Search Results (230)

Background: Residual deficits after early treatment of developmental dysplasia of the hip (DDH) using osteotomy often led to asymmetrical gait deviations with increased repetitive rates of ground reaction force (GRF) in both hips, resulting in a higher risk of early osteoarthritis. This study investigated lower limb inter-joint coordination and swing foot control during level walking in adolescents with early-treated unilateral DDH. Methods: Eleven female adolescents treated early for DDH using Pemberton osteotomy were compared with 11 age-matched healthy controls. The joint angles and angular velocities of the hip, knee, and ankle were measured, and the corresponding phase angles and continuous relative phase (CRP) for hip–knee and knee–ankle coordination were obtained. The variability of inter-joint coordination was quantified using the deviation phase values obtained as the time-averaged standard deviations of the CRP curves over multiple trials. Results: The DDH group exhibited a flexed posture with increased variability in knee–ankle coordination of the affected limb throughout the gait cycle compared to the control group. In contrast, the unaffected limb compensated for the kinematic alterations of the affected limb with reduced peak angular velocities but increased knee–ankle CRP over double-limb support and trajectory variability over the swing phase. Conclusions: The identified changes in inter-joint coordination in adolescents with early treated DDH provide a plausible explanation for the previously reported increased GRF loading rates in the unaffected limb, a risk factor of premature OA. Full article

Introduction: The figure-of-eight walk test (F8WT) assesses gait on a curved path, reflecting everyday walking complexity. Despite recognized validity among elderly individuals, its application in neurological disorders remains inadequately explored. This scoping review summarizes evidence regarding F8WT use, validity, and clinical applicability among individuals with neurological disorders. Methods: A systematic literature search was conducted in the PubMed, Scopus, Embase, and Web of Science databases. After reading the full text of the selected studies and applying predefined inclusion criteria, seven studies, involving participants with multiple sclerosis (n = 3 studies), Parkinson’s disease (n = 2 studies), and stroke (n = 2 studies), were included based on pertinence and relevance to the topic. Results: F8WT demonstrated strong reliability and validity across various neurological populations and correlated significantly with established measures of gait, balance, and disease severity. Preliminary evidence supports its ability to discriminate individuals at increased fall risk and detect subtle motor performance changes. Discussion: The F8WT emerges as a valuable tool, capturing multifaceted gait impairments often missed by linear walking assessments. Sensitive to subtle functional changes, it is suitable for tracking disease progression and intervention efficacy. Conclusions: F8WT is reliable and clinically relevant, effectively identifying subtle, complex walking impairments in neurological disorders. Full article

Background: Advanced sensor insoles and motion capture technology can significantly enhance the monitoring of rehabilitation progress for patients with distal tibial fractures. This study leverages the potential of these innovative tools to provide a more comprehensive assessment of a patient’s gait and weight-bearing capacity following surgical intervention, thereby offering the possibility of improved patient outcomes. Methods: A patient who underwent distal medial tibial plating surgery in August 2023 and subsequently required revision surgery due to implant failure, involving plate removal and the insertion of an intramedullary nail in December 2023, was meticulously monitored over a 12-week period. Initial assessments in November 2023 revealed pain upon full weight-bearing without crutches. Following the revision, precise weekly measurements were taken, starting two days after surgery, which instilled confidence in accurately tracking the patient’s progress from initial crutch-assisted walking to full recovery. The monitoring tools included insoles, hand pads for force absorption of the crutches, and a motion capture system. The patient was accompanied throughout all steps of his daily life. Objectives: The study aimed to evaluate the hypothesis that the approximation and formation of a healthy gait curve are decisive tools for monitoring healing. Specifically, it investigated whether cadence, imbalance factors, and ground reaction forces could be significant indicators of healing status and potential disorders. Results: The gait parameters, cadence, factor of imbalance ground reaction forces, and the temporal progression of kinematic parameters significantly correlate with the patient’s recovery trajectory. These metrics enable the early identification of deviations from expected healing patterns, facilitating timely interventions and underscoring the transformative potential of these technologies in patient care. Conclusions: Integrating sensor insoles and motion capture technology offers a promising approach for monitoring the recovery process in patients with distal tibial fractures. This method provides valuable insights into the patient’s healing status, potentially predicting and addressing healing disorders more effectively. Future studies are recommended to validate these findings in a larger cohort and explore the potential integration of these technologies into clinical practice. Full article

