Search Results (167)

Background/Objectives: Parkinson’s disease (PD) is a neurodegenerative disorder that impairs mobility. Treadmill training (TT) is a common rehabilitation strategy for improving gait parameters in individuals with PD. This systematic review evaluated the effectiveness of TT in improving motor function, walking ability, and overall functional mobility in PD patients. Methods: We compared TT to other forms of gait and motor rehabilitation, including conventional and robotic gait training. Trials that compared a treadmill training group with a non-intervention group were excluded from this review. We searched multiple databases for RCTs involving Parkinson’s patients until January 2025. The primary outcomes were motor function (UPDRS-III) and walking ability (6 MWT and TUG test). Results: We identified 285 articles; 199 were excluded after screening. We assessed the full text of 86 articles for eligibility, and 13 RCTs met the inclusion criteria. Some of them were included in the meta-analysis. The TT group showed a significant improvement in UPDRS-III scores [mean difference (MD): −1.36 (95% CI: −2.60 to −0.11)] and greater improvement in TUG performance [MD, −1.75 (95% CI: −2.69 to −0.81)]. No significant difference in walking capacity as assessed through the 6 MWT was observed [MD: 26.03 (95% CI: −6.72 to 58.77). Conclusions: The current study suggests that TT is effective in improving the motor symptoms and functional mobility associated with PD. Further studies are needed to develop protocols that consider the patients’ clinical characteristics, disease stage, exercise tolerance, and respiratory function. Full article

Background and Objectives: Research on the impact of leucine on older sarcopenic patients is scarce, and investigations on this subject have led to contradictory findings in the literature. Our goal was to compile data from the available studies in the literature to explore the effect of leucine supplementation on parameters associated with sarcopenia in elderly individuals. Methods: The meta-analysis included older persons over 65 years of age who were recruited on the basis of the European Working Group on Sarcopenia in Older People sarcopenia criteria. Studies that were included were those in which at least one sarcopenia criterion was measured, including grip strength, appendicular skeletal muscle mass/height², gait speed, and the short physical performance battery index. Results: The meta-analysis included ten randomized controlled trials and one prospective study. The leucine group included 566 participants, whereas the placebo group included 567 patients. Patients receiving leucine and patients receiving a placebo had significantly different handgrip (p = 0.03), appendicular skeletal muscle mass/height² (p = 0.0.2), and gait speed (p = 0.008). Patients received a high dosage of leucine, and there was a significant difference in the appendicular skeletal muscle mass/height² (p = 0.02) and gait speed (p = 0.01) between the high dosage of the leucine group and the control group. When vitamin D was combined with leucine, the appendicular skeletal muscle mass/height² (p = 0.03) significantly differed between the leucine group receiving vitamin D and the control group. Conclusions: Low-quality evidence was found that older sarcopenic patients receiving leucine may show trends toward improved skeletal muscle strength, skeletal muscle quality, and physical performance. The capacity of leucine supplementation to have a beneficial therapeutic impact in older sarcopenic individuals is restricted when it is used alone without concurrent additional therapy. Full article

Background/Objectives: Artificial tendons offer an alternative to biological tendon grafts and may restore normative biomechanical functions in humans and animals suffering segmental or complete tendon loss. The aim of this study was to quantify movement biomechanics during hopping gait and muscle properties of New Zealand White rabbits with a polyester silicone-coated (PET-SI) artificial tendon. Methods: In five rabbits, the biological Achilles tendon of the left hindlimb was surgically replaced with a PET-SI artificial tendon; five operated control rabbits underwent complete surgical excision of the biological Achilles tendon in the left hindlimb with no replacement (TE). Results: Across both groups at 2 and 8 weeks post-surgery compared to baseline, the maximum ankle angle during stance and swing phases of stride was significantly lower (i.e., more dorsiflexed) (p < 0.001), the peak vertical force was significantly higher (p < 0.001), and the average ground contact area was significantly lower (p < 0.001). At 8 weeks post-surgery, the muscle cross-sectional area of the lateral gastrocnemius was significantly higher in the PET-SI group than in the TE group (p = 0.006). Muscle mass and length were lower in the operated limb compared to the non-operated limb across the two groups (TE and PET-SI), with no significant differences between groups. Conclusions: The artificial Achilles tendon did not appear to provide superior biomechanical support during hopping compared to the TE group. However, the artificial tendon preserved muscle structural properties that correspond to the muscle’s capacity to generate force. Future studies should optimize the tendon–tissue interface. Full article

