ participation in rehabilitation exercises, and care are also worth attention. In the last 10 years, research on telerehabilitation technology in the field of rehabilitation for stroke survivors has steadily developed, and is characterized by multidisciplinary joint development. Countries around the world can combine their own characteristics and advantages, strengthen academic exchanges and cooperation with mature research institutions or authors, and explore suitable poststroke remote rehabilitation technologies and service models in different environments. In 2019, approximately 17.04 million people aged 40 and above had or once had experienced a stroke in China. In 2018, 1.94 million people died of stroke. Stroke has become the leading cause of death and disability among adults in China. The incidence of stroke may continue to increase due to the aging of the population. Approximately 75% of survivors have functional impairments in the domains of language, movement, and perception, putting great pressure on society and the family.,6 Considering factors such as economy, transportation distance, disease, and long-term care, many stroke patients return to the community or family to continue to recover in the acute phase until their illness is stable.,8 Continuous rehabilitation after stroke has been confirmed to effectively promote the recovery of motor function and the improvement of daily living ability in patients.,10 In China, the community health care service capacity is insufficient because of a lack of community rehabilitation resources and talent, and the rehabilitation needs of stroke survivors in home or community backgrounds cannot be met.According to the World Stroke Organization, the total number of chronic stroke survivors worldwide is estimated at 80 million, and over 13.5 million people experience stroke each year, approximately 40% of whom require recovery.–14 Telerehabilitation is commonly defined as the use of electronic information and communication technologies to provide and support health care when distance separates the participants, covering a range of healthcare services such as assessment, testing, intervention, supervision, education and counseling. There are different forms of telerehabilitation, which can be synchronous, asynchronous, or a combination of both. Synchronous telerehabilitation is a communication technology based on real-time data transmission in both directions, allowing the patient and therapist to be online simultaneously so that the therapist can provide real-time rehabilitation services to the patient. Asynchronous telerehabilitation is based on “storage” technology, where the therapist stores information in text or video form on a “server” and the patient performs self-exercise according to the instructions.,17 Functional recovery and improvement in stroke survivors is usually over a long time window, so individual rehabilitation needs, treatment goals and plans must be redefined periodically. The future of telerehabilitation faces both opportunities and obstacles and challenges. The clinician or physical therapist does not have face-to-face access to the patient, which can lead to a lack of quantitative and objective assessment of the patient. The trait of technology dependence may hinder the development of telerehabilitation to some extent. The accessibility of technology for elderly patients, low education level groups, and low income groups may affect their participation and motivation.,21 On the other hand, the COVID-19 pandemic has given a boost to telemedicine, which can be the complementary service of choice in the postCOVID-19 era. Policy assurance from the health sector is essential. Today, many countries have developed guidelines and information for conducting telemedicine, which is undoubtedly beneficial for telehealth care. In addition, although some therapists have suggested that data security, privacy, and confidentiality may also affect the spread of telehealth, 1 study confirmed the satisfaction and acceptance of telehealth among patients, who claimed that personal privacy was protected.In recent years, owing to the exploration of remote rehabilitation technology and the popularity of remote rehabilitation programs and models, remote rehabilitation with the help of computer technology, information and communication technology, mobile network technology, and rehabilitation therapy can overcome spatial barriers, expand the scope of rehabilitation resources, and enhance doctor-patient communication with stroke survivors in families, communities, and remote areas. It can also avoid transportation inconveniences for patients and provide professional rehabilitation guidance and advice.To gain a comprehensive understanding of the current status and hot spots of poststroke remote rehabilitation research in the past decade and to explore the frontiers of future development, this study visually analyzed the literature on stroke telerehabilitation in the Web of Science database through CiteSpace, hoping to provide a basis for subsequent in-depth research in this field in the future.Ethical approval is not required for this study because it is conducted based on secondary data.With the Web