Search Results (781)

Background: Drop finger may occur in patients with C7 and/or C8 cervical radiculopathy caused by cervical spondylosis. Although surgical decompression of the affected nerve roots is performed in patients with drop finger refractory to conservative treatment, postoperative recovery of drop finger is often unsatisfactory. Furthermore, no effective rehabilitation strategy for improving drop finger has yet been established. Methods: Here, we report a patient with drop finger who underwent a novel postoperative rehabilitation program. A 64-year-old man presented with drop finger of the left hand caused by left C7 and C8 radiculopathy and underwent cervical foraminotomy. For postoperative rehabilitation, we applied the single-joint Hybrid Assistive Limb (HAL), a wearable robotic suit. The patient underwent a total of 21 sessions of metacarpophalangeal HAL training, which assisted voluntary flexion and extension movements of the metacarpophalangeal joints, and 6 sessions of wrist abduction HAL training, which assisted ulnar-direction wrist abduction movements. Results: As a result, improvement in the left-sided drop finger was achieved. In this case, the use of HAL enabled voluntary motor training within the normal range of motion of the fingers and wrist even during the early postoperative phase, when sufficient neurological recovery had not yet been achieved. Conclusions: This successful motor experience may have facilitated the reacquisition of normal movement patterns, thereby contributing to improvement in drop finger. Full article

Background: Lateral eye movements are part of natural ocular motility, and their effect on tear film behavior is largely unknown because they are usually not evaluated during tear film examinations, where patients are required to look straight ahead. This study aimed to determine what happens to the tear film during lateral eye movements in the absence of blinking. Methods: Tear film dynamics during a sequence of open-eye lateral gaze maneuvers were recorded using an infrared camera system (TearView). Results: The study included 15 healthy participants (5 female; median age 26) who had no ocular surface-related complaints. It was observed that lateral eye movements exposed new ocular surface areas not previously covered by the tear film. The tear film margins reacted to lateral eye movements by spreading towards the newly uncovered ocular surface areas, thereby recoating them. This response was asymmetrical, with a tear reservoir in the lacus lacrimalis of the medial canthus providing additional tear film spread only during ocular abduction. Conclusions: These findings expand our understanding of tear film physiology beyond static gaze. They might also bear implications for dry eye disease and oculoplastic surgical techniques affecting the medial canthus. Full article

Background/Objectives: Dynamic balance during the Y-Balance Test (YBT) relies on coordinated multi-joint control of the lower extremity. Although hip muscle strength is considered important for YBT performance, the relative contribution of individual hip muscle groups remains insufficiently understood. This study aimed to examine the associations between isometric hip abduction, external rotation, and extension strength and YBT performance in healthy adults. Methods: In this cross-sectional study, 104 healthy adults underwent assessment of isometric hip abduction, external rotation, and extension strength using strap-stabilized handheld dynamometry. Hip extension strength was measured in the prone position with the knee flexed to 90°. Strength values were normalized and expressed as joint torque (Nm/kg). YBT performance was assessed in the anterior, posteromedial, and posterolateral directions and as a composite score. Associations were examined using Pearson correlation coefficients. To account for the dependency of bilateral measurements, a linear mixed model (LMM) was used to evaluate the collective and independent contribution of hip strength components to YBT performance, with sex, age, and BMI included as covariates. Results: All hip strength measures showed significant positive correlations with YBT performance (r = 0.19–0.49, p < 0.05). Hip extension strength demonstrated the strongest associations, particularly with posterolateral reach (r = 0.49). After adjustment for demographic covariates, sex was the strongest predictor of YBT performance across all directions (β = 7.8–8.9, p < 0.001), with males achieving higher scores than females. Hip extension and abduction strength were significant predictors of posterolateral reach (p < 0.05), whereas no hip strength variable independently predicted anterior reach or composite score after adjustment for demographic factors. No significant differences in YBT performance were observed between limbs. Conclusions: Sex was the strongest predictor of YBT performance in healthy adults. Hip extension and abduction strength were independently associated with posterolateral reach performance after controlling for demographic factors, suggesting that the association between hip muscle strength and dynamic balance may be direction-specific. These findings highlight the importance of accounting for sex when interpreting the relationship between hip strength and YBT performance. Full article