Background: This scoping review aims to map and summarise physical therapy interventions specifically targeting gait and balance in individuals with Charcot-Marie-Tooth disease (CMT), highlighting commonly applied strategies, methodological limitations, and clinical implications. Charcot-Marie-Tooth disease (CMT) is a hereditary neuropathy characterised by progressive motor and sensory impairment, often resulting in reduced mobility, muscle weakness, balance deficits, and fatigue. Although pharmacological options remain limited, rehabilitation is increasingly recognised as a key component of disease management. However, the scope, type, and effectiveness of rehabilitative interventions in CMT remain poorly mapped. Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology and the PRISMA-ScR guidelines. Five databases (PubMed, Cochrane, PEDro, Scopus, and Web of Science) were systematically searched up to March 2024. Studies were eligible if they involved participants with CMT undergoing rehabilitation interventions aimed at improving functional outcomes. Data extraction focused on study characteristics, methods, outcome measures, and results. Results: Eleven studies met inclusion criteria, comprising case reports, cohort studies, and two randomised controlled trials. Interventions included aerobic training, strength and balance exercises, videogame-based home programmes, and multidisciplinary rehabilitation. Most studies reported improvements in walking capacity (e.g., 6MWT, 10MWT), postural balance (e.g., BBS), and lower limb strength (e.g., MRC, dynamometry). Some also showed positive changes in fatigue and quality of life, though data were limited. Methodological heterogeneity and small sample sizes limited comparability and generalisability. Conclusions: Rehabilitation appears to yield meaningful improvements in key functional domains in people with CMT. Tailored, multimodal interventions show promise, though long-term benefits remain underexplored. Future research should adopt standardised protocols and outcome measures to better define best practices and optimise patient care. 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

The response to perturbations in the gait of elderly and young individuals can differ due to various factors, such as age-related changes in sensorimotor function, muscle strength, and balance control. This study aimed to identify and compare compensatory kinematic and kinetic gait strategies in response to sudden treadmill perturbations applied during the Pre-Swing phase in young and older adults. The analysis focused on determining age-related differences in joint behavior and force production under perturbation stress, with implications for fall prevention. Twenty-one young and an equal number of elderly healthy females walked on a treadmill in a virtual environment (GRAIL, Motek). Unexpected perturbations were applied five times. Principal Component Analysis (PCA) and k-means clustering identified three distinct compensatory strategies per limb. Young adults primarily employed Strategies I (42.2%) and II (40%), while older adults most often selected Strategy II (45.5%). Statistical analysis (SPM and Mann-Whitney U test, p = 0.05) showed significant between-group differences in joint angles and torques across the gait cycle. For instance, in Strategy I, young participants had significantly lower ankle plantarflexion angles (p < 0.01) and hip extension torques (p < 0.05) compared to the elderly. Strategy II in older adults showed significantly higher vGRF minimums (p < 0.01) and anterior-posterior GRF peaks (p < 0.001). The elderly adopted strategies compatible with their neuromuscular capacity rather than those minimizing joint load, as observed in the young group. These findings offer novel insights into age-related compensatory mechanisms and highlight the importance of tailored fall-prevention strategies based on biomechanical response patterns. Full article

Transcranial pulse stimulation (TPS) is a non-invasive neuromodulation method that uses, high-intensity acoustic shockwaves to deliver focused mechanical stimulation to neural tissue with minimal thermal effects. The mechanism of action includes but is not limited to promotion of blood flow and angiogenesis through mechanotransduction. Clinical data to date are limited and preliminary. In Alzheimer’s disease (AD), TPS has demonstrated cognitive and mood improvements in pilot studies and secondary endpoint analysis in first randomized trials. The enhancement of gamma-band oscillations and network connectivity has been reported. Clinical observations in Parkinson’s disease (PD) suggest TPS as a hypothesis-generating approach to address non-motor symptoms—such as depression, cognitive decline, and the freezing of gait—through theoretical modulation of basal ganglia–cortical circuits. TPS is CE-marked in Europe for AD and shows a favorable safety profile; however, ethical considerations arise from the limited evidence base, potential impairment of patient autonomy and judgment in dementia, and the risk of withholding established treatments. TPS should only be offered under structured scientific protocols or within patient registries to ensure rigorous oversight. Ensuring that consent processes account for cognitive capacity, and that TPS is applied as adjunct rather than replacement therapy, is paramount. Future research must include large-scale randomized controlled trials (RCTs), standardize stimulation protocols, deepen mechanistic insight, and embed robust ethical frameworks. Full article

