Search Results (909)

Objectives: The primary objective was to investigate and compare the effects of three paired-pulse repetitive trans-spinal magnetic stimulation (PP-rTSMS) protocols on balance control and corticospinal network function. Methods: PP-rTSMS (800 pulses, frequency 100 Hz, intensity 70% of the resting motor threshold) was applied over the eighth thoracic vertebra (Th8) in twenty-seven young healthy individuals. Each proband received three verum sessions (using a verum coil with handle oriented (i) cranially, (ii) caudally, and (iii) laterally) and (iv) one sham session (using a sham coil) in a randomised order. Balance ability (Y Balance Test) and corticospinal network functions (motor evoked potentials (MEPs), cortical silent periods (SCPs)) were tested immediately (i) prior to and (ii) after each interventional session. Results: Each verum session induced a significant improvement in balance ability (cranially (F_1,26 = 8.009; p = 0.009; η² = 0.236), caudally (F_1,26 = 4.846; p = 0.037; η² = 0.157), and laterally (F_1,26 = 23,804; p ≤ 0.001; η² = 0.478) oriented grip) as compared to the sham session. In addition, the laterally oriented coil grip was associated with significantly greater balance benefits than both the cranial (F_1,26 = 10.173; p = 0.004; η² = 0.281) and caudal (F_1,26 = 14.058; p ≤ 0.001; η² = 0.351) grip orientations. No significant intervention-induced effects were detected on corticospinal network functions. Conclusions: Our data show that PP-rTSMS effectively supports balance control and that coil orientation significantly influences these effects. Further studies should test variations of this promising approach on healthy and disabled cohorts. Full article

Down syndrome (DS), stemming from the triplication of human chromosome 21, results in intellectual disability, with early mid-life onset of Alzheimer’s disease (AD) pathology. Early interventions to reduce cognitive impairments and neuropathology are lacking. One modality, maternal choline supplementation (MCS), has shown beneficial effects on behavior and gene expression in neurodevelopmental and neurodegenerative disorders, including trisomic mice. Loss of basal forebrain cholinergic neurons (BFCNs) and other DS/AD relevant hallmarks were observed in a well-established trisomic model (Ts65Dn, Ts). MCS attenuates these endophenotypes with beneficial behavioral effects in trisomic offspring. We postulate MCS ameliorates dysregulated cellular mechanisms within vulnerable BFCNs, with attenuation driven by novel gene expression. Here, choline acetyltransferase immunohistochemical labeling identified BFCNs in the medial septal/ventral diagonal band nuclei of the basal forebrain in Ts and normal disomic (2N) offspring at ~11 months of age from dams exposed to MCS or normal choline during the perinatal period. BFCNs (~500 per mouse) were microisolated and processed for RNA-sequencing. Bioinformatic assessment elucidated differentially expressed genes (DEGs) and pathway alterations in the context of genotype (Ts, 2N) and maternal diet (MCS, normal choline). MCS attenuated select dysregulated DEGs and relevant pathways in aged BFCNs. Trisomic MCS-responsive improvements included pathways such as cognitive impairment and nicotinamide adenine dinucleotide signaling, among others, indicative of increased behavioral and bioenergetic fitness. Although MCS does not eliminate the DS/AD phenotype, early choline delivery provides long-lasting benefits to aged trisomic BFCNs, indicating that MCS prolongs neuronal health in the context of DS/AD. Full article

Background: Family caregivers are a vital yet often under-recognized part of the healthcare system. They provide essential emotional, physical, and logistical support to individuals with illness, disability, or frailty, and their contributions improve continuity of care and reduce system strain. However, many healthcare and social service providers are not equipped to meaningfully engage caregivers as partners. In Alberta, stakeholders validated the Caregiver-Centered Care Competency Framework and identified the need for a three-tiered education model—Foundational, Advanced, and Champion—to help providers recognize, include, and support family caregivers across care settings. This paper focuses on the development and early evaluation of the Advanced Caregiver-Centered Care Education modules, designed to enhance the knowledge and skills of providers with more experience working with family caregivers. The modules emphasize how partnering with caregivers benefits not only the person receiving care but also improves provider effectiveness and supports better system outcomes. Methods: The modules were co-designed with a 154-member interdisciplinary team and grounded in the competency framework. Evaluation used the first three levels of the Kirkpatrick–Barr health workforce education model. We analyzed pre- and post-surveys from the first 50 learners in each module using paired t-tests and examined qualitative feedback and SMART goals through inductive content analysis. Results: Learners reported a high level of satisfaction with the education delivery and the knowledge and skill acquisition. Statistically significant improvements were observed in 53 of 54 pre-post items. SMART goals reflected intended practice changes across all six competency domains, indicating learners saw value in engaging caregivers as partners. Conclusions: The Advanced Caregiver-Centered Care education improved providers’ confidence, knowledge, and skills to work in partnership with family caregivers. Future research will explore whether these improvements translate into real-world practice changes and better caregiver experiences in care planning, communication, and navigation. Full article

