József Tollár
55750689900
Publications - 14
Effects of walking training with and without a robot and standard care on clinical and mobility outcomes: A randomized clinical trial in acute ischemic stroke patients
Publication Name: Experimental Gerontology
Publication Date: 2025-10-15
Volume: 210
Issue: Unknown
Page Range: Unknown
Description:
Background: Stroke incidence rises with age. A stroke can severely affect walking ability, requiring therapy. Robot-assisted walking therapy (ROB) has been advocated as one form of walking rehabilitation in stroke patients. However, its comparative efficacy remains controversial and three-group comparisons are scant. We compared the effects of ROB, walking training therapy without a robot (WTT) and standard treatment therapy (STT) on clinical and mobility outcomes in acute ischemic stroke patients. Methods: Individuals (n = 45, 71 % males, age 64.4y ±6.34), who have recently experienced an ischemic stroke, were randomized to ROB, WTT or STT. Clinical and mobility outcomes were assessed before and after each intervention (3 weeks, 5 sessions/week) and after 5 weeks of no-intervention follow-up. Results: Outcomes did not differ between groups at baseline (p > 0.05). Modified Rankin Scale (primary outcome), improved (p < 0.05) after ROB and WTT vs. STT. These improvements were retained relative to baseline (p < 0.05) after follow-up. Barthel index, Berg Balance Scale, 10-m walking speed, the distance while walking with and without the robot for six minutes, and center pressure velocity in standing improved most after ROB (all p < 0.001), exceeding the changes after WTT which in turn were greater than the changes after STT (p ≤ 0.040). Conclusion: Older adults shortly after an ischemic stroke can quickly learn to walk with a soft robot and retain substantial clinical and mobility improvements at follow-up.
Open Access: Yes
Effectiveness of High-Intensity Therapy in Rehabilitation of Parkinson’s Disease Patients
Publication Name: Applied Sciences Switzerland
Publication Date: 2025-06-01
Volume: 15
Issue: 11
Page Range: Unknown
Description:
Parkinson’s disease (PD) is a progressive movement disorder with no cure. In this randomized controlled study, 100 patients with PD were assigned to four intervention groups (Exergame, Cycling, Agility, and Robot) for 14 weeks. This study evaluates the effectiveness of high-intensity therapy in a randomized clinical trial. Exergaming, cycling, agility, and robot therapies improved motor function, postural stability, and cardiovascular health. Heart rate monitoring and Borg Scale ratings confirmed the safety and adaptability of high-intensity training, with patients sustaining moderate-to-high exertion without adverse effects. Significant improvements were observed in gait speed (+0.30–0.50 m/s), Functional Independence Measure (FIM) (+25–30 points), and Berg Balance Scale scores. Integrating high-intensity, functional movement-based therapies into PD rehabilitation may offer superior motor, gait, and cardiovascular benefits compared to conventional methods.
Open Access: Yes
DOI: 10.3390/app15115890
Brain Structural Abnormalities in Patients with Post-COVID-19 Headache
Publication Name: Neurology International
Publication Date: 2025-04-01
Volume: 17
Issue: 4
Page Range: Unknown
Description:
Background/Objectives: Headache is one of the most common neurological symptoms associated with COVID-19, affecting approximately 25% of patients. While most headaches resolve within weeks, some persist for months, suggesting underlying structural brain changes. This study aimed to identify brain MRI abnormalities associated with chronic headaches in patients with a history of COVID-19 infection. Methods: This retrospective study included 30 patients with post-COVID-19 headaches and 30 control patients with no history of COVID-19. Demographic characteristics were analyzed using t-tests and chi-square tests. MRI findings were categorized into six types: cortical atrophy, white matter lesions, vascular lesions, lacunar lesions, vascular encephalopathy, and sinusitis. Differences in MRI findings between the two groups were evaluated using chi-square tests. Secondary outcomes included the analysis of symptoms accompanying headaches, diagnoses following MRI, and treatments applied. Results: White matter lesions were significantly more frequent in the post-COVID-19 group (50%) compared to controls (20%) (p = 0.015). Conversely, sinusitis was more prevalent in the control group (36.7%) than in the post-COVID-19 group (6.7%) (p = 0.005). Other MRI abnormalities showed no significant differences. Cognitive dysfunction (30%) and dizziness (33.3%) were the most common associated symptoms. The most frequent diagnoses after MRI in the post-COVID-19 group were headaches/migraines (23.3%), post-COVID-19 headache (20%), and vestibular syndrome (13.3%). Conclusions: Persistent post-COVID-19 headaches may be linked to structural white matter changes observed in MRI. Further research, ideally including pre-infection imaging data, is needed to determine the causal relationship between these lesions and chronic headache symptoms. Trial Registration: This study was registered in ClinicalTrials with the trial registration number NCT06825741 on 13 February 2025.
