Search Results (10,825)

Background: Toe motor control contributes to postural stability and walking, yet clinical assessments have focused on toe-grip strength. The kinematics of selective toe extension under conditions requiring non-target toes to remain in contact with the ground remain poorly quantified. The aim of the present study was to characterize the kinematics and reliability of selective toe extension tasks using three-dimensional motion capture and to compare young and older adults. Methods: A total of 40 participants (20 young adults and 20 older adults) performed three tasks twice: all-toe extension, selective hallux extension, and selective four-toe extension (toes 2–5), with non-target toes required to remain in contact with the ground during selective tasks. Extension angles of the hallux, second, and fifth toes were quantified, and toe-grip strength was measured. Reliability was assessed using the intraclass correlation coefficient (ICC(1,2)). Toe angles were analyzed using two-way analysis of variance (group × condition, including resting and task conditions). Results: Toe angles demonstrated moderate to excellent reliability (ICC(1,2) = 0.81–0.95; 95% CI: 0.637–0.974). Compared with all-toe extension, both selective tasks showed reduced extension ranges, indicating an incomplete extension phenomenon in both groups. Significant group × condition interactions were observed for the hallux and second toes. During selective tasks, older adults exhibited greater unintended extension of non-target toes. Toe-grip strength was significantly lower in older adults (p < 0.001, Cohen’s d = 2.51). Conclusions: Selective toe extension tasks provide reliable kinematic indices of inter-toe motor control by quantifying incomplete extension and associated movements. Older adults showed greater associated movements under ground-contact constraints, suggesting age-related declines in motor coordination and possible reductions in toe flexor strength. Full article

This paper proposes a learning-based contact force controller using deep neural networks (DNN) and a PI controller. Stable contact force control between the foot and the ground is essential for humanoid robots to maintain balance during bipedal walking. While admittance controllers have been extensively employed for contact force control in humanoid robots, their performance is limited by the high nonlinearity inherent in robot systems. To overcome these limitations, we propose a deep neural network (DNN)–based inverse model, which leverages input–output data that inherently capture system nonlinearities. The proposed learning-based contact force controller computes the target foot height based on the target force, measured force, and measured foot height, without relying on a dynamic model of the articulated robotic leg. Furthermore, a PI controller is integrated to mitigate steady-state errors. Experimental comparisons between the proposed controller and an admittance controller were conducted using an articulated robotic leg. Compared with an admittance controller, the proposed method reduced overshoot by 96% and settling time by 61% on average in step responses and decreased force-tracking RMSE by 66.3% on average across both step and sinusoidal experiments. Full article

Background and aim: Traditional marker-based optical motion capture systems are costly, time-consuming to operate, and constrained by laboratory environments, limiting their broader adoption in clinical practice and naturalistic settings. Markerless motion capture based on a sums-of-Gaussians (SoG) body model is a potential alternative; however, its metrological properties for kinematic assessment during walking and slow running remain insufficiently validated. Using a conventional marker-based Vicon system as the reference, this study evaluated the reliability and concurrent validity of an SoG-based markerless system (MocapGS) for bilateral lower-limb joint range of motion (ROM) during gait. Methods: Thirty-six healthy adults completed self-selected-pace speed walking and slow running tasks while both systems synchronously acquired bilateral lower-limb kinematics. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM percentage (SEM%), minimal detectable change (MDC), MDC percentage (MDC%), and root mean square error (RMSE) were used to assess reliability. Concurrent validity was evaluated using the Pearson correlation coefficient, paired-sample t-tests, and the concordance correlation coefficient (CCC) to compare the ROM. Results: Vicon showed moderate-to-high reliability for ROM in most joints across both tasks. By contrast, the MocapGS achieved acceptable ICC values mainly for the sagittal-plane ROM at the hip and knee. The CCC analysis showed no significant agreement between the two systems. Bland–Altman plots showed systematic biases with spatially heterogeneous random errors. During walking, MocapGS systematically overestimated ROM relative to Vicon at several joint axes; the widest limits of agreement (LOA) occurred at the left knee X-axis and right hip Z-axis. During running, overestimation was consistent across all bilateral joints at the X-axis and the right hip at the Y-axis, while the widest LOA were found at the bilateral hip X-axes. These specific discrepancies highlighted the joint–axis combinations with the greatest measurement variance. In walking, the test–retest reliability of the knee flexion–extension ROM measured by the MocapGS approached that of Vicon; however, the SEM% and MDC% were generally larger for MocapGS than for Vicon. The RMSE exceeded 5 degrees for ROM in most joint planes, especially in the frontal and transverse planes and at distal joints; errors increased further during slow running. Conclusions: MocapGS may be used for coarse monitoring of large-magnitude changes in sagittal-plane kinematics during gait; however, it is currently unlikely to replace Vicon for clinical decision-making or detecting subtle gait changes, and its outputs should be interpreted with caution, particularly for ankle kinematics and non-sagittal-plane motion. Full article