Background/Objectives: Standard plyometric, flexibility and balance drills are central to youth rhythmic gymnastics but can be limited by repetitive monotony and reduced engagement. This study evaluated whether embedding plyometric or flexibility exercises within traditional games improves physical performance and lower-limb flexibility in young female gymnasts. Methods: Forty-two female gymnasts (age 13.7 ± 1.5 years) were randomly assigned (1:1:1, permuted-block randomization with allocation concealment) to a game-based plyometric group (PECG), a game-based flexibility group (FECG), or a standard gymnastics control (GE). Over 8 weeks (five sessions per week) the experimental groups performed their protocols immediately before regular training, with load recalibrated every two weeks. Squat jump (SJ), countermovement jump (CMJ) and hip flexibility were pre-specified primary outcomes; agility, Stork balance and Y-Balance were exploratory. Linear mixed models tested Group × Time interactions, with within-group effect sizes expressed as Cohen’s d. Results: Significant Group × Time interactions emerged for the squat jump (F_2,39 = 6.09, p = 0.005) and countermovement jump (F_2,39 = 6.77, p = 0.003), favoring PECG (SJ β = 1.90; CMJ β = 1.86). FECG produced the largest flexibility gains, with significant Group × Time interactions for hip abduction and left hip flexion; a marked within-group increase in right hip extension (β = 2.65) was not accompanied by a significant interaction and is interpreted with caution. PECG also improved agility (p = 0.001), static balance and several Y-Balance directions. No injuries or dropouts were recorded. Conclusions: An 8-week game-based intervention enhanced physical performance in adolescent rhythmic gymnasts, with effects largely specific to the training modality: plyometric games improved explosive power, agility and dynamic balance, whereas flexibility games improved range of motion. Given the small sample, the findings should be regarded as preliminary and hypothesis-generating. Full article

Background: Evidence on powered wearable exoskeleton gait training in patients with chronic hypoxic-ischemic encephalopathy (HIE) is virtually absent, and existing studies have focused on macroscopic functional outcomes while neglecting joint-level neuromuscular force-generation characteristics such as rate of force development (RFD). Objective: To examine the effects of a six-week powered exoskeleton gait training program on isometric hip strength and RFD, sit-to-stand (STS) performance, frontal-plane hip strength, and center-of-pressure (CoP) dynamics in a patient with chronic HIE-induced quadriparesis. Methods: A case report with pre- and post-intervention evaluation was conducted. A 47-year-old male with chronic HIE-induced quadriparesis (onset 2017) completed 18 sessions (three per week, six weeks) of powered lower-limb exoskeleton gait training. Outcomes included isometric hip peak force and RFD (DynaMo, Vald Performance), STS peak force and body mass-normalized RFD (ForceDecks, Vald Performance), frontal-plane hip strength (ForceFrame, Vald Performance), and CoP path length and mean velocity. Results: Hip extension peak force increased by 247–256% bilaterally, and hip extension RFD increased by 174–188%, whereas hip flexion peak force showed minimal change (+3.3–5.2%). Body mass-normalized STS RFD increased by 250% (10 to 35 N·s⁻¹·kg⁻¹), representing the largest relative gain. Hip abduction strength increased by 27.1–36.8% with improved bilateral symmetry; hip adduction imbalance reversed from right to left dominance. CoP path length and mean velocity each decreased by 3.7%. Conclusions: Six weeks of powered exoskeleton gait training selectively enhanced time-dependent neuromuscular output—particularly RFD—beyond maximal strength gains, with meaningful improvements in functional weight acceptance during STS. These findings support exoskeleton-based training as a promising rehabilitation strategy for patients with chronic CNS injury. Full article