of Science Core Collection (WoSCC) Science Citation Index Expanded as the retrieval source, the following topics were searched: “stroke * OR apoplex * OR (cerebrovascular accident) OR (brain vascular accident) OR  OR  OR (subarachnoid hemorrhage)” AND topic: “telerehabilitation OR tele-rehabilitation OR (remote rehabilitation) OR (online rehabilitation) OR (web-based rehabilitation).” Articles published in English from January 1, 2012, to December 31, 2022, were retrieved. The literature types included original articles, review articles, early access, and book chapters, excluding meeting abstracts, editorial materials, proceedings papers, correspondences, corrections, and reprints. In total, 968 articles were included. Figure  Previous studies have proved that CiteSpace has become a relatively influential analysis software in the field of bibliometrics.–28 The WoSCC has been included in the literature selection record content as “Full record and cited reference” in plain text file format for export. The downloaded files were renamed as download 1. txt and download 2. txt. Running CiteSpace, importing text files, removing duplicates, and transcoding yielded 0 duplicate documents and 968 valid documents. The project (Project) was created, and the parameters were set. The time section (Time Slicing) was defined from 2012 to 2022, with every 1 year as 1 time slice; Node types included the following: Author, Country, Institution, Keyword, and Reference. These nodes yielded an author cooperative network knowledge map, a national cooperative network map, an institution cooperation network knowledge map, a keyword co-occurrence knowledge map, and a literature co-cited knowledge map. The selection criteria were defined as follows: top N = 50; pruning was conducted as follows: tracing was selected (Pathfinder), the section network was switched (Pruning sliced networks), and the merged network was pruned to obtain a clear prominent network map.Visual analysis software CiteSpace 6.1. R 6 (64-bit) was used as a research tool. CiteSpace, written in the Java language, draws a visual knowledge map based on the co-citation analysis theory and pathfinding network algorithm to present potential knowledge, rules, and distribution contained in the scientific literature. It helps researchers to explore the knowledge base, research hotspot and frontiers of a certain research field.The analysis of the basic information of the 968 included documents showed that the number of publications in the field of telerehabilitation after stroke has been increasing yearly in the past 10 years Fig. . The numJournal of Neuroengineering and Rehabilitation (36), accounting for 3.719% of papers; Disability and Rehabilitation (33), accounting for 3.409% of papers; Frontiers in Neurology (33), accounting for 3.409% of papers; Sensors (27), accounting for 2.789% of papers; and Archives of Physical Medicine and Rehabilitation (23), accounting for 2.376% of papers. Table The top 5 journals from 2012 to 2022 are the Related studies on the application of telerehabilitation technology in the rehabilitation treatment of patients after stroke are concentrated in Europe, the United States, and Oceania. In the past 10 years, the United States has published the most articles, totaling 259 articles; 118 articles were published in Australia and 111 articles were published in England. The top ten countries and regions in this field are the United States, Australia, England, China, Canada, Italy, Spain, Germany, the Netherlands, and Switzerland . Nmax is the total number of papers published by the most published authors in a particular research field. The CiteSpace analysis shows that Guidetti S and Gramer Steven C are the authors with the most publications (seven publications), and the formula calculated M ≈ 2.62. Therefore, the authors of the 3 published papers are the core authors. The top 5 authors in terms of the number of publications in the research areas discussed in this study are listed in Table We identified the core authors according to Price Law.Keywords include the condensation of core content in the literature. Analysis of the frequency of keywords in a research field helps researchers grasp research hotspots and directions in the research field. The node type was selected as the keyword to obtain a visual map of keyword co-occurrence. The co-occurrence analysis of key words in telerehabilitation after WoSCC from 2012 to 2022 found that, excluding search words and meanings similar to rehabilitation, stroke, recovery, telerehabilitation, stroke rehabilitation, people, and chronic stroke. The keyword with the highest frequency was virtual reality (VR) (142), followed by care 105)  of S = 0.5496, representing reasonable cluster results. A module value >0.3 is considered significant in the cluster structure, and the closer the S value is to 1, the higher the homogeneity of keywords within the cluster. A keyword clustering map is shown in Figure Burstness keywords are those detected by CiteSpace in a certain period of time, which can, to some extent, reflect the dynamics of a certain research field and the rise or decline of a certain research direction. In the keyword co-occurrence operation