Context: Intermittent fasting (IF) and calorie restriction (CR) have gained interest as dietary strategies due to their potential for weight loss and multiple metabolic benefits. These strategies are often accompanied by exercise in an attempt to improve body composition and physical performance. However, further research is crucial to understanding whether or not physical performance is affected by the expected weight loss and related body composition changes in individuals on IF and CR, even when exercise is combined. Objective: We aimed to systematically evaluate the effects of IF and CR on exercise performance and body composition in adults aged 18 to 65 years. Data Source: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic review was conducted up to April 2024 by searching electronic databases, including PubMed, Web of Science, and Scopus. There was no limit on publication dates. Data Extraction: The search explored the impact of IF and CR combined with exercise vs. exercise alone (control) on exercise performance outcomes: VO_2max, handgrip strength, bench press strength, knee extensor strength, leg press strength, countermovement jump (CMJ), 400 m walk test, and gait speed; body weight, body mass index (BMI), and body composition: fat-free mass (FFM), fat mass (FM), and body fat percentage (BFP). Analyses included calculation of weighted mean difference (WMD), standardized mean difference (SMD), and 95% confidence intervals (CIs) to assess outcomes. Data Analysis: The meta-analysis included a total of 35 studies, ranging from 4 to 52 weeks and involving 1266 participants. The results showed that IF (hypocaloric or eucaloric diet) and CR combined with exercise increased handgrip strength [WMD = 1.707 kg, p = 0.01] compared to exercise alone. Moreover, IF and CR combined with exercise did not significantly affect VO_2max [SMD = 0.005, p = 0.94], bench press strength [WMD = 0.377 kg, p = 0.778], knee extensor strength [WMD = −4.729 kg, p = 0.12], leg press strength [WMD = −2.874 kg, p = 0.415], countermovement jump [WMD = −0.226 cm, p = 0.80], 400 m walk test performance [WMD = −8.794 s, p = 0.06], or gait speed [WMD = 0.005 m/s, p = 0.82] compared to exercise alone. Moreover, IF and CR combined with exercise decreased body weight [WMD = −4.375 kg, p = 0.001], BMI [WMD = −1.194 kg·m⁻², p = 0.001], FFM [WMD = −1.653 kg, p = 0.001], FM [WMD = −2.858 kg, p = 0.001], BFP [WMD = −0.826%, p = 0.001] compared to exercise alone. Conclusions: IF (hypocaloric or eucaloric) and CR can be effectively integrated into exercise training without negatively impacting most measures of physical performance, while significantly enhancing weight loss and adiposity-related outcomes. The findings from this meta-analysis involving both athletes and non-athletes suggest that weight loss induced by IF and CR combined with exercise does not necessarily result in reduced physical performance. In real-world scenarios, however, different outcomes are conceivable, as body composition, physical capacity, diet and exercise can vary considerably based on individual conditions. Full article

Bio-inspired joints play a pivotal role in legged robots, directly determining their motion capabilities and overall system performance. While shape memory alloy (SMA) actuators present superior power density and silent operation compared to conventional electromechanical drives, their inherent nonlinear hysteresis and restricted strain capacity (typically less than 5%) limit actuation range and control precision. This study proposes a bio-inspired joint integrating an antagonistic actuator configuration and differential dual-diameter pulley collaboration, achieving amplified joint stroke (±60°) and bidirectional active controllability. Leveraging a comprehensive experimental platform, precise reference input tracking is realized through adaptive fuzzy control. Furthermore, an SMA-driven bio-inspired leg is developed based on this joint, along with a motion retargeting framework to map human motions onto the robotic leg. Human gait tracking experiments conducted on the leg platform validate its motion performance and explore practical applications of SMA in robotics. Full article

