Search Results (407)

Background/Objectives: Oral frailty and hypofunction in older adults are strongly associated with declines in nutritional status, physical function, swallowing ability, and overall health. Isolated interventions usually fail to achieve sufficient improvement since these conditions result from interrelated biological, psychological, and social factors. Multidisciplinary approaches combining oral management, nutritional support, and physical rehabilitation have shown promise. This narrative review synthesized evidence from 15 studies examining multifaceted interprofessional interventions across hospitals, communities, long-term care facilities, and home-care settings. Methods: A structured search of PubMed and Web of Science (2000–2025) identified original studies assessing oral, nutritional, or physical outcomes in older adults post-interprofessional interventions. Fifteen eligible studies were extracted; the findings were integrated using narrative synthesis owing to design and outcome heterogeneity. Results: Educational multidisciplinary interventions improved oral hygiene, caregiver awareness, and oral motor function. Multidisciplinary rehabilitation and multidomain programs consistently improved tongue pressure, swallowing function, mastication ability, appetite, body composition, activities of daily living, and oral intake resumption. Nutrition support team-delivered interventions reduced aspiration risks and improved oral environment and swallowing function. Community-based programs using munchy meals and combined exercises enhanced oral and physical functions. Social participation provided psychological benefits. Home-care dysphagia rehabilitation enabled 69% of tube-fed patients to resume oral intake. Conclusions: This narrative review supports a triadic, interprofessional approach in geriatric care, highlighting consistent improvements in oral function through integrated oral, nutritional, and rehabilitative interventions. Full article

This study aims to assess hand function recovery in stroke patients during the mid-to-late Brunnstrom stages and to encourage active participation in rehabilitation exercises. To this end, a deep residual network (ResNet) integrated with Focal Loss is employed for gesture recognition, achieving a Macro F1 score of 91.0% and a validation accuracy of 90.9%. Leveraging the millimetre-level precision of Leap Motion 2 hand tracking, a mapping relationship for hand skeletal joint points was established, and a static assessment gesture data set containing 502,401 frames was collected through analysis of the FMA scale. The system implements an immersive augmented reality interaction through the Unity development platform; C# algorithms were designed for real-time motion range quantification. Finally, the paper designs a rehabilitation system framework tailored for home and community environments, including system module workflows, assessment modules, and game logic. Experimental results demonstrate the technical feasibility and high accuracy of the automated system for assessment and rehabilitation training. The system is designed to support stroke patients in home and community settings, with the potential to enhance rehabilitation motivation, interactivity, and self-efficacy. This work presents an integrated research framework encompassing hand modelling and deep learning-based recognition. It offers the possibility of feasible and economical solutions for stroke survivors, laying the foundation for future clinical applications. Full article

Background: Spasticity, which occurs with certain neurological conditions, substantially affects quality of life, function, and social participation. Despite widespread botulinum toxin use, variability persists in patient information, access to specialized rehabilitation, and follow-up models. Methods: This two-phase Delphi-Dialogue Patients–Professionals study (DDPP), promoted by SERMEF, integrated perspectives from 77 patients and 141 rehabilitation professionals. Phase 1 used parallel surveys to assess satisfaction, perceived effectiveness of botulinum toxin, communication preferences, and rehabilitation follow-up. Phase 2 applied Real-Time Delphi with 38 experts to generate consensus recommendations to improve spasticity management. Results: Patients and professionals agreed on botulinum toxin benefits, the importance of ongoing rehabilitation, and the value of hybrid (in-person/remote) follow-up. Key gaps concerned access to Physical Medicine and Rehabilitation services, clarity and timing of information, and shared goal setting. Experts translated these misalignments into 10 prioritized recommendations, with highest feasibility for actions standardizing access pathways, optimizing botulinum toxin use, reinforcing structured education, and consolidating hybrid rehabilitation models. Conclusions: The DDPP approach offers a reproducible framework to align stakeholder perspectives by converting quantified divergence into consensus-based innovation priorities. Implementing the recommendations—particularly those strengthening communication, education, and hybrid pathways regarding botulinum toxin treatment—may support more accessible, personalized, patient-centered spasticity care. Full article