European sustainability transitions are increasingly defined by the convergence of blue, green, and circular economy agendas. Traditionally analysed and governed in isolation, these domains generate important interdependencies, trade-offs, and coordination challenges that remain insufficiently understood. Drawing on the multi-level perspective (MLP) and recent advances in multi-system dynamics, this article introduces the Resource Infrastructure Economy (RIE) as a novel integrative framework. The RIE differs from existing multi-system frameworks by explicitly integrating marine governance as a full socio-technical regime, theorising regulatory-driven regime coupling as a distinct transition pathway, and foregrounding the constitutive role of shared physical and digital infrastructures in shaping value creation, path dependencies, and distributional outcomes. The RIE conceptualises contemporary European transitions as processes of deep regime coupling and infrastructural integration, whereby energy, marine, and material regimes become tightly coordinated through shared physical and digital infrastructures and assertive regulatory steering. Through a systematic integrative literature review (58 core publications selected from over 450 records following PRISMA guidelines, analysed using abductive thematic analysis with MAXQDA 26 software) and comparative analysis of six countries—Portugal, Spain, Denmark, Germany, the Netherlands, and Norway—the study reveals persistent structural gaps between the three agendas alongside emerging patterns of pairwise and triadic regime coupling. While Northern and Central European frontrunners demonstrate more advanced infrastructural coordination, Southern peripheral regions face greater difficulties in governance integration and just transition outcomes. The RIE framework advances sustainability transitions theory in three ways: (1) systematically integrating blue economy scholarship into multi-system analysis; (2) theorising regulatory-driven regime coupling as a distinct transition pathway; and (3) foregrounding the constitutive role of physical and digital infrastructures and environmental data systems in shaping value creation, path dependencies, and distributional outcomes. By reframing European sustainability transitions through the lens of the Resource Infrastructure Economy, this article provides a new conceptual lens to understand uneven transition geographies and offers actionable insights for more integrated and just policy coordination across the European Green Deal. Full article

Introduction: Breast cancer-related lymphedema (BCRL) is a disabling complication, and the effectiveness of exercise as treatment remains uncertain. Objective: We aimed to evaluate the effectiveness and safety of exercise in women with BCRL. Methods: A comprehensive search was conducted in MEDLINE, Embase, Cochrane Library, PEDro, and LILACS from database inception to March 2025, collating systematic reviews (SRs) of randomized controlled trials (RCTs) evaluating exercise, alone or combined with physiotherapy, in women with BCRL. Risk of bias was assessed using ROBIS and RoB 2, certainty of evidence (CoE) using GRADE, and overlap using GROOVE. Results: Of 2023 records, 9 SRs including 170 primary studies were included; after overlap management, eligible RCT data were synthesized by comparison and outcome. Supervised weightlifting probably reduced the risk of a ≥5% long-term increase in lymphedema volume (RR: 0.13; 95% CI: 0.07–0.25; moderate CoE), but evidence is very uncertain regarding ≥5% volume reduction (RR: 0.85; 95% CI: 0.44–1.66; very low CoE). Aquatic exercise may improve shoulder flexion (MD: 8.73 degrees; 95% CI: 3.55–13.91; low CoE) and shoulder abduction (MD: 6.87 degrees; 95% CI: 2.50–11.24; low CoE) compared with Pilates. No adverse events were reported, although they were not systematically defined or reported. Conclusions: Supervised weightlifting probably prevents increases in lymphedema volume, and aquatic exercise may improve shoulder mobility; however, the evidence remains uncertain, and the absence of adverse events does not confirm safety. Registration: PROSPERO (CRD42022334433). Full article

