Digital Commons Network^™

Motionteller: Multi-Modal Integration Of Wearable Time-Series With Llms For Health And Behavioral Understanding, Aiwei Zhang, Arvind Pillai, Andrew Campbell, Nicholas C. Jacobson

Computer Science Senior Theses

As wearable sensing becomes increasingly pervasive, a key challenge remains: how can we generate natural language summaries from raw physiological signals such as actigraphy - minute-level movement data collected via accelerometers? In this work, we introduce MotionTeller, a generative framework that natively integrates minute-level wearable activity data with large language models (LLMs). MotionTeller combines a pretrained actigraphy encoder with a lightweight projection module that maps behavioral embeddings into the token space of a frozen decoder-only LLM, enabling free-text, autoregressive generation of daily behavioral summaries.

We construct a novel dataset of 54,383 ⟨actigraphy, text⟩ pairs derived from real-world NHANES recordings, and …

Importance Of Outbreak Response Research In Bridging Knowledge Gaps On Emerging Infectious Diseases, Robert F Breiman, David Wang, Michael Diamond, Adrianus C M Boon, Et Al.

2020-Current year OA Pubs

An important outcome of the devastating 2014 West African Ebola virus disease outbreak and the 2020 COVID-19 pandemic has been the growing promotion of conducting research during outbreaks of emerging infectious diseases (EIDs) as a valuable and acceptable process of acquiring knowledge to enhance our ability to better prevent and control these diseases in the future. Recognising the unique opportunity during outbreaks to leverage increases in cases over a short time interval and in a circumscribed area, we articulate a systematic process of conducting EID outbreak response research, highlighting knowledge gaps that should be prioritised, and measures that can be …

Detecting Physical Activity Using Wearable Sensor Data, Dipok Deb

Data Science and Data Mining

This study focuses on detecting physical activity using wearable sensor data, specifically distinguishing between walking and running. A dataset comprising accelerometer and gyroscope readings is used to train and evaluate various machine learning models, including logistic regression, random forest, k-nearest neighbors, naïve Bayes, and XGBoost. Extensive preprocessing, such as creating lag features and rolling statistics, is performed to enhance temporal data representation. The models are evaluated using metrics like accuracy, precision, recall, and F1 score. Incorporating lag and rolling features significantly improves model performance, with logistic regression achieving perfect scores across all metrics. These findings demonstrate the effectiveness of enhanced …

Biomarker-Guided Imaging And Ai-Augmented Diagnosis Of Degenerative Joint Disease, Rahul Kumar, Kyle Sporn, Aryan Borole, Akshay Khanna, Chirag Gowda, Phani Paladugu, Alex Ngo, Ram Jagadeesan, Nasif Zaman, Alireza Tavakkoli

Department of Medicine Faculty Papers

Degenerative joint disease remains a leading cause of global disability, with early diagnosis posing a significant clinical challenge due to its gradual onset and symptom overlap with other musculoskeletal disorders. This review focuses on emerging diagnostic strategies by synthesizing evidence specifically from studies that integrate biochemical biomarkers, advanced imaging techniques, and machine learning models relevant to osteoarthritis. We evaluate the diagnostic utility of cartilage degradation markers (e.g., CTX-II, COMP), inflammatory cytokines (e.g., IL-1β, TNF-α), and synovial fluid microRNA profiles, and how they correlate with quantitative imaging readouts from T2-mapping MRI, ultrasound elastography, and dual-energy CT. Furthermore, we highlight recent developments …

Tumor Microenvironment Governs The Prognostic Landscape Of Immunotherapy For Head And Neck Squamous Cell Carcinoma: A Computational Model-Guided Analysis, Priyan Bhattacharya, Alban J Linnenbach, Andrew P. South, Ubaldo E. Martinez-Outshoorn, Joseph M. Curry, Jennifer M. Johnson, Larry A. Harshyne, Mỹ G. Mahoney, Adam J. Luginbuhl, Rajanikanth Vadigepalli

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

Immune checkpoint inhibition (ICI) has emerged as a critical treatment strategy for squamous cell carcinoma of the head and neck (HNSCC) that halts the immune escape of the tumor cells. Increasing evidence suggests that the onset, progression, and lack of/no response of HNSCC to ICI are emergent properties arising from the interactions within the tumor microenvironment (TME). Deciphering how the diversity of cellular and molecular interactions leads to distinct HNSCC TME subtypes subsequently governing the ICI response remains largely unexplored. We developed a cellular-molecular model of the HNSCC TME that incorporates multiple cell types, cellular states, and transitions, and molecularly …