Open Access: Yes
Comparison of Five Rehabilitation Interventions for Acute Ischemic Stroke: A Randomized Trial
Publication Name: Journal of Clinical Medicine
Publication Date: 2025-03-01
Volume: 14
Issue: 5
Page Range: Unknown
Description:
Background: Comparative efficacy of rehabilitation interventions in persons with acute ischemic stroke (PwS) is limited. This randomized trial assessed the immediate and lasting effects of five interventions on clinical and mobility outcomes in 75 PwS. Methods: Five days after stroke, 75 PwS were randomized into five groups: physical therapy (CON, standard care, once daily); walking with a soft robotic exoskeleton (ROB, once daily); agility exergaming once (EXE1, once daily) or twice daily (EXE2, twice daily); and combined EXE1+ROB in two daily sessions. Interventions were performed 5 days per week for 3 weeks. Outcomes were assessed at baseline, post-intervention, and after 5 weeks of detraining. Results: Modified Rankin Scale (primary outcome) and Barthel Index showed no changes. EXE1, EXE2, ROB, and EXE1+ROB outperformed standard care (CON) in five secondary outcomes (Berg balance scale, 10m walking speed, 6-min walk test with/without robot, standing balance), with effects sustained after 5 weeks. Dose effects (EXE1 vs. EXE2) were minimal, while EXE1+ROB showed additive effects in 6-min walk tests. Conclusions: These novel comparative data expand evidence-based options for therapists to design individualized rehabilitation plans for PwS. Further confirmation is needed.
Open Access: Yes
DOI: 10.3390/jcm14051648
Effects of 2 consecutive badminton matches on motor and cognitive abilities among adult elite badminton players An observational study
Publication Name: Medicine United States
Publication Date: 2024-12-27
Volume: 103
Issue: 52
Page Range: e40947
Description:
The goal of our study was to investigate the effect of 2 consecutive badminton matches among elite badminton players on visuomotor integration, dynamic balance ability, inhibitory control, short-term memory capacity, and changes in cardiovascular fitness. Badminton is the fastest racket sport regarding the speed of the shuttle leaving the racket. The play with open move skills is characterized by series of short range and high intensity workload phases. The effectiveness is affected by the execution of the specific movement techniques within a certain time period and the optimal function of decision-making techniques. The experiment included a tournament with 2 simulated matches among elite, adult, male badminton players. The quality of visuomotor integrity and dynamic balance task were measured with Blazepod modified adapted Y-Balance Test induced reactive balance test, pre and post matches. Stroop test was used to evaluate the inhibition capability, and Digit Span Test was applied to measure the cognitive short-term capacity. Remarkable changes could not be detected in the visuomotor reaction in each time points. Gradual increase was observed in balance errors due to the dominant leg (right) support. Digit Span Test decreased between pre and post match measurements, however, significant changes (P < .01) could be detected after the restitution period between pre and post match. No alteration could be seen with Stroop test in each time points, nevertheless, notable increase in false results were observed at the 4th measurements points. Heart rate did not remarkably differ. In summary, the intensive, consecutive strength had a negative effect on peripheral system, and therefore on dynamic balance control. Cognitive ability indicated gradual deterioration, but showed optimal regeneration between loads.
Open Access: Yes
Walking on a Balance Beam as a New Measure of Dynamic Balance to Predict Falls in Older Adults and Patients with Neurological Conditions
Publication Name: Sports Medicine Open
Publication Date: 2024-12-01
Volume: 10
Issue: 1
Page Range: Unknown
Description:
Background: Beam walking is a new test to estimate dynamic balance. We characterized dynamic balance measured by the distance walked on beams of different widths in five age groups of healthy adults (20, 30, 40, 50, 60 years) and individuals with neurological conditions (i.e., Parkinson, multiple sclerosis, stroke, age: 66.9 years) and determined if beam walking distance predicted prospective falls over 12 months. Methods: Individuals with (n = 97) and without neurological conditions (n = 99, healthy adults, age 20–60) participated in this prospective longitudinal study. Falls analyses over 12 months were conducted. The summed distance walked under single (walking only) and dual-task conditions (walking and serial subtraction by 7 between 300 to 900) on three beams (4, 8, and 12-cm wide) was used in the analyses. Additional functional tests comprised grip strength and the Short Physical Performance Battery. Results: Beam walking distance was unaffected on the 12-cm-wide beam in the healthy adult groups. The distance walked on the 8-cm-wide beam decreased by 0.34 m in the 20-year-old group. This reduction was ~ 3 × greater, 1.1 m, in the 60-year-old group. In patients, beam walking distances decreased sharply by 0.8 m on the 8 versus 12 cm beam and by additional 1.6 m on the 4 versus 8 cm beam. Beam walking distance under single and dual-task conditions was linearly but weakly associated with age (R2 = 0.21 for single task, R2 = 0.27 for dual-task). Age, disease, and beam width affected distance walked on the beam. Beam walking distance predicted future falls in the combined population of healthy adults and patients with neurological conditions. Based on receiver operating characteristic curve analyses using data from the entire study population, walking ~ 8.0 of the 12 m maximum on low-lying beams predicted future fallers with reasonable accuracy. Conclusion: Balance beam walking is a new but worthwhile measure of dynamic balance to predict falls in the combined population of healthy adults and patients with neurological conditions. Future studies are needed to evaluate the predictive capability of beam walking separately in more homogenous populations. Clinical Trial Registration Number NCT03532984.
