Search Results (1,707)

Patients with cerebral palsy (CP) experience complex gait disorders that change with age, leading to reduced activity and social participation. This study aimed to analyse how gait patterns developed over five years and to examine the relationships between the Observational Gait Scale (OGS), Amsterdam Gait Classification (AGC), Gross Motor Function Classification System (GMFCS), and the Functional Mobility Scale (FMS) at 5 and 50 m (FMS 5/50) during treatment. This retrospective, single-centre observational study involved annual assessments over a five-year period, which were analysed. Patients underwent a rehabilitation programme including physiotherapy, orthotics, multilevel botulinum toxin type A injections (BoNT-A), and serial casting. Data regarding BoNT-A treatment, casting, physiotherapy, orthoses, GMFCS levels, and FMS 5/50 scores were obtained from medical records. OGS and AGC were evaluated through two-plane clinical video recordings conducted in the same gait laboratory for all children. A cohort of 200 pediatric subjects (120 boys and 80 girls) diagnosed with bilateral cerebral palsy, predominantly classified as GMFCS II (48%) and III (36%), was analyzed. The average initial age was 32.23 months (±6.96), and GMFCS levels improved in 33. 5% of children and worsened in 2% (p < 0.001). Improvements were observed in 50% of children with GMFCS III and 40% with GMFCS IV levels. FMS 5 and 50 improved by 54% and 52%, respectively. OGS scores showed improvement in 74% and 76% of patients, respectively, while deterioration was observed in 5% and 7% for the right and left lower limbs, respectively. Most changes in OGS scores ranged from 1 to 4 points. A negative correlation was found between OGS and GMFCS (p < 0.001), and a positive correlation was found between OGS scores and FMS 5 and FMS 50 (p < 0.001). Additionally, significant relationships were identified between AGC and GMFCS, as well as FMS at 5 and 50 m. Complex gait disorders identified by the AGC are associated with higher GMFCS E&R scores and lower FMS scores. During the five-year follow-up, relationships were observed among GMFCS, FMS, OGS, and AGC. Our findings indicate that integrated treatment has a positive effect on functional mobility and gait patterns in patients with CP. Full article

Background/Objectives: Therapeutic exercise (TE) has been shown to be an effective tool for slowing physical and cognitive decline in patients with dementia. However, its true impact on physical and functional variables, as well as the duration of its effects once therapy is discontinued, remains unclear. The aim was to analyze the short- and medium-term effects of a structured and monitored TE program on motor function in patients with dementia. Methods: A pre–post clinical trial was conducted in individuals with a medical diagnosis of mild-to-moderate cognitive impairment (Mini-Mental State Examination scores between 10 and 23) who had not engaged in regular exercise during the previous 6 months. The study variables and their measurement tools included general motor function (Short Physical Performance Battery), trunk control (Trunk Control Test), balance (Berg Balance Scale), overall mobility and gait (Timed Up and Go Test), and degree of independence in activities of daily living (ADLs) (Barthel Index). Participants completed a 12-week TE intervention at moderate intensity, 3 days per week for 45 min sessions. The program included aerobic training and strength, coordination, flexibility, and balance exercises. TE intensity was monitored through heart rate and dynamic maximal resistance. Assessments were conducted at baseline (t0), immediately after the program (t1), and 6 months after completion (t2). Results: Significant global longitudinal effects of time were observed for general motor function, balance, trunk control, and mobility and gait, whereas no significant global effect was detected for independence in activities of daily living. Post-intervention changes were non-significant; however, several pairwise comparisons showed moderate-to-large effect sizes. Follow-up assessments revealed shifts in performance distributions consistent with functional decline. Conclusions: A structured TE program performed at moderate intensity may help slow or attenuate the physical decline experienced by individuals with dementia. Full article