panel, burstness was selected, and years per slice was set to 1, obtaining the keyword burst map of stroke telerehabilitation from 2012 to 2022 Fig. . The horTwo (or more than 2) articles were cited by 1 or more later papers, indicating that the 2 documents were jointly cited in the relationship. Literature with a higher co-citation frequency during a given time period is considered to have an important influence within this research field during this time period. The co-cited knowledge map can also reveal closely connected literature and common themes in similar literature. Therefore, researchers can explore the development status and change in scientific structure with the help of co-citation knowledge graphs and conduct frontier analysis and scientific research evaluation of the research field of concern. The node type reference was selected to obtain information for the literature co-citation analysis Table . Tele-ReIn the past 10 years, research on telerehabilitation after stroke has developed rapidly. In WoSCC, the number of publications in 2018 more than doubled compared with that in 2012, showing a yearly increase, indicating that this research field has been widely studied by researchers and has good development prospects. Australia, the United States, Canada, the United Kingdom, and China are keen on research on telerehabilitation technology combined with rehabilitation of stroke patients. Most institutions with strong academic research ability in this field are from these countries. Research on these institutions is relatively mature and has a strong academic influence. In total, Chinese scholars have published 101 articles in the past 10 years, and a number of core authors and important literature in the field has prompted China to build a foundation for stroke telerehabilitation study. Some achievements have been made, and researchers should continue to strengthen study and exchange with advanced research groups and outstanding scholars abroad to enhance academic influence and promote further development of tele-rehabilitation technology in the field of stroke.The results of the visualization analysis indicate that research connections exist between countries, research institutions, and scholars and that some relatively concentrated collaborative networks have been formed; however, such connections are relatively limited. In general, European countries have the most intensive cooperation networks, and more frequent exchanges and cooperation. In Asia, China has published more articles, while Singapore and Pakistan are more central. A randomized longitudinal controlled trial, designed by Spanish, Swedish and French hospitals, evaluated whether a digital health-based rehabilitation game system intervention combined with traditional care is superior to traditional care alone for stroke patients in hospital and home recovery. This study is scheduled to be completed in July 2023, and the trial authors predicted improved recovery, higher acceptance and lower costs due to a soft landing from clinic to home rehabilitation. In addition, the trial results may identify new criteria for online and remote assessment, diagnosis, and intervention in European hospitals. Although many studies have tested the efficacy of telerehabilitation through RCTs, conclusions about the effect of this strategy are not easily drawn because interventions and compared subjects vary widely in these studies.,42 Blinding participants is difficult in these studies, which will affect the persuasiveness of the trial conclusions to some extent.,43 In randomized controlled studies in this field, researchers need to ensure quality control as much as possible, including inclusion and exclusion criteria, scientific randomization, control of bias, and scientific data statistics.,45 Palmcrantz et al introduced an interactive remote rehabilitation technology through a mixed research method and explored its advantages and disadvantages, proved the feasibility and safety of the technology, and provided guidance for further development and testing of interactive remote technology for home rehabilitation. RCTs can be predicted to remain an important research method in the field of stroke rehabilitation, and an increasing number of researchers will select mixed research methods in the future because of their advantages.According to keyword clustering and keyword burst analysis, RCTs had the strongest burst period from 2015 to 2018 and were a popular research method related to poststroke rehabilitation. In addition to RCTs, the research focus included outcome index measurements and trial design. Chen J single-blind RCT randomly assigned stroke survivors to a home remote-monitoring rehabilitation group or a routine rehabilitation group. The participants were evaluated at baseline, postintervention week 12, and follow-up week 24 using the Barthel index, Berg balance scale, modified Rankin scale, and caregiver strain index. The results showed that home-based remote monitoring rehabilitation is likely as effective as routine outpatient rehabilitation in improving the functional recovery of stroke survivors and can reduce the burden of caregivers.,47 The study of telerehabilitation has