Ocular ductions deform the optic disc and peripapillary blood vessels, and deformations can be interpreted as mechanical strain. We used confocal scanning laser ophthalmoscopy (cSLO) to map strain in disc and peripapillary retinal vessels associated with the cardiac pulse and determine if such strain is influenced by gaze direction. Sets of 13 infrared cSLO images were obtained sequentially for each eye using a Heidelberg Spectralis scanner in cinematic mode over a 3 sec interval in adults. Imaging was repeated in central, and horizontally (30° adduction/abduction) and vertically eccentric gazes (10° supraduction/infraduction). Retinal vessels, optic disc, and fovea were segmented using custom-trained, deep learning-based models. Frame to frame vascular displacements were automatically determined using optical flow analysis, allowing computation of equivalent strain. A total of 25 eyes of 13 subjects of mean age 39 ± 18 (standard deviation, range: 25 to 81) years were included. Average equivalent strain over 3 sec ranging from 0.27% to 0.36% exceeded the 0.16% noise threshold across all gazes and regions, indicating measurable pulse-induced deformation. After adjustment for age and axial length, pulsatile maximum and minimum strain were influenced slightly by gaze direction, maximally for supraduction, whereas mean strain did not vary significantly with gaze. The cardiac pulse induces measurable deformation of retinal vessels that can be quantified as equivalent strain in the image plane using optical flow-derived displacement fields. However, the interaction of pulse strain with gaze direction is unlikely to be a significant confound for investigations of strains associated with eye movements. Full article

(1) Introduction: Transit-oriented development is often framed as a strategy to expand opportunity and advance equitable transportation. However, evidence suggests it can also contribute to rising housing costs and displacement in historically marginalized communities. This study examines how a light rail expansion reshaped displacement risk in a Latina/o community in the U.S. Southwest, identifying early mechanisms through residents’ interpretations of the expansion during construction. (2) Materials and Methods: Using a qualitative, community-engaged design, the study draws on ten in-depth pláticas with Latina/o residents conducted during construction of a major rail expansion. Data were analyzed abductively and guided by Critical Race Ecological Systems Theory (CrEST) to identify multilevel mechanisms linking infrastructure policy to lived social conditions. (3) Results: Findings identify three mechanisms through which transit investment generated displacement risk prior to relocation. First, historical and intergenerational memory shaping anticipatory displacement. Second, place-based belonging intensifying psychosocial stress and loss. Third, policy-mediated mobility constraining residents’ ability to remain or benefit from reinvestment. (4) Discussion: Transit infrastructure operates as a structural policy intervention that reorganizes risk, belonging, and stability when histories of racialized disinvestment are not incorporated into policy design. These findings position infrastructure planning as a critical site for social work policy analysis and prevention-oriented intervention. Full article

Digital Transformation (DT) increasingly relies on project-based organizing to develop and deploy new capabilities, yet corporate innovation projects frequently stall not for lack of ideas but because of recurring governance and resource-commitment bottlenecks. This study presents a micro-longitudinal, AI-enabled, and human-reviewed analysis of 711 episodes drawn from 28 weekly project governance meetings across two corporate startup initiatives participating in the same internal incubation program, conducted between November 2024 and April 2025. Employing a six-stage analytical pipeline that combines episode-level segmentation, linguistic tension markers, and a large language model (LLM) classifier, we identify 28 decision-relevant governance tensions, which are then abductively grouped into 13 project governance dilemmas and mapped onto Teece’s dynamic capabilities framework (sensing, seizing, reconfiguring). The key finding is that 62% of dilemmas are structural in nature—reflecting persistent governance design tensions between autonomy and control, compliance and agility, and centralization and decentralization—and that 69% concentrate at the seizing stage, corresponding to resource-commitment and execution decisions. This pattern indicates a governance choke point in corporate DT projects that is structural and decisional rather than ideational. By shifting attention from lagging indicators (overruns) to governance tension leading indicators, the approach supports earlier interventions to reduce decision latency and protect project delivery performance. We further synthesize two incubation-specific meso-level governance dilemmas—stakeholder engagement and compliance vs. agility—that serve as transmission mechanisms between macro structural constraints and micro-level decision bottlenecks. The AI-enabled pipeline is proposed as a replicable early-warning system for project governance tensions in organizations pursuing digital transformation. Full article