Background/Objectives: Children with severe physical and communication disabilities face many challenges. They have very limited opportunities for upright, hands-free, self-initiated mobility. Current findings in neuroscience and theories on child development suggest that self-initiated mobility can have positive cascading effects on various developmental areas, including language and communication. This study was conducted to examine the current use of hands-free support walkers with children who have severe physical and communication disabilities and use augmentative and alternative communication and to identify the benefits and problems perceived by their parents and professionals from different disciplines. Methods: Online surveys were utilized to collect information from 127 participants, including 31 parents and 96 professionals or paraprofessionals. Results: The participants reported that these children could perform various motor activities in the hands-free support walkers to achieve different goals. Benefits identified by both parents and professionals included providing a way to exercise and stay active, improving motor control, enhancing independence, and bringing enjoyment. Professionals also observed positive impacts on communication, vocalization, use of eye contact, and problem solving. Conclusions: Results suggest that children with severe physical and communication disabilities can benefit from the upright, hands-free, self-initiated mobility provided by hands-free support walkers. Clinical implications and needs for future research are discussed. Full article

Osteoarthritis (OA) remains a major contributor to pain and disability; however, the current management is largely reactive, focusing on symptoms rather than preventing irreversible cartilage loss. This review first examines the mechanistic foundations for pharmacological chondroprotection—illustrating how conventional agents, such as glucosamine sulfate and chondroitin sulfate, can potentially restore extracellular matrix (ECM) components, may attenuate catabolic enzyme activity, and might enhance joint lubrication—and explores the delivery challenges posed by avascular cartilage and synovial diffusion barriers. Subsequently, a practical “What–How–When” framework is introduced to guide community pharmacists in risk screening, DMOAD selection, chronotherapeutic dosing, safety monitoring, and lifestyle integration, as exemplified by the CHONDROMOVING infographic brochure designed for diverse health literacy levels. Building on these strategies, the P4–4P Chondroprotection Framework is proposed, integrating predictive risk profiling (physicians), preventive pharmacokinetic and chronotherapy optimization (pharmacists), personalized biomechanical interventions (physiotherapists), and participatory self-management (patients) into a unified, feedback-driven OA care model. To translate this framework into routine practice, I recommend the development of DMOAD-specific clinical guidelines, incorporation of chondroprotective chronotherapy and interprofessional collaboration into health-professional curricula, and establishment of multidisciplinary OA management pathways—supported by appropriate reimbursement structures, to support preventive, team-based management, and prioritization of large-scale randomized trials and real-world evidence studies to validate the long-term structural, functional, and quality of life benefits of synchronized DMOAD and exercise-timed interventions. This comprehensive, precision-driven paradigm aims to shift OA care from reactive palliation to true disease modification, preserving cartilage integrity and improving the quality of life for millions worldwide. Full article