Harvesting energy from human walking offers a promising alternative to batteries for powering wearable devices. However, existing energy harvesters suffer from limited power output. So, a novel non-resonant energy harvester was proposed in this paper. The core mechanism of the harvester integrates three components: a helical twin-rod twist rod, a face gear with dumbbell-shaped holes, and a rotor featuring bevel teeth on its upper surface. This core mechanism can efficiently harvest low-frequency reciprocating motion and convert it into unidirectional rotational motion, thereby enabling highly efficient acquisition of low-frequency energy. It offers advantages such as high energy harvesting efficiency and a simple structure. Then an electromagnetic generator converts this rotational energy into electricity. A prototype of the proposed harvester was developed and tested on a vertical reciprocating motion platform. Experiments investigated the influence of parameters including human input energy and mechanical harvesting structure on output performance of the harvester. Application testing demonstrated that manual pressing at 1 Hz successfully illuminated 120 LEDs. When integrated into a shoe heel and tested with a 60 kg person stepping in place at 2 steps per second, the harvester achieved an RMS output voltage of 18.5 V, an output power of 263.27 mW, and a power density of 4.21 mW/cm³. Overall, this research presents a new approach for designing high-efficiency energy harvesters for human walking applications. Full article

As a step towards advancing adaptive DBS control for Parkinson’s disease, we have developed an automated algorithm that detects tremor continuously on a seconds-resolution time scale from a wearable accelerometer and present the feasibility study test results. Triaxial acceleration data were wirelessly streamed from an Apple Watch as well as acquired from an internal accelerometer in the implanted DBS device itself. The algorithm first determines if there is any high-power voluntary activity, such as walking, using the arm, or transitioning from sitting to standing; then, it identifies peaks in the 4–7 Hz Parkinsonian tremor frequency band. Peak detection for tremor activity was more accurate using the Apple Watch than the IPG. Peak and harmonic detection were also more accurate using continuous wavelet transforms than short-time Fourier transform. According to the repeated measures correlation, our detection algorithm correlated strongly with DBS intensity (Subject RZCH: r = −0.93, p = 3.6 × 10⁻⁵; 6KOZ: r = −0.97, p = 1.6 × 10⁻⁵, NU5U: r = −0.94, p = 0.057). Pearson’s correlation coefficient between our tremor detection algorithm and the currently accepted industry metric was found to be 0.57 (t-value = 8.5, dof = 148, p < 1 × 10⁻⁶). Our algorithm is distinctive in the capability to detect Parkinsonian tremor, with a high degree of clinical relevance, during daily living activities and is able to discriminate tremor from walking, using a convenient, commercial wrist-worn accelerometer. Full article

Objective: The objective of this study was to examine how functional, mental, and physical health outcomes differ between younger (<age 50) and older (≥age 50) stroke survivors. Methods: Data from adult stroke survivors examined health-related outcomes (physical and mental health) over the past 30 days. Logistic regression models were used for binary functional outcomes, and Poisson regression models were used to estimate count outcomes for poor mental and physical health days. Results: Compared with older adults, younger stroke survivors were more likely to report difficulty concentrating or remembering (41.1% vs. 23.2%, p < 0.0001) and difficulty doing errands alone (27.11% vs. 23.67%, p = 0.00), but less likely to report difficulty walking or climbing stairs (34.3% vs. 47.6%, p < 0.0001). Additionally, younger adults with stroke reported significantly more poor mental health days (10.81 vs. 5.76, p < 0.0001) than older adults. In adjusted models, being out of work or out of the labor force was consistently associated with greater odds of functional limitations (e.g., OR for activity difficulty = 2.07, 95% CI: 1.56–2.75) and higher counts of poor mental and physical health days. Younger stroke survivors who were out of the labor force had significantly greater odds of difficulty concentrating (OR = 2.02, 95% CI: 1.17–3.48) and increased days of poor mental (IRR = 1.27, 95% CI: 1.19–1.70) and physical health (IRR = 1.26, 95% CI: 1.19–1.53). Conclusions: These findings highlight the intersection of age and employment on stroke outcomes. Younger stroke survivors face unique and disproportionate challenges in functional and mental health. Full article