been closely integrated with electronic science, telecommunications and sports science. Therefore, research on VR technology and rehabilitation robot technology has become a hot topic in remote rehabilitation after stroke. Brain-computer interface technology, which detects motion images from the electroencephalogram, has been further developed in a project from Singapore. Chen J et al provided real-time video conferencing, education, consultation, neuromuscular electrical stimulation, electromyography parameter collection, and other remote rehabilitation services for stroke patients through a remote rehabilitation system integrated with electromyography-triggered neuromuscular stimulation. Maddahi et al introduced a portable remote rehabilitation mobile platform that includes a robotic health glove developed by the researchers, a cell phone application that employs wireless network technology, video transmission capabilities, supplemented by task-oriented exercise tasks. Spits et al linked a robotic assistive device (Arm Assist) to an Antari home care platform to help patients train in upper extremity function in the home environment. The therapist achieves the desired results with the help of the biomechanical data collected by the system and with remote communication and remote monitoring of the patient on the platform. Mura et al developed a cloud-based rehabilitation game system that combines VR, motion capture, and wearable devices to enable artificial intelligent rehabilitation. The system provides rehabilitation exercises in specific, goal-oriented, and task-specific forms of action. VR technology can provide individualized treatment for stroke survivors with highly repetitive task-specific movements, specific feedback, and carried out in a rich environment, which has improved patient satisfaction with rehabilitation to some extent. However, the current VR technology still needs to be improved, such as increasing the variety of games, enriching the picture level, enhancing the realism of training, and addressing the problem of monotony. Similar to VR technology, rehabilitation robots offer advantages over traditional rehabilitationco-. However, even multi-degree-of-freedom robots cannot currently move all joints. It is predictable that VR and rehabilitation robots will be an important part of the future of intelligent rehabilitation.Remote rehabilitation has advanced with the development of telemedicine. Mobile health and digital health technology are both emerging telemedicine service modes that combine rehabilitation medicine technology with computer technology, communication technology and mobile network technology. and researchers have noticed this characteristic. Future studies should implement measures to improve rehabilitation participation and exercise enthusiasm in remote intervention programs.The remote supervision, professional rehabilitation guidance and task training interest provided by the remote rehabilitation project can all help to cultivate the self-efficacy of patients after stroke, improve patients’ self-health management willingness, and increase the enthusiasm of patients to participate in rehabilitation exercise. Owing to bad mood, fatigue, pain, lack of health-related knowledge, and lack of supervision and motivation factors, stroke survivors have poor functional exercise compliance, Previous studies have shown that caregivers of stroke patients are generally anxious and depressed, and they should be given psychological counseling and more social support.,54 Due to the increasing focus on adverse events in telerehabilitation interventions, caregiver care capacity, patient safety risk identification, and the role of caregivers in telerehabilitation interventions should continue to be of interest in future studies.When telerehabilitation is conducted, therapists and patients provide guidance and advice to patients through online interactions, while caregivers indirectly participate in or directly assist patients in rehabilitation activities. The importance of caregivers in telerehabilitation interventions for stroke survivors has been noticed by investigators. The time and intensity of participation in telerehabilitation exercise after stroke is also related to patient safety and the effectiveness of rehabilitation intervention. Therefore, the time and intensity of exercise in remote interventions should follow the relevant guidelines and recommendations, but researchers need more high-quality, in-depth research. In short, VR and rehabilitation robots will be a valuable research direction in poststroke telerehabilitation. In addition to facing hardware, software, and ergonomic barriers, telerehabilitation techniques should improve the efficacy and safety of the intervention. Furthermore, cost-effectiveness should be included in the evaluation scope, which is the key to the feasibility of telerehabilitation techniques. Owing to the characteristics of remote rehabilitation and technology-driven development, developed countries, especially those that already have a good research foundation, are believed to be more likely to take the lead in making influential breakthroughs in research in this field.Studies have suggested that participants’ exercise adherence is lower if the prescribed sessions are too frequent (6–7 days/week) or last too long (12 weeks).,56 Finally, the practice patterns of tele-rehabilitation services after stroke are diverse.