Phage-Induced Protection Against Lethal Bacterial Reinfection, Yikun Xing, Haroldo J Hernandez Santos, Ling Qiu, Samantha R Ritter, Jacob J Zulk, Rachel Lahowetz, Kathryn A Patras, Austen L Terwilliger, Anthony W Maresso

Faculty, Staff and Students Publications

Bacteriophages, or phages, are viruses that target and infect bacteria. Due to a worldwide rise in antimicrobial resistance (AMR), phages have been proposed as a promising alternative to antibiotics for the treatment of resistant bacterial infections. Up to this point in history, phage use in preclinical animal studies, clinical trials, and emergency-use compassionate care cases has centered around the original observation from 1915 showing phage as lytic agent, and thus a treatment that kills bacteria. Here, we describe an activity associated with phage therapy that extends beyond lytic activity that results in long-term protection against reinfection. This activity is potent, …

Posterior Predictive Design For Phase I Clinical Trials, Chenqi Fu, Shouhao Zhou, J Jack Lee

Faculty, Staff and Student Publications

Interval-based designs represent cutting-edge adaptive methodologies for phase I clinical trials to identify the maximum tolerated dose (MTD). These designs exhibit robust performance comparable to more intricate, model-based designs, and their pretabulated decision rule enables them to be implemented as simply as the conventional algorithm-based designs. In this paper, we introduce the posterior predictive (PoP) design, a novel interval-based design that leverages advanced Bayesian predictive hypothesis testing techniques for dose escalation and de-escalation. Our work moves beyond the existing model-assisted interval-based designs by achieving global optimality in dose transition. Theoretically, the global optimality ensures that the proposed design can consistently …

Interdisciplinary Digital Health And Learning Survey Across Speech-Language Pathology, Technology, And Interior Design: Implications For Training In Rehabilitation And Aging-In-Place Practices, Jennine M. Harvey-Northrop, Isaac Chang, Gabriela Fonseca Pereira, Megan Cuellar

Teaching and Learning in Communication Sciences & Disorders

While the growing demand for technology integration in healthcare education and practice, technology training in speech-language pathology education is limited. Further research is warranted to investigate digital health and literacy training across interprofessional experiences. This study investigated interdisciplinary digital health and learning across speech-language pathology, technology, and interior design, as well as collaborators for virtual reality environments in rehabilitation and aging-in-place practices. Participants included 53 adult students studying speech-language pathology (N=35), technology (N=10), or interior design (N=7). The Interdisciplinary Digital Health and Learning survey was adapted from the Lin et al. (2021) for implementation across speech-language pathology, technology, and interior …

Arts-Based Sustainability: From New York To Malawi, Martha B. Lerski

Publications and Research

Recognizing that libraries serve multiple constituencies and subject areas, this chapter documents and advocates for development of transdisciplinary arts-based research (ABR) and culture-related projects linked to environmental challenges. Libraries contribute collections and spaces, as well as the research of library and information scientists. Libraries are currently among invisible contributors to sustainability planning and services. The chapter will link this invisibility to the value of what visual arts refer to as negative space elements in subjects ranging from traditional ecological knowledge to environmental science. Library collections, projects, and research contribute to education for sustainable development (ESD) as required to achieve the …

Molecular Insights Into The Role Of Estrogen Receptor Beta In Ecdysterone Mediated Anabolic Activity, Syeda Sumayya Tariq, Madiha Sardar, Muhammad Shafiq, Hendrick Heinz, Mohammad Nur-E-Alam, Aftab Ahmad, Zaheer Ul-Haq

Pharmacy Faculty Articles and Research

Ecdysterone, often dubbed a “natural steroid,” has garnered significant attention among athletes for its reputed growth-promoting and anabolic properties. Unlike synthetic anabolic steroids, which are classified as controlled substances, ecdysteroids remain largely unregulated in many countries and are widely marketed as dietary supplements. Notably, ecdysterone has been included in the World Anti-Doping Agency (WADA) monitoring program, highlighting its potential impact on athletic performance and raising questions about its regulation. Emerging evidence indicates that, unlike traditional anabolic steroids that act primarily via the Androgen Receptor (AR), ecdysterone’s anabolic effects may be mediated through Estrogen Receptors (ERs), particularly Estrogen Receptor beta (ERβ). …