Subjective, imprecise evaluation of lower extremity function hinders the effective treatment of gait impairments in Parkinson’s disease (PD). Markerless motion capture (MMC) offers opportunities for integrating objective biomechanical outcomes into clinical practice. However, validation of MMC biomechanical outcomes is necessary for clinical adoption of MMC technologies. This project evaluated the criterion validity of a custom MMC algorithm (CART-MMC) against gold-standard 3D motion capture (Traditional-MC) and its known-groups validity in differentiating PD from healthy controls (HC). Sixty-two individuals with PD and 29 HCs completed a stepping in place paradigm. The trials were recorded by an augmented reality headset with embedded RGB and depth cameras. The CART-MMC algorithm was used to reconstruct a 3D pose model and compute biomechanical measures of lower extremity performance. CART-MMC outcomes were statistically equivalent, within 5% of Traditional-MC, for measures of step count, cadence, duration, height, height asymmetry, and normalized path length. CART-MMC captured significant between-group differences in step height, height variability, height asymmetry, duration variability, and normalized path length. In conclusion, CART-MMC provides valid biomechanical outcomes that characterize important domains of PD lower extremity function. Validated biomechanical evaluation tools present opportunities for tracking subtle changes in disease progression, informing targeted therapy, and monitoring treatment efficacy. Full article

Objectives: Hypertension is common in Alzheimer’s disease (AD) and contributes to functional decline. While ACE inhibitors are widely used for hypertension, their systemic effects on intestinal permeability and physical capacity in AD patients remain unclear. Materials and Methods: We investigated the potential contribution of increased intestinal permeability to handgrip strength (HGS) and physical capacity in patients with Alzheimer’s disease (AD) taking ACE inhibitors. We investigated hypertensive AD patients taking ACE inhibitors (n = 55) or other anti-hypertensive medications (n = 57) at baseline and one year later, along with age-matched controls (n = 64) and normotensive AD patients (n = 61). We measured plasma zonulin, a marker of intestinal permeability, and HGS, and performed the short physical performance battery (SPPB). Results: AD patients had lower HGS, gait speed, SPPB, and higher plasma zonulin than controls at baseline (all p < 0.05). The use of ACE inhibitors was associated with increased HGS and gait speed, and reduced plasma zonulin in AD patients. Conversely, AD patients on other anti-hypertensive medications had higher zonulin and lower HGS but no change in gait speed and SPPB after one year. The patients taking ACE inhibitors also exhibited significant dynamic correlations of zonulin with HGS, gait speed, and SPPB (p < 0.05). ACE inhibitors also reduced plasma C-reactive proteins and 8-isoprostanes as markers of oxidative stress and inflammation. Conclusions: ACE inhibitors may improve physical performance and cognitive function in hypertensive AD patients, primarily through vascular smooth muscle modulation, leading to better perfusion. These effects may indirectly support intestinal barrier and muscle function, highlighting a novel gut–vascular–muscle interface relevant to therapeutic strategies. Full article

Quantitative gait analysis is essential for assessing motor function, as altered walking patterns are linked to functional decline and increased fall risk. Although recent advances in markerless motion analysis and human pose estimation enable gait feature extraction from low-cost video systems compared to expensive motion analysis laboratories, clinical translation remains limited by fragmented descriptors or approaches that directly regress clinical scores, often reducing interpretability and generalizability. We propose the Gait Alteration Index (GAI), an interpretable index that quantifies gait abnormality as a functional deviation from typical walking patterns, independently of specific pathologies. The GAI is computed from a small set of gait parameters and integrates three complementary domains: spatio-temporal characteristics, surrogates of dynamic stability, and arm swing behaviour, providing both a global index and domain-specific sub-indices. Preliminary evaluation on a heterogeneous cohort using clinician-derived assessments showed that the GAI captures clinically meaningful gait alterations (Spearman’s $\rho =0.65$), with the strongest agreement for spatio-temporal features ($\rho =0.77$). These results suggest that the GAI is a promising low-cost, and interpretable tool for objective gait assessment, screening, and longitudinal monitoring. Full article