Background/Objectives: In recent decades, new technologies have been progressively integrated into various areas of mental health care. Mobile applications are potentially effective tools that allow psychiatric patients themselves to access self-management resources and tools within the community setting. Mental health nursing plays a key role in enabling patients to take an active role in their care and in promoting activities that foster their involvement and empowerment. The primary aim of this pilot study was to develop the PsyAPP mobile application to support both nurses and individuals with mental illness in managing care and improving health outcomes, and to assess its feasibility within a real-world clinical setting. Methods: A mobile application (PSYAPP) and a complementary web-based nursing management platform were designed and implemented. A total of 20 psychiatric patients enrolled in a partial hospitalization program in Soria (Spain) participated. Participants were assigned to experimental (app users) and control groups. Psychological empowerment, global functioning, and suicide risk were assessed before and after the intervention. Results: Patients who used the application showed significantly greater psychological empowerment (W = 2.04, p ≤ 0.04) compared with the control group. Statistically significant improvements were observed in psychological, social, and occupational functioning. Regarding suicide risk, no statistically significant changes were detected between pre- and post-intervention measurements in either group. Overall, PSYAPP demonstrated feasibility and potential utility as an innovative tool to support mental health care follow-up. Conclusions: This study developed and implemented a mobile application designed to enhance mental health care by supporting both patients and psychiatric nurses. Results showed significant improvements in global functioning in both the app and control groups, suggesting that rehabilitative treatment contributed to overall progress. Suicide risk did not significantly change within groups, although improvements were seen in the full sample, likely due to clinical care rather than app use. Only the experimental group demonstrated increased psychological empowerment, indicating that the app may effectively enhance patient engagement and involvement in their own care. Full article

Spinal Cord Injury (SCI) rehabilitation is undergoing a transformative shift with the emergence of new treatment strategies. Historically, treatment options were limited, and few offered meaningful recovery. Recent work in human models has shown that neuromodulation specifically with spinal cord epidural stimulation (SCES) paired with task-specific training (TsT) can partially restore motor function such as the ability to stand, step, and perform volitional movements. Despite these advances, the recovery has been shown to plateau even with the combination of therapies. The recovery process typically leads to partial rather than complete restoration of function. This limitation arises because current approaches primarily reactivate existing circuits rather than repair the disrupted pathways. Scar tissue and loss of descending and ascending connections remain major barriers to full recovery, restricting the transmission of neural signals. We argue that the next phase of research should be a synergistic strategy building upon the successes of neuromodulation and TsT while incorporating a regenerative therapy such as stem-cell-based interventions. Whereas neuromodulation and task-specific training increases excitability and reorganizes existing networks, stem cells have the potential to repair structural damage and re-establish communication across injured regions or facilitating the establishment of dormant pathways. The future of SCI recovery relies on multi-modal synergistic interventions that are likely to maximize long-term functional outcomes. In the current perspective, we summarized the basic findings on applications of SCES on restoration of sensory-motor functions. We then projected on current interventions on utilizing stem cell therapy intervention. We highlighted the outcomes of randomized clinical trials, and the major barriers for considering the synergistic approach between SCES and stem cell intervention. We are hopeful that this perspective may lead to roundtable scientific discussion to bridge the gap on how to conduct numerous clinical trials in the field. Full article

Background: Black and racialized immigrants with disabilities in Canada face overlapping systems of exclusion rooted in racism, ableism, and migration status. Yet, their experiences within health and rehabilitation services during the COVID-19 pandemic remain largely undocumented. This study explores how structural inequities shaped access to healthcare, rehabilitation, information, and community supports in the Greater Toronto and Hamilton Area (GTHA). Methods: Using narrative inquiry, ten in-depth interviews were conducted with participants who identified as Black or racialized, disabled, and having immigrated to Canada within the last 10 years. Narratives were analyzed through reflexive thematic analysis to identify how systems, relationships, and policies interacted to shape daily life, health and rehabilitation navigation during the pandemic. Results: Participants described systemic barriers in health and rehabilitation systems, experiences of “othering” and conditional belonging, and the critical role of informal and faith-based networks in navigating inaccessible services. Pandemic policies often intensified existing inequities. Conclusions: Findings underscore the need for intersectional health and rehabilitation planning that centers the voices of Black and racialized disabled immigrants. Addressing systemic racism and ableism is essential for equitable preparedness in future public health emergencies. Full article