Background/Objectives: Neck pain caused by myofascial pain syndrome (MPS) is a highly prevalent musculoskeletal condition. Repetitive peripheral magnetic stimulation (rPMS) is a promising treatment option; however, its therapeutic effect and optimal treatment frequency remain unclear. This study aimed to investigate the therapeutic effect and duration of effect of rPMS in patients with MPS of the neck. Methods: In this randomized, sham-controlled, crossover trial, 27 patients with neck MPS and baseline visual analog scale (VAS) scores ≥ 40 were enrolled. The mean age was 43.8 ± 9.1 years, and 63% were female. Participants were randomly assigned to receive either an initial rPMS treatment (a 10 min session delivering 3900 pulses at 5–10 Hz) or sham stimulation. After 7 days, groups crossed over. Pain intensity (VAS), disability (Neck Disability Index; NDI), and analgesic use were recorded daily for seven consecutive days. A linear mixed-effects model was used for analysis. Results: At baseline, the VAS and NDI scores were 61.8 ± 10.5 and 26.0 ± 6.3, respectively. rPMS produced a significantly greater reduction in both VAS and NDI scores, with the greatest differences observed on Day 4: the differences were −24.1 points in VAS and −8.5 points in NDI compared to the sham group. There was no significant difference in analgesic use between the two groups. Conclusions: A single rPMS session provides short-term improvement in pain and disability in neck MPS. Based on the observed therapeutic window, more frequent sessions (e.g., twice weekly) may provide sustained benefit and should be explored in future studies. Full article

Transportation is often cited as a significant barrier to healthcare access by Veterans, particularly those from minority groups, who have disabilities, or live in rural areas. Autonomous shuttles (AS) offer a potential solution, yet limited research has explored Veterans’ experiences with this technology. This study qualitatively investigated Veterans’ lived experiences with AS through focus groups, enrolling participants aged 18+ from Gainesville, The Villages, and Lake Nona, Florida. Via a directed content analysis, six key themes were identified: Perceived Benefits, Safety, Experience with Autonomous Vehicles (AV), AS Experience, AV Adoption, and Perception Change. Among 26 participants (aged 30–85; 77% men; 88% urban residents), prominent themes included Safety (n = 161), Perceived Benefits (n = 153), and AS Experience (n = 118), with predominantly positive counts in all themes except AS Experience. Participants acknowledged safety advantages and multitasking potential of AS over human-operated vehicles while recommending improvements to the shuttle’s slow speed, availability and convenience. While the AS ride was positively received overall, some participants noted issues with comfort and braking, emphasizing the need for further technological enhancements. Real-world exposure to AS appeared to influence acceptance positively, offering insights for policymakers and industry stakeholders aiming to optimize AS deployment for mobility-vulnerable Veterans. Full article

Sarcopenia is a progressive age-related musculoskeletal disorder characterized by loss of muscle mass, strength, and physical performance, contributing to functional decline and increased risk of disability. Emerging evidence suggests that vitamin D (Vit D) plays a pivotal role in skeletal muscle physiology beyond its classical functions in bone metabolism. This review aims to critically analyze the relationship between serum Vit D levels and sarcopenia in older adults, focusing on pathophysiological mechanisms, diagnostic criteria, clinical evidence, and preventive strategies. An integrative narrative review of observational studies, randomized controlled trials, and meta-analyses published in the last decade was conducted. The analysis incorporated international diagnostic criteria for sarcopenia (EWGSOP2, AWGS, FNIH, IWGS), current guidelines for Vit D sufficiency, and molecular mechanisms related to Vit D receptor (VDR) signaling in muscle tissue. Low serum 25-hydroxyvitamin D levels are consistently associated with decreased muscle strength, reduced physical performance, and increased prevalence of sarcopenia. Although interventional trials using Vit D supplementation report variable results, benefits are more evident in individuals with baseline deficiency and when combined with protein intake and resistance training. Mechanistically, Vit D influences muscle health via genomic and non-genomic pathways, regulating calcium homeostasis, mitochondrial function, oxidative stress, and inflammatory signaling. Vit D deficiency represents a modifiable risk factor for sarcopenia and functional impairment in older adults. While current evidence supports its role in muscular health, future high-quality trials are needed to establish optimal serum thresholds and dosing strategies for prevention and treatment. An individualized, multimodal approach involving supplementation, exercise, and nutritional optimization appears most promising. Full article