–60 In this case, unified guidelines or standards are needed to ensure and promote high-quality healthcare services. A scoping review found that most guidelines for tele-rehabilitation programs do not specifically address movement-related assessments and cannot effectively address the limitations of remote physical assessments, especially when patients are unable to move their bodies or have limited mobility. Remote physical examination is another major challenge for remote assessment. Guidelines and implementation processes regarding the safety and accuracy of remote assessments and remote physical examinations are necessary, and while some research in this area has been conclusive, it is still insufficient.,63A review of the literature shows that most research subjects of telerehabilitation after stroke had strict restrictions, and patients with more than a moderate or severe stroke degree were excluded. At present, a few explored telerehabilitation techniques are designed for patients with moderate and severe stroke, and research in this direction may also be a major difficulty in the study of telerehabilitation after stroke. In addition, although some studies investigated participants’ satisfaction with the telerehabilitation program, system and safety after the intervention, the evaluation methods and tools varied, and the development of evaluation tools for the telerehabilitation intervention model is warranted.In the past 10 years, research on telerehabilitation technology in the field of stroke survivors rehabilitation has developed rapidly and gained a relatively mature research basis, but higher quality research and more reliable evidence to show that the efficacy of telerehabilitation is better than or equivalent to that of traditional rehabilitation methods is still necessary. Telemedicine services for stroke rehabilitation are interdisciplinary and involve professional research based on computer technology, mobile communication technology, and electronic information technology. VR technology and rehabilitation robotics are already destined as popular directions for the future development of tele-rehabilitation. Moreover, the choice of exercise duration and intensity needs to be supported by more valuable scientific evidence from future studies. The safety and cost-effectiveness of poststroke telerehabilitation intervention are also issues that cannot be ignored by researchers, which ensures the generalizability of research results. Previous studies will help to explore the rehabilitation modalities and efficacy of tele-rehabilitation technologies for patients with moderate-to-severe stroke. Researchers worldwide should combine their own characteristics and advantages, strengthen academic exchanges and cooperation with advanced foreign research institutions or research teams, achieve scientific breakthroughs, and explore poststroke remote rehabilitation technologies and service models suitable for promotion in different environments to improve the quality of survival and living standards of stroke survivors.Only the WoSCC database was included as a source of record collection; consequently, the present analysis does not reflect the full context of the research area explored. CiteSpace, developed by Professor Chen Chaomei at Drexel University, was used as the analytical tool in this study. Because of the software itself, some subtle data may be biased, and the interpretation criteria of the visual map may not be completely consistent, which will also have a certain impact on the data analysis results. We aim to improve the accuracy of the data and interpret them in subsequent studies.We would like to thank the editor and anonymous reviewers for their useful comments on earlier drafts.Conceptualization: Yan Sun.Data curation: Linzhang Li.Formal analysis: Linzhang Li, Yan Sun.Funding acquisition: Yan Sun.Methodology: Yan Sun.Supervision: Yan Sun.Validation: Linzhang Li.Visualization: Linzhang Li.Writing – original draft: Yan Sun.Writing – review & editing: Linzhang Li, Yan Sun.


Robotic-assisted rehabilitation is currently being applied to improve the effectiveness of human gait rehabilitation and recover the mobility and strength after a stroke or spinal cord injury; a robotic assistant can allow the active participation of the patient and the supervision of the collected data and decrease the labor required from therapists during the patient’s training exercises. The goal of gait rehabilitation with robotic-based assistance is to restore motor function by using diverse control strategies, taking account of the physical interaction with the lower limbs of the patient. Over the last few years, researchers have extracted useful information from the patient’s biological signals that can effectively reflect movement intention and muscle activation. One way to evaluate progress in rehabilitation is through isokinetic prototype tests that describe the dynamic characteristics of an isokinetic leg extension device for