This study aimed to determine whether hand grip strength (HGS) could estimate the physical function of older women with or without obesity or sarcopenia in South Jeolla Province, South Korea. Methods: A total of 541 elderly women aged 60–95 years (mean age: 79.87 ± 6.64) participated in the study. Physical function was assessed using HGS, 10 m walk test, figure-of-8 walk test, and 30-s chair stand test. Among the participants, 400 (76.8%) were classified as obese, and 137 (26.3%) had sarcopenia. Results: Results showed that HGS was significantly lower in the sarcopenic group (16.58 ± 2.86 kg) than in the normal group (24.31 ± 3.33 kg, p < 0.001). HGS was negatively correlated with body fat (r = −0.146, p = 0.001) and positively correlated with physical performance. Additionally, exercise habits were significantly associated with reduced obesity risk (OR = 0.592, p = 0.027). This study was approved by the Institutional Review Board of Chonnam National University (IRB No. 1040198-220210-BR-009-03). The significance of hand grip strength was comparable to that of gait speed, walking capacity, coordination, and balance function. Conclusions: These findings suggest that grip strength can serve as a physical indicator of healthy condition and physical function with or without sarcopenia or obesity in older women. Full article

Background and Objectives: Whole-body vibration (WBV) therapy presents controversial evidence regarding its effectiveness in improving lower limb functional capacity in children with cerebral palsy (CP), particularly when applied continuously as an adjunct to a physiotherapy program with demonstrated efficacy. This study aimed to evaluate the effectiveness of adding WBV to an intensive therapeutic exercise and functional training program in improving lower limb functional capacity in children with spastic CP. Materials and Methods: Thirty children with spastic CP were randomly assigned to a control or experimental group. Both groups completed a 4-week intensive therapeutic exercise and functional training program (4 sessions/week). The experimental group additionally received daily WBV. Results: Both groups showed significant improvements in all analysed variables at 1, 2, and 6 months post-treatment (p < 0.001). However, no significant between-group differences were found for primary (GMFM-88 D: p = 0.80; GMFM-88 E: p = 0.91) or secondary outcomes in relation to muscle tone and strength, and balance. A trend toward greater improvement was observed in the experimental group but without statistical significance. Conclusions: The addition of WBV to an intensive program of therapeutic exercise and functional training does not yield additional benefits in motor function, spasticity, gait capacity, lower limb muscle strength, or balance compared to intensive physiotherapy and functional training alone in children with spastic CP. The significant within-group improvements can be attributed to the intensive physiotherapy intervention, comprising therapeutic exercises and functional training. Full article

Multiple sclerosis is a prevalent neurodegenerative disease that significantly affects gait and exercise capacity. The core system is involved in providing sufficient spinal stability for dealing with stability demands. People with multiple sclerosis exhibit reduced trunk stability, which may affect stability during tasks such as reaching, stepping, and unexpected perturbations. This systematic review aimed to evaluate the effects of core training on gait and exercise capacity in people with multiple sclerosis. A systematic review was conducted in the databases PubMed/Medline, Web of Science (WOS), ScienceDirect, CINAHL, Scopus, and Physiotherapy Evidence Database (PEDro). Randomized controlled trials up to January 2025 included the following PICO inclusion criteria: (Participants) adults with a multiple sclerosis diagnosis; (Intervention) a core stability training program (alone or combined with another intervention); (Comparison) compared to no intervention, placebo or any other intervention; (Outcomes) and including at least one outcome related to gait and/or exercise capacity. The search identified 781 records, and finally 12 studies were included in this review. Methodological quality and risk of bias were assessed using the PEDro scale (with 8 as the median score) and the Cochrane risk assessment tool (ROB2), showing in most cases some concerns, particularly regarding outcome selection. Most of the studies included reported significant improvements in gait assessed with the timed up and go, timed 25-foot walk, and six spot step tests. Also, the results of exercise capacity assessed with the 6 min and 2-min walk test significantly increased in most of the studies. The reviewed articles suggest that a core-based exercise program may be effective in improving gait and exercise capacity in people with multiple sclerosis. However, considering the heterogeneity of the interventions, results, population, and the high risk of bias of some trials, more research is needed to validate these preliminary results. Full article