This study aimed to evaluate the feasibility of using serious games for the (tele)rehabilitation of children with disabilities affected by the Ukrainian war. Additionally, it provides requirements for technologies that can be used in war-affected areas. Structured interviews and Likert scale assessments were conducted on-site and remotely with patients of the tertiary care facility in Ukraine. All participants used the telerehabilitation platform for motor and cognitive training. Nine serious games were employed, involving trunk tilts, upper limb movements, and head control. By mid-September 2023, 186 positive user experiences were evident, with 89% expressing interest in continued engagement. The platform’s accessibility, affordability, and therapeutic benefits were highlighted. The recommendations from user feedback informed potential enhancements, showcasing the platform’s potential to provide uninterrupted rehabilitation care amid conflict-related challenges. This study suggests that serious games solutions that suit the sociopolitical and economic context offer a promising solution to rehabilitation challenges in conflict zones. The positive user experiences towards using the platform with serious games indicate its potential in emergency healthcare provision. The findings emphasize the role of technology, particularly serious gaming, in mitigating the impact of armed conflicts on children’s well-being, thereby contributing valuable insights to healthcare strategies in conflict-affected regions. Requirements for technologies tailored to the context of challenging settings were defined. Full article

There is limited knowledge about the benefits of functional textile in arthritis management. This study aimed to evaluate the effect of wearing functional socks in patients with rheumatoid or psoriatic arthritis. Patients were randomized into an experimental group (n = 23) and control group (n = 18). The intervention involved wearing functional textile socks for 12 weeks. Sock composition was analyzed using X-ray fluorescence spectrometry and scanning electron microscopy. Outcome measures included the Numeric Rating Scale, Health Assessment Questionnaire–Disability Index (HAQ-DI), and RAND-36 (Estonian version). At week 12, the experimental group showed significantly lower metatarsophalangeal and toe joint pain (p = 0.001), stiffness (p = 0.005), and ankle stiffness (p = 0.017) scores than the control group. Improvements were also observed in HAQ-DI reaching (p = 0.035) and activity (p = 0.028) scores. RAND-36 scores were higher in physical functioning (p = 0.013), social functioning (p = 0.024), and bodily pain (p = 0.006). Role limitations due to physical problems improved in the experimental group but worsened in the control group (p = 0.029). In conclusion, wearing functional socks led to some statistically significant improvements in foot and ankle pain and stiffness, physical function, and health-related quality of life. However, the effect sizes were small, and the clinical relevance of these findings should be interpreted with caution. Full article

Multiple Sclerosis (MS) is a chronic neurological disorder affecting the central nervous system that significantly impairs postural control and functional abilities. Robotic-assisted gait training mitigates this functional deterioration. This preliminary study aims to investigate the effects of a four-week gait training with the ExoAtlet II exoskeleton on static balance control and functional mobility in five individuals with MS (Expanded Disability Status Scale ≤ 2.5). Before and after the training, they were assessed in quiet standing under Eyes Open (EO) and Eyes Closed (EC) conditions and with the Timed Up and Go (TUG) test. Center of Pressure (CoP) Sway Area, Antero–Posterior (AP) and Medio–Lateral (ML) CoP displacement, Stay Time, and Total Instability Duration were computed. TUG test Total Duration, sit-to-stand, stand-to-sit, and linear walking phase duration were analyzed. To establish target reference values for rehabilitation advancement, the same evaluations were performed on a matched healthy cohort. After the training, an improvement in static balance with EO was observed towards HS values (reduced Sway Area, AP and ML CoP displacement, and Total Instability Duration and increased Stay Time). Enhancements under EC condition were less marked. TUG test performance improved, particularly in the stand-to-sit phase. These preliminary findings suggest functional benefits of exoskeleton gait training for individuals with MS. Full article

Disability Certification is an instrument that can contribute to the identification of persons with disabilities who are potential beneficiaries of social protection programmes. In Colombia, the disability certification process was changed in 2020 to include a human rights perspective. However, little information exists on how far the process aligns with the recommendations made by the Convention on the Rights of Persons with Disabilities or to what extent it provides useful information for the operation of the country’s social protection system. This study aims to analyse how the changes implemented in 2020 have contributed to the identification and determination of persons with disabilities in social protection programmes in Colombia. This research uses an analytical-descriptive design, in which legal documents related to the social protection programme and disability certification were analysed. In addition, we conducted semi-structured interviews in Colombia with people with disabilities, professionals conducting the certification, and with key stakeholders, and we analysed the information using thematic analysis. Colombia changed its certification process in 2020, moving from a capacity-to-work assessment to a process of assessing functioning capacity and participation limitations following the International Classification of Functional Disability and Health. However, the new certification process has not provided an instrument to contribute to determining persons with disabilities who should be prioritised or receive social benefits in Colombia. The certification does not establish the support needs of people with disabilities, does not recommend reasonable adjustments to support their participation in society, and has not been used systematically in social protection programmes. Finally, individuals with disabilities commented that the disability certification is a process that does not open up opportunities to receive social benefits and social transfers, and in most cases, it is an expensive and lengthy process. Disability certification in Colombia is not an instrument that determines the needs of people with disabilities, nor the reasonable accommodations that they require in order to participate in society. Full article