The evolution of the mHealth era offers the possibility of behavioral interventions to promote changes in lifestyle habits with prevention relevance. These tools are considered digital therapeutics (DTx) and follow the MDR 745/2017 for testing, validation, and certification. In the frame of the ACTIVE3 project, we developed a platform composed of a mobile app, a wearable device, and a cloud backend to support healthy aging intervention in a population of 60–80-year-old subjects. This paper describes the clinical trial protocol and the baseline data of the recruited population. The explored parameters describe the effect of the DTx in the physical, nutritional (and metabolic), and cognitive domains, leveraging the Walking Group initiatives coordinated by ATS Brianza that are active in the Lecco area; in addition, system usability and acceptance were analyzed. The study started on 1 September 2024, and the analyzed baseline data are presented here. With respect to an expected population of 200 subjects, we received interest and consent to participate from 237 subjects: over-enrollment was allowed and all these subjects were accepted into the study. The characterization of the study population at the initial time of the trial was carried out, and the outcomes are presented here. The population is generally more active than Italian people of the same age. According to the outcome of the 6MWT, the population was divided into three groups: trained participants (42 subjects), active participants (142 subjects), and sedentary participants (58 subjects). The tests at month 12 were recently competed, and the final results will be available in winter 2025–2026. Full article

Background/Objectives: Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral artery disease characterized by ischemic rest pain or ulcer necrosis. In Europe, spinal cord stimulation (SCS) can be offered to CLTI patients with chronic pain to improve mobility and prolong limb preservation. We evaluated the long-term, real-world outcomes of SCS therapy in patients with CLTI. Methods: In this observational study, medical chart review data from consecutive CLTI patients treated with SCS were analyzed. Results: Fifty-three patients (56.6% Fontaine Stage III, 39.6% Fontaine Stage IV, 3.8% Fontaine Stage IIb) had a single-stage SCS implant procedure between 2013 and 2022. Two years after SCS therapy activation, claudication pain intensity had significantly improved; the overall numerical rating scale pain score decreased from 9.4 ± 0.9 at baseline to 3.7 ± 3.2 (p < 0.0001). In addition, walking distance increased by more than 350 m (from 70 ± 87 to 429 ± 320 m, p < 0.0001), and pre-existing skin lesions stabilized in ten patients (63%). The probability of limb survival in Fontaine’s stage IIb/III and Fontaine’s stage IV patients at 12 months was 90% and 70%, respectively (log-rank p-value = 0.04). Finally, significant associations were found between the occurrence of an amputation after SCS and Fontaine Stage (p = 0.01), active smoking (p = 0.02), hypertension (p = 0.04), and prior minor amputation (p = 0.02). No major complications were reported. Conclusions: Our real-world experience suggests that SCS for CLTI patients provides significant and durable improvements in ischemic pain and functional outcomes. SCS may also help reduce the natural risk of major amputation, especially when implemented at early CLTI stages. Full article