Open Access: Yes
Investigation of the Effectiveness of the Robotic ReStore Soft Exoskeleton in the Development of Early Mobilization, Walking, and Coordination of Stroke Patients: A Randomized Clinical Trial
Publication Name: Robotics
Publication Date: 2024-03-01
Volume: 13
Issue: 3
Page Range: Unknown
Description:
Medical robotics nowadays can prevent, treat, or alleviate numerous severe conditions, including the dire consequences of stroke. Our objective was to determine the effect of employing a robotic soft exoskeleton in therapy on the development of the early mobilization, gait, and coordination in stroke patients. The ReStore™ Soft Exo-Suit, a wearable exosuit developed by a leading company with exoskeleton technology, was utilized. It is a powered, lightweight device intended for use in stroke rehabilitation for people with lower limb disability. We performed a randomized clinical intervention, using a before–after trial design in a university hospital setting. A total of 48 patients with a history of stroke were included, of whom 39 were randomized and 30 completed the study. Interventions: Barthel Index and modified Rankin scale (mRS) patients were randomly assigned to a non-physical intervention control (n = 9 of 39 completed, 30 withdrew before baseline testing), or to a high-intensity agility program (15 sessions, 5 weeks, n = 30 completed). The main focus of assessment was on the Modified Rankin Scale. Additionally, we evaluated secondary factors including daily life functionality, five dimensions of health-related quality of life, the Beck depression inventory, the 6 min walk test (6MWT), the Berg Balance Scale (BBS), and static balance (center of pressure). The Robot-Assisted Gait Therapy (ROB/RAGT) program led to significant improvements across various measures, including a 37% improvement in Barthel Index scores, a 56% increase in 10 m walking speed, and a 68% improvement in 6 min walking distance, as well as notable enhancements in balance and stability. Additionally, the intervention group demonstrated significant gains in all these aspects compared to the control group. In conclusion, the use of robotic therapy can be beneficial in stroke rehabilitation. These devices support the restoration and improvement of movement in various ways and contribute to restoring balance and stability.
Open Access: Yes
The Future of Health Management—How Virtual Reality and 5G Networks Can Contribute to Sustainability in Healthcare
Publication Name: Springer Proceedings in Business and Economics
Publication Date: 2023-01-01
Volume: Unknown
Issue: Unknown
Page Range: 459-470
Description:
Developments in healthcare usually directly target innovations in intervention techniques and medical devices for diagnosis, analysis and treatment. On the other hand, digital development in administration, handling and accessing (sensitive) patient data or real-time availability of information also contribute to improvement of management. The CoVid situation highlighted emerging technologies that covers both, and blurs the border between, management (i.e., cost reduction) and actual treatment. The newly introduced 5G New Radio wireless technology and the expansion of virtual, augmented and mixed reality applications not only assist medical personnel during treatment, but can increase safety, availability and sustainability of services, and at the same time, can reduce costs. This paper briefly introduces benefits of these technologies focusing on state-of-the-art use cases.