Analyzing “Sex Ed: The College Edition” - A Comprehensive Workshop Increasing Sexual Literacy On Cal Poly’S Campus, Merav Tzori

Kinesiology and Public Health

"Sex-Education: The College Edition", is a comprehensive and interactive workshop based on Cal Poly student data collected via survey. The workshop aimed to address sexual health knowledge and behavior gaps in the student population and provide sexual education about anatomy, barrier methods, contraception, STIs, and more. The following paper discusses the creation, execution, and efficacy of the workshop that was conducted with seven student groups.

Tailoring Evaluations Of Chronic Rhinosinusitis: Understanding Sleep And Its Effect On Memory Through Actigraphy, Donyea Moore, Rachel Nolte, Yitong Pepper Huang, Shreya Maharana, Pavan Nataraj, Bichun Ouyang, Mahboobeh Mahdavinia

Mathematics Sciences: Faculty Publications

Background/Objectives: Chronic rhinosinusitis (CRS) is a persistent inflammatory condition of the sinonasal mucosa lasting for at least three months. For patients, CRS-related sleep disturbances can significantly disrupt circadian rhythms, leading to further health complications such as cognitive impairment. Despite the well-documented sleep disturbances associated with CRS, there is limited research on objective assessment methods. Additionally, the severity of these issues can vary among patients. This study aims to assess sleep quality and timing in CRS patients and investigate their impact on cognition, providing guidance for personalized and tailored assessment and management of CRS. Methods: Our case–control study compares sleep patterns …

Computerized Diagnostic Decision Support Systems-Isabel Pro Versus Chatgpt-4 Part Ii, Joe M Bridges, Xiaoqian Jiang, Michael Ige, Oluwatoniloba Toyobo

Faculty, Staff and Student Publications

Objective: Does a Tree-of-Thought prompt and reconsideration of Isabel Pro's differential improve ChatGPT-4's accuracy; does increasing expert panel size improve ChatGPT-4's accuracy; does ChatGPT-4 produce consistent outputs in sequential requests; what is the frequency of fabricated references?

Materials and methods: Isabel Pro, a computerized diagnostic decision support system, and ChatGPT-4, a large language model. Using 201 cases from the New England Journal of Medicine, each system produced a differential diagnosis ranked by likelihood. Statistics were Mean Reciprocal Rank, Recall at Rank, Average Rank, Number of Correct Diagnoses, and Rank Improvement. For reproducibility, the study compared the initial expert panel run …

Graduate School Blog - June 2025, Cynthia Haynes

UofM Grad School Blog

The June 2025 edition of the UofM Graduate School Blog helps prospective and current students make informed financial decisions with Part 1 of the Graduate School Cost Guide, breaking down tuition structures such as per-credit hour versus flat-rate models, highlighting UofM’s tuition cap for in-state students, and explaining key university fees and cost differences between online and on-campus formats. The blog also features Brianna Reilly, a Doctor of Musical Arts graduate from New York, who shares how a graduate assistantship and her passion for music education led her to continue at UofM through the pandemic. Additional resources include an …

Topodino: Self-Supervised Topological Representation Learning For Neuronal Morphologies, Yasser Binbisher

Master's Theses

Neuronal cell types are categorized by transcriptomic identity, yet their morphological heterogeneity defies this classification. In response, researchers have adopted unsupervised graph representation learning as a tool to reveal morphological variation within single-class transcriptomic types. However, the complex geometry of neuronal morphology—especially long axons and dense dendrites—challenges graph neural networks, which struggle with message propagation across extended structures. To mitigate this, current approaches enforce sub-sampling on neuronal graphs and omit axons entirely, sacrificing critical biological features for computational efficiency. To overcome this trade-off, this thesis introduces TopoDINO, a self-supervised, topology-aware representation learning model designed to preserve the full hierarchical organization …

Access To Healthcare For Rural Transgender Adults In The United States, Devon Smith

University Honors Theses

Urban and rural healthcare differ significantly in the amount of facilities, providers and kinds of specialty care that are offered in each environment. The United States is split into urban and rural counties in any given region, and based on those population sizes, are the allocation of healthcare resources for residents. In rural areas in the U.S., transgender adults lack access to gender-affirming care and encounter a lack of gender-affirming care providers due to workforce shortages, discrimination, and a lack of cultural competency. To determine if these residents lacked access to care compared with their urban counterparts, I performed a …