Tai Chi has evolved into a widely used mind–body practice increasingly incorporated into complementary therapy, rehabilitation, and public health. This study provides an updated global bibliometric overview, with VOSviewer mapping publication performance, co-authorship networks, and keyword-based thematic clusters. Articles and reviews with Tai Chi–related terms in the title were retrieved from Scopus, with no restrictions on language or publication year. A total of 2253 publications from 1978 to 2025 were analyzed, revealing steady growth, concentrated largely in the past decade. China led the publication output, while the United States had the highest number of citations, forming a dual-core pattern. The field is largely driven by a small group of authors and regional clusters, and its visibility in mainstream medical journals remains limited. Nine software-generated keyword clusters were manually synthesized into five themes: motor function (balance and fall prevention), musculoskeletal conditions (osteoarthritis, rheumatoid arthritis, fibromyalgia), chronic disease management (cardiovascular disease, stroke, COPD), psychological health (quality of life, depression, anxiety, mindfulness), and cognitive aging (dementia, mild cognitive impairment). Future progress requires greater methodological rigor, including mechanistic inquiry, long-term study designs, and community- or population-level applications, along with stronger international collaboration and deeper integration into clinical and public health practice. Full article

Unmitigated climate change, coupled with habitat loss, has made the grassland and shrubland bird communities particularly vulnerable to extinction. Climate change-induced drought reduces net primary productivity, food availability, habitat quality, and alters vegetation structure. These factors collectively increase mortality in grassland and shrubland birds. However, limited data on habitat use by tropical birds hampers the development of effective management plans for drought-affected landscapes. We examined the foraging sites of 18 shrubland bird species, including two endemic and four declining species, across three shrubland forest sites in the Eastern Ghats of India during the dry season. We recorded microhabitat features within an 11 m radius of observed foraging points and compared them with random plots. Additionally, we examined the association between bird species and plant species where a bird was observed foraging. Foraging sites differed significantly from random plots, indicating active selection of microhabitats by shrubland birds. Using linear discriminant analysis, we found that the microhabitat features important for the bird species were presence of ground cover, shrub density, vegetational height, and vertical foliage stratification. Our results show that diet guild and foraging strata influence the foraging microhabitat selection of a species. Microhabitat attributes selected by shrubland specialist species differed from those of generalist shrubland users. Thirteen out of 18 focal species showed a significant association with at least one plant species. Birds were often associated with plants that were green during the dry season. Based on habitat selection and plant associations, we identified several habitat attributes that can be actively managed. Despite being classified as wastelands, the heavily degraded shrub forests can be rehabilitated through strategic and selective harvesting of forest products, targeting invasive species, and a spatially and temporally controlled livestock grazing regime. Full article

Nature-Based Solutions (NBS) are recognized as urban strategies to face environmental degradation and climate change vulnerability to address social challenges. However, NBS are context-dependent and must be based on evidence. Thus, this document details the NBS implementation in a global south city such as Tijuana, a semiarid city at the Mexico–USA border, which has rapidly grown under poor urban planning, widespread irregular settlements, increase in air and water pollution, and limited green spaces. In response, six hectares of a severely eroded slope have been transformed by El Colef into Ecoparque, an Urban Resilience Laboratory. This academic initiative aims to enhance residents’ quality of life by analyzing environmental problems, raising awareness, and engaging the community, in addition to identifying opportunities for implementing NBS. This paper presents the 32 years’ experience of implementing NBS at Ecoparque, such as a constructed wetland as part of a wastewater treatment, reforestation with native plants grown in an in situ nursery, soil restoration using its own-produced compost, and urban ecosystem rehabilitation. Moreover, main challenges and upscaling opportunities are identified to adopt NBS in a Global South city. Results showed that the most relevant problems have been insufficient human and financial resources, as well as the lack of a proper legal framework. This study provides an analytical significance that could be useful to apply under similar contexts. Full article