Background and Objectives: Developmental dysplasia of the hip (DDH) is an orthopedic condition in the pediatric population, affecting between 0.1% and 3% of infants. Chile has one of the highest incidences in South America, reaching 1 per 500 live births. Given the potential of adverse consequences of DDH on infant health, preliminary studies are needed to determine its prevalence in the population and assess its association with relevant risk factors. Materials and Methods: The study is single-center, conducted in a Chilean population. The sample size calculation determined the use of 100 pelvic radiographs, considering a 95% confidence level and a proportion of 0.5. The infants were between 90 and 150 days old. Information was collected on possible DDH-related risk factors. For the analysis, normality tests, Chi-square tests, independent samples t-tests, Mann–Whitney U tests, and multivariate analyses were applied. Results: The prevalence of DDH was determined to be 12%, affecting the left hip to a greater extent. Female infants had a higher frequency of DDH. A statistically significant association was found between the prevalence of DDH and the presence of asymmetry in the abduction of the hip joint (p = 0.023), acetabular roof obliquity (p = 0.003), left hip involvement (p = 0.002), and height at two months of age (p = 0.016). Conclusions: The prevalence of DDH in infants was higher than that reported in the literature. However, with regard to sex, the data coincide with those previously reported by other authors. Full article

Hip joint position sense (JPS), a key component of neuromuscular function arising from muscle spindle and periarticular mechanoreceptor input, remains underexplored, with no standardized and reliable clinical protocol available to assess hip proprioception. This study evaluated the intra- and inter-rater reliability of a laser- and inclinometer-based active hip JPS protocol and established preliminary references in healthy adults. A two-phase reliability study was conducted in accordance with GRRAS and COSMIN guidelines: 17 participants for reliability analyses and 57 for preliminary references. Six movement directions were assessed (flexion, extension, abduction, adduction, medial and lateral rotations). Reliability was quantified using intraclass correlation coefficients with their 95% confidence intervals, using two-way random-effects models with absolute agreement (ICC(3,1) for intra-rater and ICC(2,1) for inter-rater analyses), interpreted as poor (<0.50), moderate (0.50–0.70), or good (≥0.70). Absolute measurement error was reported as standard error of measurement (SEM%) and 95% minimal detectable change (MDC95%), normalized to target amplitudes to allow direct cross-direction comparison. Intra-rater reliability ranged from poor to moderate, with experienced raters reaching ICC = 0.64 (95% CI [0.39; 0.80]) for medial rotation. Inter-rater reliability improved across sessions, peaking for medial rotation (ICC = 0.78; 95% CI [0.50; 0.91]). Rotational movements yielded the lowest SEM% (3–6%), indicating high measurement precision despite trial-to-trial variability (MDC% 9–31%). Normative errors were largest in flexion (21.4 cm) and smallest in rotations (≈2.2–2.3°). Despite overall low-to-moderate reliability, the protocol achieved clinically acceptable measurement precision (SEM% < 10%) for rotational tasks, whereas the laser-based sagittal and frontal-plane components remained exploratory. The protocol provides preliminary reference values for hip JPS in healthy adults and requires further validation before clinical use. Full article

Background and Objectives: Brachial plexus birth injury (BPBI) is a peripheral nerve injury occurring during birth that may result in upper-extremity weakness and functional impairment. This systematic review aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on motor function, muscle strength, range of motion, and upper-extremity function in children with BPBI. Materials and Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO. PubMed, CINAHL, Scopus, Web of Science, PEDro, and the Cochrane Library were searched from inception to 5 May 2026. Only randomized controlled trials were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the RoB 2 tool. Results: Seven randomized controlled trials involving 197 participants were included. Several studies reported improvements in shoulder abduction, elbow flexion, wrist extension, muscle strength, and motor function following NMES compared with conventional therapy. The combination of NMES and constraint-induced movement therapy demonstrated favorable outcomes in functional performance. However, substantial heterogeneity was observed across studies regarding participant characteristics, NMES parameters, treatment duration, and outcome measures. The certainty of evidence ranged from low to very low. Conclusions: Current evidence suggests that NMES may serve as a potential adjunct to conventional rehabilitation in children with BPBI. However, given the low to very low certainty of the evidence, high risk of bias, and substantial clinical and methodological heterogeneity among the included studies, definitive clinical recommendations cannot currently be made. Future well-designed randomized controlled trials using standardized protocols, consistent outcome measures, and longer follow-up periods are warranted. Full article