Transforming The Future Of Health: Building Learning Health Systems Across The Globe, Sandra Yankah, Robert Saunders, Mark L. Tykocinski, Claudia Salzberg, Jonathan Gonzalez-Smith, Rachel Bonesteel, Cameron Joyce, Charles Kahn, Mark Mcclellan, Eyal Zimlichman

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Health care has faced disruptions over the past 5 years, including a global pandemic, supply chain interruptions, workforce shifts, and the introduction of new artificial intelligence (AI) tools. Health care organizations continue to leverage the learning health system (LHS) concept to adapt to these challenges through iterative feedback loops. The Future of Health (FOH), an international community of over 50 senior health leaders that focuses on shared challenges across international health systems, collaborated with the Duke-Margolis Institute for Health Policy in a consensus-building process with FOH members to identify opportunities for action in an LHS. Key areas for action identified …

Nf2 Loss-Of-Function And Hypoxia Drive Radiation Resistance In Grade 2 Meningiomas, Bhuvic Patel, Sangami Pugazenthi, Collin W English, Vijay Nitturi, Shree S Pari, Tatenda Mahlokozera, William A Leidig, Hsiang-Chih Lu, Alicia Yang, Kaleigh Roberts, Patrick Desouza, Kyle P Mcgeehan, Diane D Mao, Namita Sinha, Joseph E Ippolito, Sonika Dahiya, Allegra Petti, Hiroko Yano, Tiemo J Klisch, Akdes S Harmanci, Akash J Patel, Albert H Kim

Duncan NRI Faculty and Staff Publications

Background: World Health Organization Grade 2 meningiomas (G2Ms) often recur and resist therapies. Grade 2 meningiomas with histopathological necrosis have been associated with worse local control (LC) after radiation therapy, but the drivers and biomarkers of radiation resistance in G2Ms remain unknown.

Methods: We performed genetic sequencing and histopathological analysis of 113 G2Ms and investigated the role of genetic and microenvironmental factors on clonogenic survival after ionizing radiation. We performed transcriptional profiling of our in vitro model and 18 human G2M tumors by bulk RNA sequencing as well as 8 G2Ms by single nuclei RNA sequencing.

Results: NF2 loss-of-function (LOF) …

What References Are Chatgpt, Gemini, Copilot, And Perplexity Providing For Consumer Health Questions?, Ivan Portillo, Scott Johnson, Catherine Johnson

Library Presentations, Posters, and Audiovisual Materials

No abstract provided.

Functional Vs Structural Cortical Deficit Pattern Biomarkers For Major Depressive Disorder, Peter Kochunov, Bhim M Adhikari, David Keator, Daniel Amen, Si Gao, Nicole R Karcher, Demetrio Labate, Robert Azencott, Yewen Huang, Hussain Syed, Hongjie Ke, Paul M Thompson, Danny J J Wang, Braxton D Mitchell, Jessica A Turner, Theo G M Van Erp, Neda Jahanshad, Yizhou Ma, Xiaoming Du, William Burroughs, Shuo Chen, Tianzhou Ma, Jair C Soares, L Elliot Hong

Faculty, Staff and Student Publications

Importance: Major depressive disorder (MDD) is a severe mental illness characterized more by functional rather than structural brain abnormalities. The pattern of regional homogeneity (ReHo) deficits in MDD may relate to underlying regional hypoperfusion. Capturing this functional deficit pattern provides a brain pattern-based biomarker for MDD that is linked to the underlying pathophysiology.

Objective: To examine whether cortical ReHo patterns provide a replicable biomarker for MDD that is more sensitive than reduced cortical thickness and evaluate whether the ReHo MDD deficit pattern reflects regional cerebral blood flow (RCBF) deficit patterns in MDD and whether a regional vulnerability index (RVI) thus …

Predictors Of Nursing Students' Stress, Anxiety, And Depression During The Covid-19 Pandemic In A Hispanic-Serving University In South Texas: A Cross-Sectional Study, Maria I. Diaz, Eleftherios Gkioulekas, Nancy Nadeau

School of Mathematical & Statistical Sciences Faculty Publications

Background: In nursing education, there have been several studies on the impact of the COVID-19 pandemic on the ability of nursing students to cope while in nursing school.