rehabilitation and control action. These tests use an isokinetic system to assess muscle strength and performance in a patient during isometric or isokinetic contraction. An experimental prototype shown in the following work allows the device’s performance to be evaluated in a controlled environment before the patient’s use. New features provide a control system that can be teleoperated for distributed structures, enabling the remote operation and management of the device. In order to achieve physical recovery from musculoskeletal injuries in the lower limbs and the reintegration of the affected subject into society as an independent and autonomous individual in their daily activities, a control model that introduces a medical isokinetic rehabilitation protocol is presented, in which the element that carries out such protocol consists of a magnetic particle brake whose control action is strongly influenced by the dynamics of the system when in contact with the end user—specifically, the patient’s legs in the stretch from the knee to the ankle. The results of these tests are valuable for health professionals seeking to measure their patient’s progress during the rehabilitation process and determine when it is safe and appropriate to advance in their treatment. An isokinetic testing protocol based on an experimental prototype is an approach to evaluate the effectiveness of a device or treatment by using a prototype and an isokinetic testing system. The isokinetic concept refers to the ability of the system to maintain a constant speed during muscle contraction, allowing for accurate measurement of strength and performance . MoreoveIsokinetic rehabilitation is a technique used to recover muscle injuries and other conditions that affect the ability to move and perform physical activities. This technique uses isokinetic devices, allowing muscles to be exercised at a constant speed and measured torque. It has been shown to be effective in recovering injuries, allowing patients to exercise safely with controlled intensity, facilitating muscle strength and endurance recovery. This technique can also help prevent muscle wasting and atrophy in patients with physical disabilities or prolonged periods of inactivity . Other rThis research aims to design a control system for an isokinetic rehabilitation protocol to recover leg muscle injuries. For this purpose, a study of the dynamic components involved in lower limb extension will be performed using the rehabilitation device from Universidad del Valle, seen in The leg rehabilitation mechanism seen in Regarding the electrical power supply, the system is connected to a standard 110-volt (V) power source, which is then reduced to 24 V to power the mechanism’s power systems. An additional conversion is used to obtain a 5 V voltage for device control. This configuration ensures a stable and safe electrical supply, guaranteeing optimal performance and protecting the electronic components. The control interface of the mechanism has been developed using the PHP programming language. This interface integrates with an intuitive touchscreen, enabling simple and precise device control. Users can adjust specific parameters, monitor exercise progress, and make custom configurations based on individual needs. Furthermore, thanks to its portable and adaptable design, the mechanism is compatible with teleoperation medical technologies, allowing for remote monitoring and efficient patient supervision in real-time .Physical therapists often use Isokinetic exercise as a relatively safe and effective way to strengthen certain muscles in a person recovering from an injury. Some of its benefits include experiencing resistance throughout a joint’s entire range of motion, controlled resistance, and speed to reduce the risk of injury; and others, such as physical therapists, can measure a person’s progress accurately. According to a prior study, isokinetic exercises have been shown to be more effective in improving functional performance than isometric and isotonic exercises .Additionally, this type of exercise may be a better form of muscle recovery than other types. A study  showed tAn isokinetic dynamometer is used in sports, exercise, and clinical settings to measure muscle strength, torque, and power. The device allows specific testing on different joints and muscle groups, adapting to different speeds and ranges of motion. Isolation of the joint of interest allows a complete evaluation to compare right and left limbs, detecting potential injury risks or areas for improvement.Isokinetic dynamometry is used to evaluate and strengthen limbs by measuring maximum force at a specific speed during movement; dynamometry systems allow comparison of concentric and eccentric muscle contractions while maintaining a constant speed; they are commonly used in physical therapy clinics for patients who have suffered injuries or are in the post-surgical state, making comparisons between the affected and non-affected limb. The percentage of the strength of the non-affected limb is used to determine when a patient can return to physical activity. In countries such as the United States, these systems are still used to assess limb strength, although