Background: Motor imagery (MI) and mirror therapy (MT) are widely used neurorehabilitation strategies to enhance motor recovery after stroke and are commonly applied as adjuncts to conventional rehabilitation therapy (CRT). However, direct comparative evidence between these interventions remains limited. This systematic review compared the effects of MI and MT on motor function, functional performance, spasticity, and gait-related outcomes in adults after stroke. Methods: A systematic comparative review with narrative synthesis was conducted following PRISMA guidelines and registered in PROSPERO (CRD420251274308). PubMed, Cochrane Library, CINAHL, Scopus, Web of Science, and ScienceDirect were searched up to July 2025. Clinical trials directly comparing MI and MT in adults with stroke were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated with the Cochrane RoB 2 tool. Results: Six clinical trials involving 206 participants were included. Both MI and MT were associated with significant pre–post improvements across motor function, functional performance, spasticity, and gait-related outcomes. Between-group comparisons yielded heterogeneous findings, with no consistent evidence supporting the superiority of either intervention. Isolated advantages of MI were reported for specific upper-limb subdomains, but these effects were not consistently replicated. Overall methodological quality ranged from low to moderate, and all included studies were judged to be at high risk of bias according to the RoB 2 tool. Conclusions: MI and MT appear to provide comparable benefits for motor and functional recovery after stroke when used as adjuncts to CRT. Current evidence does not support the preferential use of one intervention, highlighting the need for well-designed trials with improved methodological rigor. Full article

Artificial intelligence (AI), virtual reality (VR), gamification, and telerehabilitation are increasingly incorporated into neurorehabilitation to deliver adaptive, personalized, and remotely accessible interventions for individuals with stroke and other neurological disorders. These technologies aim to address key limitations in conventional rehabilitation by enhancing training intensity, patient engagement, accessibility, and real-time monitoring. This systematic review synthesizes evidence from clinical and simulation-based studies evaluating AI-assisted systems, non-AI gamified platforms, VR/exergames, telerehabilitation models, and simulation-driven architectures across neurological populations. A comprehensive search of PubMed, Scopus, Embase, CINAHL, and Web of Science (2010–2025) identified randomized controlled trials, pilot and quasi-experimental studies, telerehabilitation systems, VR/exergame interventions, AI-based adaptive tools, and computational or model-driven investigations, guided by a revised PICO framework. Data were extracted using a standardized template, with studies categorized by design, population, technological modality, and outcome domain. Risk of bias was assessed using validated tools, and GRADE was applied to stroke-specific clinical outcomes. Twenty-two studies met the inclusion criteria, encompassing both clinical trials and simulation/modeling research. Clinical studies reported improvements in motor function, balance, gait, swallowing, cognition, and psychosocial well-being, often accompanied by high usability and adherence. AI-enabled systems facilitated adaptive difficulty adjustment, automated feedback, and individualized progression, while non-AI platforms demonstrated strong engagement and meaningful functional gains. Simulation studies provided valuable insights into algorithm behavior, sensor-based modeling, and system optimization. Despite promising multi-domain benefits, methodological heterogeneity, limited long-term follow-up, and inconsistent AI transparency remain key challenges, underscoring the need for standardized outcomes, explainable AI, inclusive design, and robust multicenter trials. Full article

Fibromyalgia is a complex chronic disorder involving persistent widespread pain accompanied by functional limitations, cognitive impairments, and alterations in neural processing. Previous research indicates that exercise-based interventions can play a key role in alleviating symptom burden and enhancing physical performance; however, there is limited evidence regarding their impact on neurophysiological mechanisms. Creative dance, in combination with strength training, may stimulate both motor and cognitive systems, promoting brain plasticity and functional improvements. This study will analyze the effects of a six-week strength and creative dance program on physical fitness under single- and dual-task conditions in women with fibromyalgia and will explore the associated changes in brain electrical activity and autonomic modulation. Methods: This randomized controlled trial will be divided into an exercise group (n = 22) and a control group (n = 22). The 6-week supervised intervention consists of two 60-min sessions per week, combining strength exercises and creative dance. Primary outcomes include physical fitness tests (strength, mobility, balance, and agility gait test in single-task and dual-task), fibromyalgia symptoms, and quality of life. Secondary outcomes include changes in electroencephalography, heart rate variability, physical activity level, and fear of falling. Statistical analyses will compare within- and between-group differences using non-parametric tests and effect sizes. It is hypothesized that the intervention will improve physical fitness and dual-task performance, alongside increases in brain activity power. This study may provide insights into the neurophysiological mechanisms underlying the benefits of exercise benefits in fibromyalgia. Full article