Methicillin-resistant Staphylococcus aureus (MRSA) represents a major therapeutic challenge due to its multidrug-resistance and the associated clinical burden. Daptomycin (DAP), a cyclic lipopeptide antibiotic, has become a key agent for the treatment of severe MRSA infections owing to its rapid bactericidal activity and favourable safety profile. In this narrative review, we examine studies published between 2010 and April 2025. The data suggest that treatment with high-dose (8–10 mg kg⁻¹) DAP shortened the time to blood-culture sterilisation by a median of 2 days compared with standard-dose vancomycin without increasing toxicity when model-informed area-under-the-curve monitoring was employed. Particular attention is given to the synergistic effects of DAP combined with fosfomycin or β-lactams, especially ceftaroline and ceftobiprole, in overcoming persistent and refractory MRSA infections; this approach results in a reduction in microbiological failure relative to monotherapy. Resistance remains uncommon (<2% of isolates), but recurrent mutations in mprF, liaFSR, and walK underscore the need for proactive genomic surveillance. Despite promising preclinical and clinical evidence supporting combination strategies, further randomized controlled trials are necessary to establish their definitive role in clinical practice, as are head-to-head cost-effectiveness evaluations. DAP remains a critical option in the evolving landscape of MRSA management, provided its use is integrated with precision dosing, resistance surveillance, and antimicrobial-stewardship frameworks. Full article

The purpose of this study was to determine the power produced by knee muscles in normal adults when performing self-selected walking. The power of a single knee muscle is not directly measurable without invasive methods. An EMG-to-force processing (EFP) model was developed, which scaled muscle–tendon unit (MTU) power output to gait EMG. Positive power by each muscle occurred when force was developed during concentric contractions, and negative power occurred with lengthening contractions. The sum of EFP power produced by knee muscles was compared with the kinematics plus kinetics (KIN) knee power at percent gait cycle intervals. Closeness-of-fit of the EFP and KIN power curves (during active muscle forces) was used to validate the model. Key findings were that most knee muscles have a characteristic eccentric-then-concentric contraction pattern, and greatest power was produced by the Semimembranosis, with peak magnitude nearly matched by two vastus muscles (VL, VMO). The EMG-to-force processing approach provides reasonable estimates of active individual knee muscle power in self-selected speed walking in neurologically intact adults. Further, a prolonged period of the gait cycle showed substantial knee flexion or extension in the absence of power produced by muscles acting at the knee. Full article

Introduction: Intermittent claudication, an early symptom of peripheral artery disease, can be treated by cilostazol to alleviate symptoms and improve walking distance. Our previous investigation focused on cilostazol-induced alterations in the thermodynamic properties of plasma, utilizing differential scanning calorimetry (DSC) as a potential monitoring tool. The current proof-of-concept study aimed to enhance the interpretation of DSC data through deconvolution techniques, specifically examining protein transitions within the plasma proteome during cilostazol therapy. Results: Notable differences in thermal unfolding profiles were found between cilostazol-treated patients and healthy controls. The fibrinogen-associated transition exhibited a downward shift in denaturation temperature and decreased enthalpy by the third month. The albumin-related transition shifted to higher temperatures, accompanied by lower enthalpy. Transitions associated with globulins showed changes in thermal stability, while the transferrin-related peak demonstrated increased structural rigidity in treated patients compared to controls. Discussion: These observations suggest that cilostazol induces systemic changes in the thermodynamic behavior of plasma proteins. DSC, when combined with deconvolution methods, presents a promising approach for detecting subtle, therapy-related alterations in plasma protein stability. Materials and methods: Ten patients (median age: 58.6 years) received 100 milligrams of cilostazol twice daily. Blood samples were collected at the baseline and after 2 weeks, 1 month, 2 months, and 3 months of therapy. Walking distances were also assessed. The DSC curves were retrieved from the thermal analysis investigated by deconvolution mathematical methods. Conclusions: Although the exact functional consequences remain unclear, the observed biophysical changes may reflect broader molecular adaptations involving protein–protein interactions, post-translational modifications, or acute phase response elements. Full article