Purpose statement: The goal of this study is to assess undergraduate nursing students' support mechanisms as predictors of stress, anxiety, and depression during the COVID-19 pandemic within a Hispanic-serving institution in South Texas.

Methods: Across-sectional design was used in this study. An online survey using self-reported questionnaires was used to gather data from an undergraduate nursing student cohort during the Fall 2021 semester. Linear regression was used to identify the predictors of …

Biological Age Acceleration Associated With The Progression Trajectory Of Cardio-Renal–Metabolic Multimorbidity: A Prospective Cohort Study, Yixing Tian, Jinqi Wang, Tianyu Zhu, Xia Li, Haiping Zhang, Xiaoyu Zhao, Xinghua Yang, Yanxia Luo, Lixin Tao, Zhiyuan Wu, Xiuhua Guo

Research outputs 2022 to 2026

Objectives: Previous studies have confirmed that biological age (BA) acceleration is associated with single cardio-renal–metabolic diseases (CRMDs), typically including type 2 diabetes mellitus, cardiovascular disease, and chronic kidney disease. However, its association with progression to cardio-renal–metabolic multimorbidity (CRMM, coexistence of ≥2 CRMDs) and subsequent mortality remains unexplored. Methods: Using the multi-state model, we analyzed 278,927 UK Biobank participants free of CRMDs at baseline to investigate the association between BA acceleration—measured by phenotypic age (PhenoAge) and Klemera–Doubal method age (KDMAge)—and CRMM progression trajectory, from health to the first CRMD and then to CRMM and death. BA acceleration was the residual from …

An Eco-Epidemiological Model For Malaria With Microsporidia Mb As Bio-Control Agent, Charlène N.T. Mfangnia, Henri E.Z. Tonnang, Berge Tsanou, Jeremy Keith Herren

All Peer-Reviewed Publications

Microsporidia MB is an endosymbiont which naturally infects Anopheles mosquitoes. Due to its ability to block Plasmodium transmission, it shows potential as a bio-based agent for the control of malaria. Its self-sustainability is promising, as it can spread through both vertical and horizontal transmissions. However, its low prevalence in mosquito populations remains a challenge. We develop an eco-epidemiological mathematical model describing the co-dynamics of Microsporidia MB (within mosquito population) and malaria (within human population). The model is used to assess the potential of Microsporidia MB-infected mosquitoes on the control of malaria infection. The results on the basic reproduction numbers, the …

Residential Factors Associated With Mental Health In United States Veterans, Air Force Military, And Air Force Employees, Andrew J. Hoisington, Christopher A. Stamper, Molly Penzenik, Meredith Reitter, Elizabeth J. Kovacs, Nazanin H. Bahraini, Lisa A. Brenner

Faculty Publications

Individuals in Westernized countries spend most of their time indoors. However, exploration of residential building factors that may influence occupants’ mental health is limited in scientific literature. The purpose of this study was to explore investigator's perceived areas of importance in residences to mental health via survey methods. To that end, we administered the Housing, Occupancy, Materials, and Environment (HOME) survey to assess factors that may influence mental health to those working in the United States (US) Air Force (n = 230) or past military members, US Veterans (n = 180). Self-reported mental health surveys were also administered to the …

Injectable Ionic Hydrogel Conductors: Advancing Material Design To Transform Cardiac Pacing, Gabriel J Rodriguez-Rivera, Allison Post, Mathews John, Derek Bashe, Fei Xu, Trace Larue, Abbey Nkansah, Megan Wancura, Malgorzata Chwatko, Christina Waldron, Nikhith Kalkunte, Janet Zoldan, Mathieu Arseneault, Abdou Elgalad, Manuel K Rausch, Mehdi Razavi, Elizabeth Cosgriff-Hernandez

Faculty, Staff and Students Publications

Direct pacing of the mid myocardium where re-entry originates can be used to prevent ventricular arrhythmias and circumvent the need for painful defibrillation or cardiac ablation. However, there are no pacing electrodes small enough to navigate the coronary veins that cross these culprit scar regions. To address this need, we have developed an injectable ionically conductive hydrogel electrode that can fill the epicardial coronary veins and transform them into flexible electrodes. A new hydrogel chemistry based on a polyether urethane diacrylamide macromer was developed that matches myocardial stiffness and is resistant to hydrolysis. Conductivity was imparted using ionic precursor solutions …

Clinical Trial Readiness In Limb Girdle Muscular Dystrophy R1 (Lgmdr1): A Grasp Consortium Study, Stephanie M Hunn, Amanda Clause, Conrad C Weihl, Et Al.