Wearable sensing technologies are increasingly used to assess neuromuscular function during daily-life activities. This study presents and evaluates a multisensor wearable system integrating a textile-based surface Electromyography (sEMG) sleeve and a pressure-sensing insole for monitoring Tibialis Anterior (TA) and Gastrocnemius Lateralis (GL) activation during gait. Eleven healthy adults performed overground walking trials while synchronised sEMG and plantar pressure signals were collected and processed using a dedicated algorithm for detecting activation intervals across gait cycles. All participants completed the walking protocol without discomfort, and the system provided stable recordings suitable for further analysis. The detected activation patterns showed one to four bursts per gait cycle, with consistent TA activity in terminal swing and GL activity in mid- to terminal stance. Additional short bursts were observed in early stance, pre-swing, and mid-stance depending on the pattern. The area under the sEMG envelope and the temporal features of each burst exhibited both inter- and intra-subject variability, consistent with known physiological modulation of gait-related muscle activity. The results demonstrate the feasibility of the proposed multisensor system for characterising muscle activation during walking. Its comfort, signal quality, and ease of integration encourage further applications in clinical gait assessment and remote monitoring. Future work will focus on system optimisation, simplified donning procedures, and validation in larger cohorts and populations with gait impairments. Full article

Background and Objectives: Orthopedic patients recovering from lower extremity trauma frequently experience gait disturbances that affect mobility, independence, and quality of life. Engaging patients in recognizing their own gait abnormalities may enhance participation in rehabilitation and improve functional outcomes. The purpose of this study to assess if patients recovering from lower extremity trauma can self-recognize the presence or absence of a gait abnormality, and if the PROMIS physical function scores correlate with gait abnormality. Materials and Methods: An IRB-approved prospective cross-sectional study was conducted at a Level One U.S. trauma center, assessing gait disturbance in patients recovering from lower limb surgery. Participants completed the PROMIS physical function survey along with self-assessing the presence or absence of a limp, then received a clinical gait assessment by a clinician. Of 243 patients screened, only those with an isolated lower limb injury, status post-operative trauma care, and able to ambulate unassisted were included. This yielded a final study cohort of 66 patients. Results: Post-lower extremity trauma patients were able to self-identify the presence (95.92% p < 0.00001) or absence 89.47% (p < 0.00001) of a gait abnormality. There was a statistically significant difference in PROMIS physical function t-scores between patients with and without a limp, 37.2 and 44.4 (p-value 0.00012), respectively. Conclusions: Patients recovering from lower extremity trauma can effectively identify the presence or absence of gait disturbances. Limp recognition was associated with lower PROMIS Physical Function scores. Promoting patient awareness and involvement in tracking their recovery may enhance engagement, guide clinical decision-making, and support better rehabilitation outcomes. Full article