they were used more frequently in the past .Regarding assessing muscles across a full range of movements, isokinetic testing has several advantages over isometric testing. Isokinetic testing allows the health specialist to analyze agonist–antagonist relationships, determine maximum strength, and evaluate endurance and other indicators of muscle capacity. Through specialized computer tools, it is possible to compare two limbs and provide feedback during the test, delivering valuable information on the degree of recovery of average strength. For patients with extreme cases of weakness, evaluations can be performed with isokinetic devices using torque values obtained through comparison between passive isokinetic motion and concentric maximum effort movement, two of the most significant variables in this type of test .Dynamometry is a technique used to measure muscle strength, which includes different functional and manual muscle tests. Functional tests are easy to perform and do not require equipment, but they have limitations in their exact relationship to muscle strength. Manual muscle testing is a technique used in neurological examinations but requires an experienced examiner and has high variability due to evaluators. Isometric dynamometry measures static muscle strength, while isokinetic dynamometry measures dynamic muscle strength. These techniques provide accurate information about the muscle strength of all major muscle groups of the upper and lower extremities. However, comparisons between different studies are rarely made due to the lack of standardization of test procedures and different equipment in laboratories and neuromuscular centers .Some studies have evaluated the reliability of different dynamometers in measuring maximum torque in knee flexion and extension in athletes; the results showed that knee maximum flexion and extension tests performed in specific contractions with different times of use had similar values; this indicates that the measurement of muscle strength of the dynamometer does not change over time. Therefore, the hypothesis is not supported; the study suggests that the IsoMed-2000 isokinetic dynamometer, owned by D. & R. Ferstl GmbH located in Hemau, Germany, is suitable for evaluating muscle strength and changes in athletes, despite some measurement errors; it can be used in physiotherapy and rehabilitation clinics and for athletes in injury risk analysis and muscle strength development. However, it is not reliable for measuring knee flexion torque. Furthermore, this study also highlights that the control system of the IsoMed-2000 dynamometer may not be robust enough. As a result, the dynamometer may not be reliable in certain conditions or for specific populations. It is essential to be mindful of this limitation when using the device to evaluate muscle strength and to be careful when interpreting the results. It would be beneficial to consider alternative methods or equipment with a more robust control system for measuring knee flexion torque . SeveralIsokinetic exercises are a specific rehabilitation approach based on using isokinetic machines to exercise muscles at a constant speed. This approach is considered more accurate and safer than traditional exercises, allowing for a more precise measurement of strength and performance . HoweverThe study  comparedAdditionally, these devices are expensive and not very durable, requiring a significant investment in equipment and qualified personnel. Moreover, they do not consider the dynamics of the mechanisms and the patient for isokinetic control, which limits their effectiveness in muscle injury rehabilitation. It is important to continue researching and developing solutions to improve the accessibility and effectiveness of isokinetic exercises in rehabilitation. In summary, although isokinetic exercises are a valuable technique for rehabilitation, current solutions on the market do not aim to develop this technique due to the lack of availability, cost, and access to the necessary equipment and trained personnel. However, it is important to continue researching and developing solutions to improve the accessibility and effectiveness of isokinetic exercises in rehabilitation.In , a catalThis document delves into the development of an isokinetic rehabilitation control system, encompassing various aspects of its architecture and functionality. The subsequent sections explore different components and considerations involved in the system. Characterizing a device for isokinetic rehabilitation of the leg with architecture see  requiresIn a testing scenario, the kinematic and dynamic characteristics of the bodies interacting within the system must be considered to achieve rehabilitation through techniques that allow for controlling the speed of a patient’s leg extension.During lower limb rehabilitation processes, particularly in the case of the knee and leg, activities of limb extension are performed in which the body posture remains seated with a slight inclination of the back. The goal is to extend the leg from a reference position of 0° when the leg is perpendicular to the ground and extend it to achieve an inclination of 90° while keeping the axis of the leg parallel