Background: Defined as a self-selected speed of <0.4 m/s, chronic stroke survivors falling in this category are classified as “severe”, usually homebound and sedentary, and they experience worse outcomes. Limited rehabilitation strategies are available to improve walking speed and related outcomes in this subgroup, and questions regarding effective rehabilitation options remain. The objective of this study was to determine the effects of backward (BLTT) and forward (FLTT) locomotor treadmill training on overground walking speed, spatiotemporal symmetry, and dynamic postural stability. Methods: In this single-center, assessor-blinded, randomized controlled pilot trial, 14 stroke survivors with severe waking impairment underwent 12 sessions of BLTT (n = 7) or FLTT (n = 7). The primary outcome was the proportion of participants reaching clinically meaningful important difference (MCID) on the 10-meter walk test following training completion. Secondary outcomes were between-group differences in walking speed, spatiotemporal symmetry, and completion time on the 3-meter timed up and go (3M TUG) at 24 h, 30 days, and 90 days POST. Results: Two subjects in the BLTT group (28.6%) and one (14.3%) in FLTT achieved MCID following training; however, most subjects did not, with significant variability in response. At 24 h POST, the median (IQR) percent change in walking speed was 28.9 (9.01–36.7) and 17.4 (12.6–39.7) with BLTT and FLTT, respectively; however, no between-group differences were seen (p = 0.80) at this time point or at 30 (p > 0.99) and 90 (p > 0.99) days follow up. Likewise, there were no significant between-group differences in spatiotemporal symmetry and the 3M TUG across time points. Conclusions: While preliminary, this study found that 12 training sessions did not lead to group-level achievement of MCID for walking speed in our cohort and found no significant between-group differences in walking capacity or dynamic postural stability. Future well-powered dosing trials and mechanistically driven studies are needed to optimize and identify predictors of training response. Full article

Background/Objectives: Overcoming an oncological process has a significant impact on lower-extremity sarcoma survivors’ quality of life, due to the deterioration in their physical and functional state. This study evaluated the effects of a six-month multicomponent physical training program on the physical function and quality of life of a mesenchymal chondrosarcoma survivor. Methods: The mesenchymal chondrosarcoma survivor was subjected to an internal hemipelvectomy including right hemipelvis plus femoral joint and resection of the right proximal femur followed by chemotherapy and radiotherapy according to the oncology protocol. The program was performed twice weekly and included resistance, cardiorespiratory, trunk control, and stability exercises. Results: Functional assessments revealed improvements in hand grip strength, walking speed, balance, and coordination. The Timed Up and Go Test showed a 50% reduction in completion time, reflecting better mobility and strength. Additionally, gait speed increased significantly, and balance trials indicated enhanced coordination. Quality of life evaluations indicated progress in physical health, psychological well-being, and environmental engagement. Conclusions: Taken together, this research emphasizes the importance of tailored exercise interventions for sarcoma survivors, particularly those with significant physical impairments. Such programs are vital complements to conventional rehabilitation strategies, fostering physical activity adapted to individual needs. By addressing the multifaceted challenges of survivorship, these interventions enhance functional capacity, reduce disability, and improve overall well-being. Therefore, this case study highlights the program’s effectiveness in managing post-treatment sequelae, opening a pathway to improved physical autonomy and quality of life. Full article

With advancements in bipedal locomotion for humanoid robots, a critical challenge lies in generating gaits that are bounded to ensure stable operation in complex environments. Traditional Model Predictive Control (MPC) methods based on Linear Inverted Pendulum (LIP) or Cart–Table (C-T) methods are straightforward and linear but inadequate for robots with flexible joints and linkages. To overcome this limitation, we propose a Flexible MPC (FMPC) framework that incorporates joint dynamics modeling and emphasizes bounded gait control to enable humanoid robots to achieve stable motion in various conditions. The FMPC is based on an enhanced flexible C-T model as the motion model, featuring an elastic layer and an auxiliary second center of mass (CoM) to simulate joint systems. The flexible C-T model’s inversion derivation allows it to be effectively transformed into the predictive equation for the FMPC, therefore enriching its flexible dynamic behavior representation. We further use the Zero Moment Point (ZMP) velocity as a control variable and integrate multiple constraints that emphasize CoM constraint, embed explicit bounded constraint, and integrate ZMP constraint, therefore enabling the control of model flexibility and enhancement of stability. Since all the above constraints are shown to be linear in the control variables, a quadratic programming (QP) problem is established that guarantees that the CoM trajectory is bounded. Lastly, simulations validate the effectiveness of the proposed method, emphasizing its capacity to generate bounded CoM/ZMP trajectories across diverse conditions, underscoring its potential to enhance gait control. In addition, the validation of the simulation of real robot motion on the robots CASBOT and Openloong, in turn, demonstrates the effectiveness and robustness of our approach. Full article