To achieve high-precision trajectory tracking control for an underwater hexapod robot, this paper proposes a hierarchical control architecture. Firstly, a multi-rigid-body dynamic model for the robot is established based on the Newton-Euler method and reasonably simplified. Secondly, a Central Pattern Generator (CPG) network with the Hopf oscillator as its core is designed to generate stable and coordinated crawling gaits. By introducing a steering parameter, a kinematic model connecting the CPG output is constructed. Furthermore, based on this dynamic and kinematic model, an upper-layer Model Predictive Controller (MPC) is designed. The optimized control quantities output by the MPC are mapped into the rhythmic parameters of the CPG network via a transfer function established by fitting experimental data, thus forming the complete MPC-CPG controller. Finally, the proposed method is validated through simulations of circular trajectory tracking. The results show that even in the presence of initial errors, the controller can converge rapidly, with trajectory position error consistently maintained within −0.1 m~0.1 m, and heading angle error confined to the range of −15~15°. The experiments fully demonstrate the effectiveness of the proposed MPC-CPG controller in ensuring trajectory tracking accuracy, motion smoothness, and system stability. Full article

Cerebral palsy (CP) is a developmental disability caused by injury to the fetal or infant brain, affecting between 1.6 to 3.7 per 1000 live births worldwide. Ambulatory patients with cerebral palsy experience various gait problems, for which they seek treatment from medical professionals. Varus foot deformities are among the most problematic for patients. Varus foot deformity is characterized by the inner border of the foot being tilted upward and the hindfoot inward, increasing weightbearing on the lateral aspect of the foot. This positioning increases weight-bearing pressure under the lateral (outside) of the foot and often under the fifth metatarsal head when walking. As such, varus foot deformity can contribute to in-toeing, make shoe and brace-wearing difficult and painful, compromise gait stability, and sometimes lead to metatarsal fractures. Current knowledge of CP etiology and classifications, as well as principles and advances in assessment and treatment decision making for varus foot deformities, are outlined in this narrative review. In younger children with flexible deformities, non-operative interventions such as bracing, botulinum toxin injection, and serial casting are effective. The literature and expert consensus suggest that, if possible, surgery should be delayed until after the age of 8 years. When surgery is indicated, soft tissue procedures are used for flexible deformities. In addition to the soft tissue procedures, bone surgery is needed for rigid deformities. Careful pre-operative foot assessment is needed, including assessment of deformity flexibility and range of motion, X-rays, and computerized gait analysis if possible. Strategies are presented for thorough assessment when gait analysis is not available or feasible. Research reports of surgical outcomes for soft tissue and bony correction are positive, but should be interpreted with caution. The quality of evidence on surgical outcomes is compromised by use of varying research design methods and selection of outcome measures, with few including measures of function or patient-reported outcomes. It is recommended that surgical outcome be assessed using standardized assessment tools, such as the Foot Posture Index, which have had their validity and reliability established. Recent advances in 3D kinematic foot model development and musculoskeletal modeling have the potential to greatly improve surgical outcomes for patients with CP. Full article

Adaptive locomotion requires the integration of cognitive and motor processes and is challenged in neurological disorders. Dual-task (DT) training may improve cognitive–motor coordination, but its feasibility across heterogeneous clinical populations is uncertain. This pilot study aimed to understand if the effects of a secondary motor or cognitive task added to a walking task depend on the functional walking abilities of the subjects. We enrolled 30 participants with neurological disorders not related to traumatic events, 5 for each one of the following groups: healthy young subjects (HeY), healthy control subjects (HeC), subjects with stroke (ictus, IC), Parkinson’s disease (PD), multiple sclerosis (MS), and Long-COVID sequelae (LC). Spatiotemporal gait parameters were recorded using a wearable inertial magnetic unit, and subjective workload was assessed with the visual analog scale (VAS) and NASA-Task Load Index. Regression models revealed strong baseline–DT coupling for stride duration (slopes 1.11–1.37; R² 0.85–0.97), stride length (slopes 0.93–0.94; R² 0.86–0.93), walking speed (slopes 0.87–0.98; R² 0.78–0.93), and gait ratio (stance/swing, slopes 0.38–0.60; R² 0.21–0.52). Mixed-effects analyses identified significant group effects for walking speed (F(5) = 7.218, p < 0.001), stride length (F(5) = 4.834, p = 0.001), gait cycle duration (F(5) = 5.630–5.664, p < 0.001), Walking Quality (F(5) = 4.340–4.373, p = 0.001), and propulsion index (F(5) = 5.668–6.843, p < 0.001). The incongruent DT condition was the most sensitive in differentiating clinical groups. NASA-TLX indicated higher perceived workload in IC and MS compared with non-clinical groups. The protocol was completed by all participants without adverse events, supporting the feasibility of the procedure in this pilot sample. Its predictable scaling across baseline gait metrics supports its use as a personalized rehabilitation tool for diverse neurological populations. (ClinicalTrials.gov NCT07254377). Full article