Therapy farms are increasingly recognized as social innovations that respond to exclusion, mental health challenges, and youth disconnection, particularly in rural areas. While often praised for their inclusive and rehabilitative potential, their broader impact on structural social transformation remains under-examined. This study explores the House of Educational Experiences, a therapeutic farm in rural Lithuania, to critically assess how such initiatives function as both agents of inclusion and stabilizers of existing socio-economic arrangements. Drawing on a qualitative case study approach, the research analyses in-depth interview data through the lens of the social innovation cycle, focusing on novelty, process, heterogeneity, impact, scalability, and transformative potential. Our findings reveal that the therapeutic farm generates significant individual and community benefits, particularly in psychosocial well-being, social skills, and pathways back into education and employment. However, the initiative also operates within institutional constraints, relying on project-based funding and reproducing aspects of conventional care systems. As such, its transformative capacity appears limited by structural dependencies and policy fragmentation. The study concludes that therapy farms represent an ambivalent form of social innovation: capable of creating inclusive, localized change, but often constrained in their ability to catalyze systemic transformation. Policy recommendations emphasize the need for long-term funding, institutional integration, and cross-sector collaboration. Full article

Background/Objectives: Multidisciplinary care is the gold-standard approach for delivering comprehensive pediatric healthcare. For children undergoing cochlear implant (CI) evaluation, multiple appointments are required to assess candidacy, set realistic expectations, and counsel families on rehabilitation and the psychosocial impact of hearing loss. Established pediatric CI users also need coordinated follow-up to address ongoing auditory, educational, and psychosocial needs. This study evaluated the satisfaction and family perspectives of the implementation of a virtual, team-based multidisciplinary model for both CI candidates and established CI users. Methods: Thirty-nine children and their families participated in discipline-specific telehealth consultations, including audiology, listening and spoken language (LSL) therapy, psychology, and educational services, followed by a 60 min multidisciplinary team meeting. Team meetings occurred during pre-implantation and at six months post-activation for CI candidates. Team meetings for established CI users were scheduled following completion of individual consultations. Providers summarized findings from their individual visits before transitioning to a caregiver-led discussion. Post-visit surveys assessed satisfaction and perceived benefit from the multidisciplinary model. Results: Thirty-nine dyads were enrolled (11 Pre-CI; 28 Established CI). Caregivers were predominantly mothers (89.7%), most identified as Hispanic (55.3%) and White (71.1%). Over half of children identified as Hispanic (59%) and White (71.8%); most were diagnosed with hearing loss at birth (55.9%). Satisfaction with the virtual model was uniformly high: 100% of caregivers were satisfied or very satisfied, and most rated care quality as “very good” or “excellent.” LSL therapy was most frequently rated as the most beneficial visit (70% Pre-CI; 45% Established CI). Caregivers strongly preferred ongoing team-based care, with 55–80% reporting that they would like it to occur every six months and 95–100% preferring remote meetings. Conclusions: A virtual multidisciplinary model offers a high-quality, family-centered approach for both CI evaluations and ongoing management of established CI users. By integrating simultaneous team-based sessions, this model not only supports the ‘whole child’ but also strengthens the family system by improving communication, streamlining care, and reducing the burden of multiple in-person appointments. Families consistently report high levels of satisfaction with the convenience, clarity, and collaboration provided through virtual team visits. Incorporating routine check-ins with families is essential to ensure their needs are addressed, reinforce progress, and guide timely, targeted interventions that maximize each child’s developmental outcomes. Full article

Background: Peer-led Active Rehabilitation Camps (ARC) aim to enhance functional independence and self-management among people with spinal cord injury (SCI). In Poland, where access to specialized spinal units and lifelong follow-up is limited, these programs may help address key health priorities—mobility, bowel and bladder management, sexual well-being, and upper-limb function. This study examined whether participation in ARC helped individuals achieve these priorities and identified factors associated with outcomes. Methods: This prospective cohort study, part of the Inter-PEER project, included 125 adults with SCI who attended one of 16 consecutive ARCs in Poland (2023–2024). Eligible participants used a manual wheelchair, were aged ≥ 16 years, and could complete written questionnaires. Data were collected at camp start (T1), completion (T2), and 3-month follow-up (T3) using surveys and wheelchair skills assessments. Validated instruments (SCIM-SR, MSES, QEWS, WST-Q, LiSat-11) were used and were aligned with the four priority domains. Associations with demographic and injury variables were examined using multivariate regression analyses. Results: Participants showed significant gains across priorities during the 10-day ARC. Mobility improved on all wheelchair-skill measures (e.g., QEWS + 2.6 points, p < 0.001), with most gains sustained at T3. Among participants with tetraplegia, self-care and hygiene scores increased by 24% and remained elevated at follow-up. Confidence in achieving a satisfying sexual relationship increased by camp end and was accompanied by higher sexual-life satisfaction at T3. Regression analyses found only modest associations between outcomes and demographic or injury characteristics. Conclusions: Participation in peer-led ARC programs was associated with rapid, clinically meaningful improvements in several health domains prioritized by people with SCI, especially upper-limb function, sexual well-being, and wheelchair mobility. Our findings highlight the value of integrating structured, peer-based community programs into the continuum of SCI rehabilitation. Full article