Open Access: Yes
Telerehabilitation After Brain Injuries: Its Efficacy and Role in Reducing Healthcare Burdens
Publication Name: Acta Polytechnica Hungarica
Publication Date: 2023-01-01
Volume: 20
Issue: 8
Page Range: 305-320
Description:
Rehabilitation following brain injuries, such as stroke and other traumatic injuries, presents significant challenges for both patients and healthcare systems. Traditional in-person rehabilitation often requires regular visits to specialized facilities, which can be difficult for patients in remote areas or those with mobility and financial constraints. Telerehabilitation offers a promising solution by enabling patients to continue essential therapy at home, ensuring continuity of care while reducing the burden on healthcare providers. It can be effectively applied across various patient groups, including children, adults, the elderly, amputees, individuals with traumatic neurological injuries, and those with neurocognitive impairments such as dementia. Our telemedicine platform integrates advanced technologies, i.e., 3D motion analysis and Virtual Reality (VR) to enhance home-based physiotherapy. These tools enable precise monitoring, real-time feedback, and immersive therapy sessions, in order to improve coordination, fine motor skills, hand-eye coordination, and the vestibular system, which is crucial for balance. This platform also performs detailed offline data analysis, allowing healthcare professionals to adjust therapy plans based on individual needs. As the demand for rehabilitation services continues to grow, adopting these technologies will be crucial for sustainable, effective healthcare, ultimately improving patient outcomes and shaping a more efficient and equitable future for healthcare systems.
Open Access: Yes
Virtual Reality in Cerebrovascular Rehabilitation: A Mini Review on Clinical Efficacy and Neurological Impacts
Publication Name: Acta Polytechnica Hungarica
Publication Date: 2023-01-01
Volume: 20
Issue: 8
Page Range: 321-336
Description:
The application of virtual reality (VR) technology in both upper and lower limb rehabilitation represents a significant advancement in the field of medicine. VR-based therapies provide patients with the opportunity to engage in intensive, repetitive, and targeted exercises that promote neuroplasticity and improve the motor skills necessary for daily life. VR has long been recommended for the rehabilitation of conditions such as in case of ischemic stroke, Parkinson’s disease, and multiple sclerosis, further underscoring its versatility and therapeutic potential. In our study, we evaluated the effectiveness of VR therapy focusing on stroke rehabilitation. The reviewed VR systems provided motion analysis, tracking, feedback reinforcement, and realistic environments to facilitate the restoration of motor functions. Furthermore, we developed a VR-based therapy aimed at both upper and lower limb motor functions, combined with traditional rehabilitation. The application of VR technology not only promotes the improvement of motor functions but also offers economic advantages by reducing the burden on healthcare workers and increasing rehabilitation capacity. Further research is needed to determine the optimal conditions for applying VR therapy in clinical practice.
Open Access: Yes
Comparative Effectiveness of 4 Exercise Interventions Followed by 2 Years of Exercise Maintenance in Multiple Sclerosis: A Randomized Controlled Trial
Publication Name: Archives of Physical Medicine and Rehabilitation
Publication Date: 2022-10-01
Volume: 103
Issue: 10
Page Range: 1908-1916
Description:
Objective: To determine the effects of exergaming (EXE) on quality of life (QOL), motor, and clinical symptoms in multiple sclerosis (MS). We compared the effects of EXE, balance (BAL), cycling (CYC), proprioceptive neuromuscular facilitation (PNF), and a standard care wait-listed control group on clinical and motor symptoms and quality of life (QOL) in people with MS (PwMS) and determined the effects of subsequent maintenance programs for 2 years in a hospital setting. Design: A randomized controlled trial, using before-after test design. Setting: University hospital setting. Participants: Of 82 outpatients with MS, 70 were randomized (N=70), and 68 completed the study. Interventions: The initial high-intensity and high-frequency interventions consisted of 25 one-hour sessions over 5 weeks. After the 5-week-long initial intervention, the 2-year-long maintenance programs followed, consisting of 3 sessions per week, each for 1 hour. Main Outcome Measures: The primary outcome: Multiple Sclerosis Impact Scale (MSIS-29). Secondary outcomes: Measures 5 aspects of health-related QOL (EuroQol 5-Dimension questionnaire), Beck Depression Inventory, 6-minute walk test (6MWT), Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT), and static BAL (center of pressure). Results: MSIS-29 improved most in EXE (11 points), BAL (6), and CYC (6) (all P<.05). QOL improved most in EXE (3 points), CYC, and BAL (2) (all P<.05). TAT and BBS improved significantly (P<.05) but similarly (P>.05) in EXE, BAL, and CYC. 6MWT improved most in EXE (57m), BAL (32m), and CYC (19m) (all P<.001). Standing sway did not change. Maintenance programs further increased the initial exercise-induced gains, robustly in EXE. Conclusions: A total of 25 sessions of EXE, BAL, CYC, and PNF, in this order, improved clinical and motor symptoms and QOL, and subsequent 2-year-long thrice weekly maintenance programs further slowed symptom worsening and improved QOL. EXE was the most and PNF was the least effective to improve clinical symptoms, motor function, and QOL in PwMS.