A 79-year-old former marathoner, with memory impairment since age 78, developed increasing stumbling and progressively worsening waddling gait. Three months after gait disturbance onset, she noted mild dysphagia. With declining walking distance and endurance, she presented to our hospital six months after onset, exhibiting frontal signs, Parkinsonism with marked trunk rigidity, and hyperreflexia of the jaw and limbs. L-dopa challenge tests showed no improvement. At seven months post-onset, she had difficulty rising. By nine months, she relied on a walker, and speech disturbance appeared. At 10–11 months, both dysarthria and dysphagia rapidly worsened, she became bed-ridden, and upper limb weakness developed (though she could still use chopsticks). Neurological examination at one year revealed severe dysarthria/dysphagia, four extremity fasciculations and muscle weakness (grade 2 in upper limbs, grade 1 in lower limbs), trunk-dominant rigidity, and hyperreflexia in the jaw and limbs. Brain MRI, specifically susceptibility-weighted imaging, revealed motor band signs. Cerebrospinal fluid study revealed albuminocytological dissociation. Needle electromyography revealed acute denervation and chronic reinnervation in the cranial nerve, cervical, and lumbar areas, which was suggestive of motor neuron disease (MND). Serum anti-GQ1b antibodies were detected. Immunotherapy was followed by mild improvement, which might suggest a reversible component, although definitive pathological overlap remains unconfirmed. This case highlights a diagnostic challenge where an acute immune-mediated neuropathy could potentially be superimposed on a chronic neurodegenerative process. Anti-GQ1b antibodies should be interpreted with caution, as they may reflect either a true clinicopathological overlap with Guillain-Barré syndrome or a secondary phenomenon (epiphenomenon) related to the primary neurodegenerative process. Full article

Background/Objectives: Pregnancy loss is a common and multifactorial complication of human reproduction, traditionally attributed to fetal chromosomal abnormalities, maternal anatomical and endocrine disorders, and immune dysfunction. Growing evidence now indicates that the maternal microbiome, particularly within the reproductive tract, plays a critical role in implantation, placental development, and the maintenance of immune tolerance during early pregnancy. Importantly, the influence of the microbiome on miscarriage appears to be strongly modulated by host genetic background and immune regulation. Methods: This narrative review summarizes current evidence linking alterations in the vaginal, endometrial, placental, and gut microbiomes to miscarriage, with a specific focus on host genetics and immune–microbial interactions. Results: We discuss how genetic variation in innate and adaptive immune pathways, inflammatory signaling, and mucosal barrier function may shape host responses to microbial communities, thereby influencing susceptibility to PL. In addition, we highlight emerging data on microbiome-driven regulation of gene expression and epigenetic modifications in the endometrium and decidua, emphasizing the role of microbial metabolites in immune tolerance and placental function. Conclusions: By integrating findings from microbiome research, host genomics, immunology, and epigenetics, this review proposes a framework in which miscarriage is viewed as a consequence of disrupted host–microbe crosstalk rather than isolated pathology. Finally, we address key methodological challenges and outline future research directions aimed at advancing mechanistic understanding and translational applications. Full article

Background/Objectives: This cross-sectional study evaluated associations between physical function, cognitive function, sarcopenia, and the lower-limb Muscle Quality Index (MQI) in older adults. Methods: Patients with various MQIs (strength-to-mass ratios) were stratified into two groups. Physical-muscular aspects were assessed using body mass index (BMI), a Simple Questionnaire to Rapidly Diagnose Sarcopenia (SARC-F), and handgrip strength. Cognitive aspects were assessed using Mini-Mental State Examination (MMSE), Trail Making Test, Stroop Test, verbal fluency, and dual-task performance. Seventy-nine older adults (73 ± 9 years) of both sexes completed the tests. Results: BMI, SARC-F, handgrip strength, MMSE, Stroop Test (L1), semantic verbal fluency (animals), and dual-task outcomes differed between MQI groups (p ≤ 0.05) and were associated with MQI in regression analyses. In the adjusted model, BMI, handgrip strength, and dual-task walking time were independently associated with MQI (adjusted R² = 0.514). Conclusion: Lower-limb MQI was associated with markers of sarcopenia and cognitive/dual-task performance in community-dwelling older adults. Full article

Accumulating evidence over the past decades has established that people conceptualize elapsing time along a sagittal mental timeline (MTL). A recent study discovered that representations of autobiographical memories (AMs) also proceed along a sagittal back-to-front MTL, consistent with the direction of sensorimotor experiences such as walking or running. The present investigation attempted to clarify and extend that work by exploring if the back-to-front axis for the temporal organization of AMs is a universal phenomenon across linguistic communities. An experiment that recruited Mandarin speakers as participants was conducted. The experimental task asked participants to categorize personal events retrieved from their AMs as past- or future-related via distinct key arrangements that corresponded to a back-to-front and a front-to-back line respectively. Results show that cross-linguistic variations may exist in the directionalities of MTL underlying AM processes. Contrary to the back-to-front MTL observed among Italian speakers in the aforementioned research, Mandarin speakers conceived of AM progression as oriented from front to back. The findings of the present study provide preliminary evidence to validate the predictive power of spatiotemporal metaphors rather than sensorimotor experience in shaping a sagittal MTL for AM representations, especially when the two forces contradict each other in terms of spatial directions. Full article