Patient access to innovative care for complex conditions like schizophrenia remains limited by systemic, clinical and policy-level barriers. Cognitive impairment associated with schizophrenia (CIAS) illustrates how critical symptom domains are often overlooked despite their impact on long-term outcomes. This study examines how systemic, infrastructural and economic factors shape access to CIAS care across eight mid-sized European countries to identify shared constraints and opportunities for improvement. Semi-structured interviews were conducted with 32 healthcare professionals and 9 health policy experts. Thematic analysis identified consistent barriers across countries, including fragmented care pathways, insufficient capacity for cognitive assessment, underdeveloped community-based rehabilitation services and reimbursement structures that favour pharmacological over psychosocial interventions. Variability across countries was shaped by differences in community infrastructure, professional training and the breadth of health technology assessment perspectives applied to non-pharmacological care. Countries with stronger community infrastructure and broader reimbursement frameworks were better positioned to deliver comprehensive care. These findings highlight that structural constraints, rather than clinical uncertainty, are the primary impediments to care in complex therapeutic areas. Addressing them will require coordinated reforms that strengthen early identification, expand multidisciplinary rehabilitation capacity and align reimbursement with functional and long-term outcomes. Full article

Background/Objectives: The growing population of stroke survivors living in rural communities, who require ongoing rehabilitation, highlights the need for effective, home-based rehabilitation methods. The aim of this study was to evaluate the potential benefits of Proprioceptive Neuromuscular Facilitation (PNF) on segmental and global motor function, gait performance, Activities of Daily Living (ADLs), and quality of life in a patient with chronic hemiplegia living at home. Methods: A 71-year-old woman, five years after an ischemic stroke of the left cerebral hemisphere, presented with severe right-sided hemiplegia and participated in a two-month home-based PNF rehabilitation programme consisting of 20 one-hour sessions delivered 2–3 times per week. To evaluate the effectiveness of the intervention, the following standardised outcome measures were used in given order: Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Trunk Impairment Scale (TIS), Timed Up and Go Test (TUG), Rivermead Motor Assessment Scale (RMA), Barthel Scale (BS), and the Short Form Health Survey (SF-36). Results: Improvements were observed in lower limb motor function (FMA-LE), gait performance (TUG), and overall quality of life (SF-36). Conclusions: PNF-based physiotherapy delivered at home environment may provide meaningful benefits for patients living in rural areas, even years after stroke. Full article

Smart assistive technologies such as sensor-based footwear and walking aids offer promising opportunities for gait rehabilitation through real-time feedback and patient-centered monitoring. While biofeedback applications show great potential, current research rarely explores integrated closed-loop systems with device- and modality-specific feedback. In this work, we present a modular sensor-based system combining a smart foot orthosis and an instrumented forearm crutch to deliver real-time vibrotactile biofeedback. The system integrates plantar pressure and motion sensing, vibrotactile feedback, and wireless communication via a smartphone application. We conducted a user study with eight participants to validate the system’s feasibility for mobile gait detection and app usability, and to evaluate different vibrotactile feedback types across the orthosis and forearm crutch. The results indicate that pattern-based vibrotactile feedback was rated as more useful and suitable for regular use than simple vibration alerts. Moreover, participants reported clear perceptual differences between feedback delivered via the orthosis and the forearm crutch, indicating device-dependent feedback perception. The findings highlight the relevance of feedback strategy design beyond hardware implementation and inform the development of user-centered haptic biofeedback systems. Full article