This paper aims to enhance the success of the Wild Horse Optimization (WHO) algorithm in optimization processes by developing strategies to overcome the issues of stuckness and early convergence in local spaces. The performance change is observed through a Multi-Layer Perceptron (MLP) sample. In this context, an advanced Wild Horse Optimization (IWHO) algorithm with a random walking strategy was developed to provide solution diversity in local spaces using a random walking strategy. Two challenging test sets, CEC 2019, were selected for the performance measurement of IWHO. Its competitiveness with alternative algorithms was measured, showing that its performance was superior. This superiority is visually represented with convergence curves and box plots. The Wilcoxon signed-rank test was used to evaluate IWHO as a distinct and powerful algorithm. The IWHO algorithm was applied to MLP training, addressing a real-world problem. Both WHO and IWHO algorithms were tested using MSE results and ROC curves. The Energy Efficiency Problem dataset from UCI was used for MLP training. This dataset evaluates the heating load (HL) or cooling load (CL) factors by considering the input characteristics of smart buildings. The goal is to ensure that HL and CL factors are evaluated most efficiently through the use of HVAC technology in smart buildings. WHO and IWHO were selected to train the MLP architecture, and it was observed that the proposed IWHO algorithm produced better results. Full article

The aim of this study is to examine the biomechanical interaction between an assistive wearable exoskeleton and the human body. For this purpose, a passive exoskeleton is designed to provide support during the transition from a squatting position to standing, while also enabling the resilient components to become active during the initial and mid-swing phases of level walking. The active period can be adjusted by a slot, which triggers the activation of the resilient components when the exoskeleton’s flexion angle exceeds a critical value. This study also compares the effect of using different passive powered components in the exoskeleton. Electromyography (EMG) signals and angular velocity during human motion are collected and analyzed. Experimental results indicate that the designed assistive exoskeleton effectively reduces muscle effort during squatting/standing motion, as intended. The exoskeleton reduces the flexion/extension (x-axis) angular velocity during both squatting/standing and the swing phase of gait. The oscillation of the angular velocity curve about the y-axis during gait is larger without the exoskeleton, suggesting that the exoskeleton may introduce interference but also a stabilizing effect in certain dimensions during gait. This study provides a stronger foundation for advancing the design of both passive and active powered exoskeletons. Full article

Goats can walk freely and flexibly in complex environments such as concave and convex or soft ground. And their flexible spine has functions such as adjusting balance and providing auxiliary power during movement, while the limbs only have support functions. The spine has an adjustable and decisive role in the pressure on the sole of the hoof of the goat. Therefore, the goat spine was taken as the bionic prototype, the three-dimensional force distribution of the goat body space was analyzed, and the optimal spinal space curve was explored, combined with the goat gait cycle. Based on the study of spinal curve arrangement and placement, the spinal curve was stretched along the grouser length direction. The soil contact surface structure of the track monomer was constructed based on functional simulation. And the bionic structure of the track monomer with superior adhesion performance was explored. The results of simulation analysis and soil tank test both showed that the attachment performance of bionic structure was better than that of an ordinary structure. It showed that adding bionic curves to the contact surface of the track monomer could significantly improve the adhesion performance, and the bionic structure with a single bionic curve arranged on the complete contact surface of the track monomer had the best adhesion performance. Moreover, the adhesion of the optimal track monomer bionic structure was increased by 19.22 N compared with an ordinary structure in the soil tank test, which verified the superiority of the track monomer bionic structure design. It provides a new method and a new idea for improving the adhesion performance of tracked vehicle in hilly areas. Full article