to the ground . Figure To improve this pre-process and the rehabilitation process, it has been suggested to implement a feature in which the patient performs the extension process with an equal speed throughout the entire arc of motion, as ensuring the speed requires the body to control the force with which the leg is lifted and, in turn, facilitates the collection of information on the patient’s activity. The considered variables involved in each subsystem are the following: Within the dynamic of the patient–machine system, the sum of torques is equal to the angular movement acceleration, The vector  for the system acceleration.Fn_activate_controller and PI_Controller blocks (red box with dotted lines), which receive the error signal and modify an activation function to regulate the voltage supply and generate a controlled For the controller dynamic observed in Equation (17), its implementation within the rehabilitation device is seen in In x-axis represents time in seconds and the y-axis represents the angular position in degrees—when the patient’s leg extension speed  exceeds the reference speed limit  and how the control action forced the leg speed dynamics to reduce each time the threshold is exceeded.The cases shown in The use of controllers to regulate the speed of human joint movements can generate certain ripples in the speed signal that affect the smoothness of the movements. However, these ripples can be smoothed out by using first- and second-order filters, which can be adjusted within the system bandwidth. In this way, sudden accelerations in the human joint can be prevented from interfering with the natural and fluid movement of the body, thus improving the user experience and the precision of controlled movement.After carrying out the development of a technique for a control system that guarantees isokinetic control in rehabilitation devices for the recovery of muscle injuries in human legs, we reach the following conclusions.Viewing the knee joint and the adjunct sections of the leg as simplified geometric figures, i.e., as triangles, facilitates the understanding of the ligament and muscle junction interactions used in the flexion and extension moments of the leg.The speed control system used in isokinetic rehabilitation is the key to ensuring the safety and effectiveness of the treatment. This system uses a particle magnetic brake that accurately adjusts the rotation speed of the pulley. For purpose-built speed control systems, computational simulation tools that reflect the dynamic characteristics of the subsystems present in the medical device are necessary, which is reflected in a reduction of physical resources when dealing with testing methods to develop a digital dynamic system comparable to physical device prototypes. The constant rotational speed enabled by the speed control system is essential to accurately measure the torque generated in a determinate time by the human muscles.The use of the proportional integrator controller for the speed control system enhances the response of the system to variations taken in early moments and during the time period of the exercise compared to the application of only a proportional-type control element, resulting in a quick response to both fast and slow changes in control action to alter the patient’s extension speed without compromising the tendon response, and providing organized and efficient information for further biomedical analysis.Isokinetic rehabilitation is a technique that promises to be effective in the recovery of leg muscle injuries. The physical variables of elements involved in the mechanical system must be considered, such as the patient’s anthropometric variables, the physical variables of the mechanical and electrical components of the device, and the dynamics in which the bodies interact. These results are valuable for guiding the treatment of patients with leg muscle injuries and improving the effectiveness of isokinetic rehabilitation. The accurate strength data collected during the rehabilitation process will provide healthcare professionals with precise information. This will enable them to make more accurate diagnoses and make informed decisions about future procedures. By using reliable measurements of muscle strength and human torque, healthcare providers can customize treatment plans for each patient, optimizing their recovery and improving the overall outcomes of isokinetic rehabilitation. These findings contribute to the growing evidence supporting the importance of accurate data in patient care and treatment success.Biomedical devices, such as the isokinetic rehabilitation system, are excellent measurement devices that help to collect data for patient evolution studies; in addition to the guidelines recommended by medical professionals, they allow for improvement to be observed when a maximum permissible speed is guaranteed during the extension process, which, in turn, can be observed by analyzing human torque and the force exerted by the anatomical elements responsible for extension. These results could be useful to guide the treatment of patients with muscular leg injuries and to improve the effectiveness of isokinetic rehabilitation in general.