Background and Objectives: Postural instability is a key feature of Parkinson’s disease (PD), contributing to disability and increased risk of falls. Pharmacological treatments are important, but it is necessary to integrate them with rehabilitation programs that provide benefits for gait and balance. Focal muscle vibration (fMV) has been proposed as a proprioceptive-oriented intervention to enhance postural control, but evidence in PD remains heterogeneous. This observational, retrospective, and controlled pilot study aimed to evaluate whether the integration of fMV into a standardized rehabilitation program provides additional benefits for balance, gait, and fall risk compared to standardized exercise alone in patients with PD. Materials and Methods: Medical records of 35 outpatients with Parkinson’s disease (Hoehn & Yahr stage II–III) were reviewed. All practiced a standardized rehabilitation exercise group program. Of these, 18 patients agreed to undergo fMV before the exercise sessions (fMV group); 17 patients did not accept fMV due to personal organizational reasons (EG) and were considered a retrospective control group. In detail, (i) the fMV group receivdc focal muscle vibration during the first three weeks in addition to a standardized group rehabilitation exercise program, and (ii) the EG underwent a standardized rehabilitation program only. Both groups then completed an identical 16-week standardized rehabilitation program. Functional outcomes were assessed at baseline (T0) and after one month (T1). Results: Groups were homogeneous at baseline. The fMV group showed significant improvements in SPPB (from 8.16 ± 1.6 to 10.2 ± 1.6 p < 0.001) in the Tinetti total (from 18.38 ± 3.2 to 21.5 ± 2.9 p < 0.05). Stabilometric analysis revealed a significant improvement in the Romberg Quotient in the fMV group (p < 0.005). Conclusions: A short time-limited fMV intervention may act as a sensory primer, enhancing the effects of a subsequent standardized rehabilitation program in PD. Full article

Background/Objectives: This article presents the feasibility and preliminary outcomes of an international cooperation project between the University of Valencia (Spain) and the University and health authorities of Pinar del Río (Cuba), designed to implement and evaluate an innovative rehabilitation protocol. Aligned with the United Nations Sustainable Development Goals (SDGs 3, 4, and 10), the initiative aims to implement a low-cost, evidence-based rehabilitation program combining mirror-neuron stimulation via Virtual Walking and therapeutic exercise. Methods: The program included multidisciplinary meetings and both digital and on-site training for healthcare professionals, caregivers, and educators, aimed at strengthening local capacities in evidence-based practice. The transferred protocol consisted of Virtual Walking (10 min) and therapeutic exercise (30 min), implemented three times per week, for eight weeks. Outcomes assessed included gait speed and endurance (10-Minute Walking Test, 6-Minute Walking Test), lower limb function (Timed Up and Go Test), frailty status (Fried criteria), pain (Visual Analog Scale), and satisfaction with the training program. Pre-post comparisons were conducted using the Wilcoxon signed-rank test for continuous data. Results: The program was successfully implemented in two polyclinics with high levels of participant satisfaction. Eleven patients completed the program, showing significant improvements in gait endurance (p < 0.05), while lower limb function and pain did not change significantly. Noteworthily, severe infrastructural and connectivity limitations were found. Overall, results demonstrate the feasibility, adaptability, and acceptability of the proposed protocol, which integrates technological innovation, clinical training, and community engagement to promote health quality and equity. Conclusions: This project provides a replicable framework for rehabilitation initiatives in low-resource settings and demonstrates the potential to achieve meaningful clinical results. Full article