This paper presents a comprehensive augmented reality (AR)-based rehabilitation system for upper-limb recovery that integrates AR-assisted art therapy, automated markerless goniometry, and the interval mathematical modeling of rehabilitation dynamics. The proposed platform combines four interconnected subsystems: a Python-based markerless video analysis module utilizing three stationary IP cameras, MediaPipe Pose Landmarker, and Kalman filtering; an AR art-therapy application developed for the Magic Leap 2 headset using Unity/OpenXR; a server-side subsystem implemented in NestJS/TypeScript; and a physiotherapist-oriented web application developed in React. The primary objective of the study is the real-time automated assessment of shoulder joint kinematics during AR-assisted rehabilitation sessions, including flexion (160–180°), extension (50–60°), and abduction (up to 180°). To describe and forecast rehabilitation dynamics, interval mathematical models based on recurrent difference equations were developed, enabling the prediction of subsequent joint angle values using the previous 3–4 observations. Structural and parametric identification of the interval models was performed using the artificial bee colony optimization algorithm. Experimental validation was conducted on rehabilitation data collected from five patients with different clinical diagnoses, including bursitis, epicondylitis, capsulitis, osteoarthritis, and fracture-related impairments. Under the considered experimental conditions, the proposed approach demonstrated promising predictive performance, with an angular prediction error below 5° and a correlation exceeding 95% between predicted and measured rehabilitation trajectories. The developed system implements a unified rehabilitation cycle of “execution–measurement–prediction–adaptation”, enabling the continuous monitoring of recovery dynamics, adaptive adjustment of rehabilitation scenarios, and estimation of the rehabilitation duration required to achieve target motor outcomes. The proposed approach contributes to the development of intelligent AR-based rehabilitation systems by combining markerless motion analysis, predictive interval modeling, and adaptive art-therapy mechanisms within a single clinical framework. Full article

Background: Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal disorder in newborns. Flexion–abduction orthoses are widely used in early treatment; however, in vivo data on their biomechanical load characteristics remain limited. This study aimed to evaluate axial force transmission in a hip flexion–abduction orthosis and to compare load patterns between healthy newborns and infants with DDH. Methods: In this exploratory observational study, 36 newborns (19 healthy, 17 with unilateral DDH) were examined within the first week of life. Axial forces transmitted through a Mittelmeier–Graf hip flexion–abduction orthosis (MGO) were measured using integrated force sensors under symmetrical and asymmetrical adjustment configurations. Intergroup comparisons were performed using non-parametric statistical tests. Results: Mean axial forces were significantly higher in healthy infants than in those with DDH under both symmetrical (4.02 N vs. 2.51 N; p = 0.019) and asymmetrical (3.67 N vs. 1.83 N; p = 0.001) conditions. Relative load corresponded to approximately 11–12% of body weight in healthy infants and 5–7% in the DDH group. No significant intra-individual differences were observed between dysplastic and contralateral hips. Orthosis configuration (symmetrical vs. asymmetrical) did not significantly affect load distribution. Conclusions: This exploratory in vivo study demonstrates that axial load transmission in a hip flexion–abduction orthosis is low and influenced by underlying hip pathology. Infants with DDH generate lower forces than healthy newborns, potentially reflecting altered biomechanics. As no significant differences were observed between orthosis configurations, symmetrical adjustment may be favored in clinical practice due to better usability and compliance. Further studies with larger cohorts are needed to confirm these findings. Full article