This study develops and evaluates machine learning models for classifying Korean Baseball Organization (KBO) playoff advancement using pitching metrics from 2015 to 2024 (N = 100 team-seasons), focusing specifically on pitching’s contribution to playoff qualification to address the ERA-FIP paradox at the team level. Five algorithms were compared: Random Forest, Support Vector Machines, Logistic Regression, Neural Networks, and Decision Trees. Independent variables included ten pitching statistics: Earned Run Average (ERA), Walks and Hits per Inning Pitched (WHIP), Fielding Independent Pitching (FIP), Strikeouts per 9 Innings (K/9), Walks per 9 Innings (BB/9), Strikeout-to-Walk Ratio (K/BB), Home Runs per 9 Innings (HR/9), batting average against (BAA), and opponent On-Base Percentage (OBP) and On-Base Plus Slugging (OPS). Logistic Regression achieved the highest classification performance with an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.804 and classification accuracy of 73.0%, followed by Neural Network (AUC = 0.799, CA = 72.0). Feature importance analysis showed ERA and WHIP, both defense-dependent metrics, as the dominant predictors of postseason qualification, collectively accounting for 33.7% of information gain, while FIP ranks fifth, indicating that defense-dependent metrics are more informative for team success than defense-independent measures. The findings highlight the strategic importance of pitching–defense synergy, demonstrate the applicability of machine learning-based playoff classification beyond Major League Baseball, and provide empirical evidence that defense-dependent metrics (ERA, WHIP) exhibit superior discriminatory power compared to defense-independent metrics (FIP) for team playoff qualification. Findings reflect pitching’s contribution to playoff success; comprehensive models integrating hitting, defense, and managerial factors would provide more complete classification frameworks. Full article

Objective: The objective of this study is to conduct a systematic review of the evidence on the use of remotely administered walking tests (RaWTs) in patients with chronic pulmonary diseases (CPDs) and heart failure (HF), focusing on agreement, reliability, feasibility, and clinical utility as outcomes. Methods: This study followed the Preferred Reporting Items for Systematic Reviews and was registered on the International Prospective Register of Systematic Reviews platform (ID: CRD420251180996). The PubMed, Web of Science, CENTRAL, Scopus, and ACM databases were comprehensively searched from inception up to October 2025. Observational, randomized and non-randomized control studies assessing the agreement, reliability, feasibility, and clinical utility of RaWTs in people with CPDs and HF and reporting quantitative outcomes were eligible. Two reviewers independently conducted study selection, data extraction, and risk of bias assessment using the COSMIN Risk of Bias tool for the reliability studies, the Risk of Bias in Non-Randomized Studies—of Interventions (ROBINS-I) tool for non-randomized studies, and the Quality in Prognosis Studies (QUIPS) tool for the prognostic studies. Results: Eleven studies met the inclusion criteria. Five studies included patients with HF, five with pulmonary hypertension (PH), and one study included candidates for lung transplantation due to advanced CPD. All studies used the 6 min walk test (6MWT); one also included the incremental shuttle walk test. Agreement with face-to-face in-clinic testing (in five studies) is setting-dependent and influenced by the testing setup. Reliability (in eight studies), derived from variable statistical indices in both patient populations, showed that RaWTs are reliable. Adherence and safety were used as the main feasibility indicators. Eight studies concluded that remote assessment is feasible, acceptable, and safe. Clinical utility was examined in only one HF study, showing that remotely administered 6MWT can predict all-cause mortality and HF hospitalization. According to COSMIN, the overall methodological quality of nine studies ranged from very good to inadequate. One study was rated as having a serious risk of bias according to ROBINS-I, and one study as having a high risk of bias according to QUIPS. Conclusions: Although the evidence is limited and heterogeneous, RaWTs demonstrate robust reliability across repeated measurements while agreement with in-clinic testing is context-dependent and strongly influenced by test setup and environmental conditions. RaWTs appear to be acceptable to patients; however, further high-quality studies are needed to confirm these findings and determine the clinical utility of RaWTs on specific clinical outcomes in these populations. Full article

Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results. Full article