2020-Current year OA Pubs

OBJECTIVE: Identifying functional measures that are both valid and reliable in the limb girdle muscular dystrophy (LGMD) population is critical for quantifying the level of functional impairment related to disease progression in order to establish clinical trial readiness in the context of anticipated therapeutic trials.

METHODS: Through the Genetic Resolution and Assessments Solving Phenotypes in LGMD (GRASP-LGMD) Consortium, 42 subjects with LGMDR1 were enrolled in a 12-month natural history study across 11 international sites. Each subject completed a battery of clinical outcome assessments (COA), including the North Star Assessment for Limb Girdle-Type Dystrophies (NSAD), 10-m walk/run, and Performance of the …

Nf2 Loss-Of-Function And Hypoxia Drive Radiation Resistance In Grade 2 Meningiomas, Bhuvic Patel, Sangami Pugazenthi, Shree S Pari, Tatenda Mahlokozera, William A Leidig, Hsiang-Chih Lu, Alicia Yang, Kaleigh Roberts, Patrick Desouza, Kyle P Mcgeehan, Diane D Mao, Namita Sinha, Joseph E Ippolito, Sonika Dahiya, Hiroko Yano, Albert H Kim, Et Al.

2020-Current year OA Pubs

BACKGROUND: World Health Organization Grade 2 meningiomas (G2Ms) often recur and resist therapies. Grade 2 meningiomas with histopathological necrosis have been associated with worse local control (LC) after radiation therapy, but the drivers and biomarkers of radiation resistance in G2Ms remain unknown.

METHODS: We performed genetic sequencing and histopathological analysis of 113 G2Ms and investigated the role of genetic and microenvironmental factors on clonogenic survival after ionizing radiation. We performed transcriptional profiling of our in vitro model and 18 human G2M tumors by bulk RNA sequencing as well as 8 G2Ms by single nuclei RNA sequencing.

RESULTS: NF2 loss-of-function (LOF) …

From Industrial Building To Affordable Senior Housing: An Idea Book Beyond Code, Weiyi Ma

Masters Theses

This thesis envisions a proposal to adaptively re-purpose Rhode Island’s extant industrial building stock into affordable housing tailored to the needs of its older and more vulnerable citizens. Architectural dignity, in terms of older citizens amidst this housing crisis, is the creation of living environments that honor their autonomy, comfort, and identity through design interventions that provide accessible, luminous, breathable, and socially enriching spaces, reaffirming their rightful place within the community. With humanistic care and logical rigor, it establishes a mathematical framework for assessment and execution, anchored in five criteria: light, air, space, accessibility, and livability, and presents itself in …

Field Journal: The Excluded Middle, Carrie E. Kouts

Masters Theses

What does it look like to engage with organisms and landscapes at the periphery of anthropocentric value structures? How does one break the internalized myth that the “built” environment is excluded from the natural world? When does a hyper-mobile and hyper-commodified society confront the exponential crisis of animal death? Within this series of journal entries, field notes, collection observations, weird prose, and sensory musings, one will find questions on the nature of being human and the complex narratives of care we encounter in a world shared with more-than-humans. Each handwritten vignette and photograph from daily life weaves a non-linear and …

Gamified Gait Rehabilitation Via Real-Time Biofeedback And Adaptive Hip-Exoskeleton Control, Mariya Huzaifa Tohfafarosh

Theses

Gait impairments arise from systemic diseases, age-related degeneration, musculoskeletal dysfunctions, or neurological conditions. While traditional rehabilitation can be effective, they often face challenges such as high costs, inaccessibility, and low patient engagement. To address these challenges, my work introduces a virtual reality-based rehabilitation (VRBR) system, integrating real-time motion and electromyographic (EMG) muscle activation feedback with a gamified virtual environment for enhanced adaptability and engagement. The system includes a custom-designed hip-exoskeleton that provides adaptive spring-like assistance or resistance, supporting both mobility-impaired users and strength training. Assistance levels can be tuned to match the user's progress. Additionally, a custom pressure insole was …