This study presents a systematic review regarding the use of augmented reality and virtual reality in exergaming by analyzing studies published during 2010–2025. This study focuses on providing an overview of the field and on examining and synthesizing the findings of related studies to identify the contexts, applications, and domains in which extended reality exergames are being used and the related implications, benefits, and challenges. Based on the results, augmented reality and virtual reality exergames offer immersive, enjoyable, engaging, and personalized experiences that support physical, cognitive, and emotional well-being, while enhancing physical performance, cognitive functioning, psychological outcomes, and mental health. They promote motivation, active lifestyles, and sustainable health behaviors across diverse populations, including older adults, individuals with disabilities, and neurological groups, as well as the general adult and youth populations. Although emphasis is placed on their use in physical and cognitive rehabilitation and treatment, they also show great potential to be effectively used in different domains, including education. Among the technologies examined, the significant majority of studies focused on virtual reality exergames, a limited number of studies involved augmented reality, and only a few studies examined mixed reality, extended reality, and the metaverse. Finally, nine main topics were identified through topic modeling, providing a clear representation of the core themes within the literature. Full article

Background: Cannabidiol (CBD) has demonstrated potential as a therapeutic agent for muscle tension, pain, and sleep bruxism, yet its broader impact on comorbid conditions such as sleep disturbance and migraine disability remains underexplored. This study aimed to assess the effects of topical CBD on sleep quality and migraine-related disability in patients with bruxism-associated muscular pain. Methods: In a randomized, double-blind clinical trial, 60 participants with bruxism were allocated equally into three groups: control (placebo gel), 5% CBD gel, and 10% CBD gel. Participants applied the gel intraorally to the masseter muscles nightly for 30 days. Sleep quality and migraine-related disability were assessed using the Pittsburgh Sleep Quality Index (PSQI) and the Migraine Disability Assessment Scale (MIDAS), respectively. Surface electromyography (sEMG) and the Bruxoff^® device were used for objective evaluation of muscle tension and bruxism intensity. Results: Both CBD treatment groups demonstrated statistically significant improvements in PSQI and MIDAS scores compared to the control group (p < 0.001). No significant differences were observed between the 5% and 10% CBD groups, suggesting comparable efficacy. The sEMG findings corroborated a reduction in muscle tension. Improvements in sleep and migraine outcomes were positively correlated with reductions in muscle activity and pain. Conclusions: Topical CBD gel significantly improved sleep quality and reduced migraine-related disability in patients with bruxism-associated muscular pain, supporting its role as a multifaceted therapeutic option in the management of TMD and related comorbidities. Further research is needed to confirm long-term benefits and determine optimal dosing strategies. Full article

Cognitive impairment is a prevalent and disabling feature of multiple sclerosis (MS), significantly impacting patients’ quality of life (QoL) and psychological well-being. Despite its clinical relevance, there are currently no approved pharmacological treatments for cognitive deficits in MS, highlighting the need for effective non-pharmacological interventions. This narrative review explores evidence from studies evaluating the efficacy of cognitive re-education (CR) approaches (including traditional, group-based, computer-assisted, virtual reality, and innovative methods such as music therapy) on cognitive and QoL outcomes in people with MS. The findings demonstrate that while CR consistently influences cognitive domains such as memory, attention, and executive function, its effects on QoL are more variable and often depend on intervention type, duration, and individual patient characteristics. Notably, integrative approaches like virtual reality and music therapy show promising results in enhancing both cognitive performance and psychosocial well-being. Several studies report that cognitive gains are accompanied by improvements in mental health and functional QoL, particularly when interventions are tailored to individual needs and delivered within multidisciplinary frameworks. However, some interventions yield only limited or transient QoL benefits, underlining the importance of personalized, goal-oriented strategies that address both cognitive and psychosocial dimensions. Further research is needed to optimize intervention strategies and clarify the mechanisms linking cognitive and QoL outcomes. Full article