Open Access: Yes
Detraining Slows and Maintenance Training Over 6 Years Halts Parkinsonian Symptoms-Progression
Publication Name: Frontiers in Neurology
Publication Date: 2021-11-19
Volume: 12
Issue: Unknown
Page Range: Unknown
Description:
Introduction: There are scant data to demonstrate that the long-term non-pharmaceutical interventions can slow the progression of motor and non-motor symptoms and lower drug dose in Parkinson's disease (PD). Methods: After randomization, the Exercise-only (E, n = 19) group completed an initial 3-week-long, 15-session supervised, high-intensity sensorimotor agility exercise program designed to improve the postural stability. The Exercise + Maintenance (E + M, n = 22) group completed the 3-week program and continued the same program three times per week for 6 years. The no exercise and no maintenance control (C, n = 26) group continued habitual living. In each patient, 11 outcomes were measured before and after the 3-week initial exercise program and then, at 3, 6, 12, 18, 24, 36, 48, 60, and 72 months. Results: The longitudinal linear mixed effects modeling of each variable was fitted with maximum likelihood estimation and adjusted for baseline and covariates. The exercise program strongly improved the primary outcome, Motor Experiences of Daily Living, by ~7 points and all secondary outcomes [body mass index (BMI), disease and no disease-specific quality of life, depression, mobility, and standing balance]. In E group, the detraining effects lasted up to 12 months. E+M group further improved the initial exercise-induced gains up to 3 months and the gains were sustained until year 6. In C group, the symptoms worsened steadily. By year 6, levodopa (L-dopa) equivalents increased in all the groups but least in E + M group. Conclusion: A short-term, high-intensity sensorimotor agility exercise program improved the PD symptoms up to a year during detraining but the subsequent 6-year maintenance program was needed to further increase or sustain the initial improvements in the symptoms, quality of life, and drug dose.
Open Access: Yes
A Cost-Effective Hardware and Software Solution for Telerehabilitation in Homecare
Publication Name: 2024 IEEE International Conference on Microwaves Communications Antennas Biomedical Engineering and Electronic Systems Comcas 2024
Publication Date: 2024-01-01
Volume: Unknown
Issue: Unknown
Page Range: Unknown
Description:
In telerehabilitation., services are provided from a distance using telecommunication technologies. With the proliferation of broadband internet services and wireless networks., high-speed and low-latency data transmission can be maintained that allows for high quality audio and video communication. However., offline solutions without outsourcing of the computational need into the cloud are still required. Homecare solutions offer possibilities for rehabilitation of patients in their home environment. Guided workouts and training sessions can be automated and controlled with the help of cost-effective hardware and software applications. This paper presents first results of a latest development in homecare telerehabilitation with automated recognition of motion, evaluation and feedback.
Open Access: Yes
Structural Brain Abnormalities, Diagnostic Approaches, and Treatment Strategies in Vertigo: A Case-Control Study
Publication Name: Neurology International
Publication Date: 2025-09-01
Volume: 17
Issue: 9
Page Range: Unknown
Description:
Background/Objectives: Dizziness is a frequent medical complaint with neurological, otolaryngological, and psychological origins. Imaging studies such as CT (Computer Tomography), cervical X-rays, and ultrasound aid diagnosis, while MRI (Magnetic Resonance Imaging) is crucial for detecting brain abnormalities. Our purpose is to identify structural brain changes associated with vertigo, assess pre-MRI diagnostic approaches, and evaluate treatment strategies. Methods: A case-control study of 232 vertigo patients and 232 controls analyzed MRI findings, pre-MRI examinations, symptoms, and treatments. Statistical comparisons were performed using chi-square and t-tests (p < 0.05). Results: White matter lesions, lacunar infarcts, Circle of Willis variations, and sinusitis were significantly more frequent in vertigo patients (p < 0.05). Pre-MRI diagnostics frequently identified atherosclerosis (ultrasound) and spondylosis (X-ray). Common symptoms included headache, imbalance, and visual disturbances. The most frequent post-MRI diagnosis was Benign Paroxysmal Positional Vertigo (BPPV). Treatments included lifestyle modifications, physical therapy (e.g., Epley maneuver), and pharmacological therapies such as betahistine. Conclusions: MRI revealed structural brain changes linked to vertigo. Pre-MRI assessments are essential for ruling out vascular and musculoskeletal causes. A multidisciplinary treatment approach is recommended. Trial Registration: This study was registered in ClinicalTrials.gov with the trial registration number NCT06848712 on 22 February 2025.
Open Access: Yes