Falls pose a significant health risk for older people, necessitating accurate predictive tools for fall prevention. This study evaluated the sensitivity of a wearable waist-belt sensor, the Booguu Aspire system, in predicting prospective fall incidents among 37 community-dwelling older people in Hong Kong. A prospective cohort design was employed, involving two analytical groups: the overall cohort and a subset with cognitive performance data available, measured using the Montreal Cognitive Assessment (MoCA). Participants were categorized into moderate- or high-risk groups for falls using the sensor and further assessed with physical function tests, including the Single Leg Stand Test (SLST), 6 Meter Walk Test (6MWT), and Five Times Sit to Stand Test (5STS). Fall incidents were monitored for 12 months through quarterly follow-up phone calls. Statistical analyses showed no significant differences in physical performance between high- and moderate-risk groups and no significant correlations between sensor-based fall risk ratings and physical function test outcomes. The SLST, 6MWT, 5STS, and MoCA tests classified sensor-determined fall risk ratings with accuracies of 51.4%, 64.9%, 59.5%, and 50%. The sensor showed low sensitivity, with 13.51% true positives for fallers and a 20% sensitivity for high-risk individuals. ROC analysis yielded an Area Under the Curve of 0.688. Our findings indicate that the wearable waist-belt Sensor System may not be a sensitive tool in predicting prospective fall incidents. The algorithm for fall risk classification in the wearable sensor merits further exploration. Full article

Background/Objectives: Disability is a term that involves mental, intellectual, or sensory impairment resulting in the loss of one’s ability to walk or perform the activities necessary to live in a society. This study aims to collect all the data regarding the absorption, distribution, and disposition of drugs in disabled Saudi patients, i.e., patients suffering from epilepsy, cancer, cardiovascular diseases, etc., and then compare these results with data reported in other ethnicities. Methods: An exhaustive online search used the key terms in Google Scholar, PubMed, Cochrane Library, and Science Direct to extract all articles that met the eligibility criteria. All research studies containing pharmacokinetic (PK) parameters (area under the curve from 0 to infinity (AUC_0–∞), maximal plasma concentration (C_max), clearance (CL), volume of distribution, time to reach maximum plasma concentration, and half-life) were included in this review. Results: In pediatric epileptic patients, carbamazepine showed a notable decrease in C_max with increasing age, which may be due to ontogenetic changes in its disposition. The AUC_0–∞ of busulphan in adult hematopoietic stem cell transplantation patients was recorded as 4392.5 ± 1354.65 μg·h/mL, with high inter-individual variability. Moreover, the CL of vancomycin was reported to be 25% higher among cancer patients in comparison to non-cancer subjects. Conclusions: The complications in disabled patients due to alterations in cytochrome P450 enzymes, pathophysiology, genetics, and ethnicity emphasize the significance of patient-centered drug dosing. These findings may aid healthcare physicians in refining therapeutic care in this population. Full article

Instrumented insoles have created opportunities for patient monitoring via long-term recordings of ground reaction forces (GRFs). As the GRF curve is altered in patients after lower-extremity fracture, parameters defined on established curve landmarks often cannot be used to monitor the early rehabilitation process. We aimed to screen several new GRF curve-based parameters for suitability and hypothesized an interrelation with days after surgery. In an observational longitudinal study, data were collected from 13 patients with tibial fractures during straight walking at hospital visits using instrumented insoles. Parametrized curves were fitted and regression analyses conducted to determine the best fit, reflected in the highest R²-value and lowest fitting error. A Wald Test with t-distribution was employed for statistical analysis. Strides were classified as regular or non-regular, and changes in this proportion were analyzed. Among the 12 parameters analyzed, those with the highest R²-values were the mean force between inflection points (R² = 0.715, p < 0.001, t₄₂ = 9.89), the absolute time between inflection points (R² = 0.707, p < 0.001, t₄₂ = 9.83), and the highest overall force (R² = 0.722, p < 0.001, t₄₂ = 10.05). There was a significant increase in regular strides on both injured (R² = 0.427, p < 0.001, t₄₂ = 5.83) and healthy (R² = 0.506, p < 0.001, t₄₂ = 6.89) sides. The proposed parameters and assessment of the regular stride ratio enable new options for analyses and monitoring during rehabilitation after tibial shaft fractures. They are robust to pathologic GRF curves, can be determined independently from spatiotemporal coherence, and thus might provide advantages over established methods. Full article

Diabetic foot ulcer patients are usually unaware of excessive pressure on their feet due to lost pressure sensitivity. Offloading insoles are used to alleviate foot pain. This study investigated the effect of infill pattern and infill density on plantar pressure reduction for 3D-printed insoles while walking. The study involves five infill patterns: grid, honeycomb, triangle, cubic, and gyroid, along with several infill densities ranging from 14% to 20%. The test 3D-printed thermoplastic polyurethane specimens were assessed for mechanical properties to identify suitable infill patterns for creating prototypes of insoles. The results indicated that the honeycomb infill pattern exhibited the highest maximum compression load at 50% compressive strain and has a significant area under the loading-unloading curve, signifying high energy absorption. Conversely, the gyroid infill pattern exhibited the lowest maximum compression load at 50% compressive strain and minimal energy absorption. Both infill patterns with 20% infill density were applied in 3D-printed insoles and tested on the foot plantar pressure of healthy male volunteers during walking. No statistically significant differences in plantar pressure were observed between the two infill patterns compared to walking without insoles. A reduction in plantar pressure at hindfoot was observed when using the insoles, although this change was not statistically significant. Full article

Background/Objectives: Advanced Glycation End Products (AGEs) are high-molecular-weight compounds formed through non-enzymatic reactions between sugars and proteins, lipids, or nucleic acids. This study aimed to comprehensively analyze the association between the accumulation of AGEs and lower-limb muscle strength, gait speed, and balance abilities related to mobility in elderly individuals. Methods: This cross-sectional correlational study included 552 community-dwelling older adults. AGE accumulation was assessed using skin autofluorescence (SAF) measured using an AGE reader. Mobility decline factors were evaluated using the sit-to-stand (STS), gait speed (4 m walk tests), single-leg stance (SLS), and Timed Up and Go (TUG) tests. Results: A comparison of the physical function across the quartile groups revealed that the group with the highest SAF values, Q4, exhibited a general decline in STS, gait speed, SLS, and TUG performance when compared with the other groups (p < 0.001). Spearman’s correlation analysis revealed that the SAF-AGEs demonstrated significant negative correlations with STS (r = −0.211, p < 0.001), gait speed (r = −0.243, p < 0.001) and SLS (r = −0.201, p < 0.001). Additionally, TUG showed a significant positive correlation (r = 0.239, p < 0.001). In the logistic regression analysis, compared with the Q1 group, the Q4 group had significantly higher odds of low STS performance (odds ratio (OR) = 2.43, p = 0.006), slow gait speed (OR = 2.28, p = 0.002), low SLS performance (OR = 2.52, p = 0.001), and slow TUG (OR = 2.00, p = 0.035). The optimal cutoff value of the SAF for mobility decline was 3.15 (area under the curve 0.694; 95% confidence interval: 0.618–0.771). Conclusions: This study has demonstrated that higher SAF values were associated with decreased lower-limb strength, gait speed, and balance, thereby suggesting that SAF may be a useful screening tool for predicting mobility decline in older adults. Full article

The objective of this study was to develop a musculoskeletal model incorporated with a subject-specific knee joint to predict the tibiofemoral contact force (TFCF) during daily motions. For this purpose, 18 healthy participants were recruited to perform the motion data acquisition using synchronized motion capture and force platform systems, and motion simulation based on an improved musculoskeletal model for five daily activities, including normal walking, stair ascent, stair descent, sit-to-stand, and stand-to-sit. The proposed musculoskeletal model included subject-specific models of bones, cartilages, and meniscus, detailed knee ligaments and muscles, deformable elastic contacts, and multiple degrees of freedom (DOFs) of the knee joint. The prediction accuracy was demonstrated by the good agreements of TFCF curves between the model predictions and in vivo measurements for the five activities (RMSE: 0.216~0.311 BW, R²: 0.928~0.992, and C_E: 0.048~0.141). Based on the validated model, the TFCF on total, medial, and lateral compartments (TFCF_Total, TFCF_Medial, and TFCF_Lateral) during the five daily activities were predicted. For TFCF_Total, the peak force for stair descent or sit-to-stand was the largest, followed by stair ascent or stand-to-sit, and finally normal walking. For TFCF_Medial, stair descent had the largest peak, followed by stair ascent. There were no significant differences between the peak TFCF_Medial values of normal walking, sit-to-stand, and stand-to-sit. For TFCF_Lateral, the peak of sit-to-stand was the largest, followed by stand-to-sit or stair descent, and finally normal walking or stair ascent. This study is valuable for further understanding the biomechanics of a healthy knee joint and providing theoretical guidance for the treatment of knee osteoarthritis (KOA). Full article