Search Results (1,524)

Osteonecrosis of the femoral head (ONFH) is a progressive and potentially disabling condition caused by compromised blood supply to the femoral head, leading to bone necrosis and collapse. Early diagnosis is essential to enable joint-preserving interventions and improve patient outcomes. Magnetic resonance imaging (MRI) is currently considered the most sensitive modality for early detection, whereas computed tomography (CT) provides superior assessment of subchondral bone integrity and structural collapse. In recent years, artificial intelligence (AI), particularly machine learning (ML) and deep learning (DL) techniques, has emerged as a promising tool to enhance diagnostic accuracy, automate lesion segmentation, and predict disease progression. This review aims to provide an overview of current AI applications in MRI for ONFH, focusing on early diagnostic, disease staging and classification, volumetric assessment, differential diagnosis and prognostic prediction. A total of 61 articles were initially identified, of which 13 studies (2021–2025) met the inclusion criteria. Results indicate that DL models, particularly convolutional neural networks (CNNs), achieve excellent diagnostic performance, with reported accuracies up to 98.4% and area under the curve (AUC) values reaching 0.98 for early-stage detection. Several models demonstrated performance comparable to or exceeding that of experienced clinicians, particularly in differentiating ONFH from other hip pathologies and in early disease recognition. AI algorithms also showed high accuracy in staging and classification (AUC up to 99.7% in internal validation), as well as in automated segmentation and volumetric assessment (Dice coefficients up to 0.89), enabling objective quantification of necrotic lesions. Furthermore, prognostic models integrating radiomics and ML techniques demonstrated promising results in predicting femoral head collapse (AUC up to 0.85). From a clinical perspective, AI appears to function primarily as a supportive tool, improving diagnostic consistency, efficiency, and reproducibility, and acting as a “second reader” capable of reducing variability among less experienced clinicians. However, significant limitations remain, including dataset heterogeneity, predominance of retrospective and monocentric studies, and limited integration of clinical data. In conclusion, AI-based MRI analysis shows strong potential to enhance the diagnosis, staging, and management of ONFH. Future research should focus on multicenter prospective validation, integration of multimodal clinical data, and development of explainable and generalizable models to facilitate widespread clinical adoption. Full article

Background/Objectives: Regular participation in physical activity is essential for maintaining health and well-being and plays a key role in disease prevention and quality of life, both in the general population and among people with disabilities, who represent approximately 16% of the global population. Martial arts-based physical activity programs incorporating safe-falling techniques may contribute to improving physical fitness, reducing fall-related injuries, and supporting adherence to the World Health Organization physical activity recommendations. This systematic review primarily aimed to identify martial arts-based fall-training programs, particularly judo-based interventions, and examine their effects on health and well-being in individuals with intellectual disability. As a secondary objective, evidence from other populations and martial arts disciplines was considered to identify relevant fall-training protocols and transferability. Methods: The research question was formulated using the PEO framework. Eligibility criteria included: people with intellectual and developmental disabilities or special educational needs; exposure to exercise programs involving martial arts, combat sports, or judo; and outcomes related to safe falling, falls, balance, motor skills, and physical condition. A systematic literature search was conducted between December 2025 and April 2026 on the Web of Science Core Collection, Scopus, PubMed, and SPORTDiscus in accordance with PRISMA guidelines. Results: From a total of 658 records identified, 27 studies met the inclusion criteria, encompassing 1892 participants with various disabilities, including intellectual disability, autism spectrum disorder, visual impairment, and deafness. The interventions involved different martial arts modalities, such as judo, taekwondo, karate, tai chi, and capoeira. Overall, the available evidence suggests beneficial effects on physical fitness, motor abilities, balance, psychosocial outcomes, and safe-falling skills across different populations; however, substantial clinical and methodological heterogeneity was observed among the included studies. Conclusions: No studies investigating structured martial arts-based fall-training programs in individuals with intellectual disability were identified. Although evidence from other populations is promising, it remains heterogeneous. Further high-quality studies are needed to evaluate these interventions in individuals with intellectual disabilities. Full article

Educational robotics is increasingly recognized as a promising tool for innovation in teaching and learning. However, its successful integration in schools often depends on the availability of targeted professional development programs that support educators with no prior experience in this field. This study addresses this gap by presenting and evaluating the development and implementation of a training program specifically designed to equip educators with the knowledge, skills, and confidence to integrate robotics into early and primary education. The program, sfera.BOT, was designed as part of a regional educational initiative in Basilicata, Italy, and was conceived within T.I. Abilito, a national initiative that promotes educational inclusion; within this broader framework, however, the training pathway examined here was addressed to educators working with all children in mainstream early childhood and primary classrooms, rather than exclusively with children with disabilities. It followed a blended learning model and was grounded in hands-on exploration, collaborative planning, and weekly mentoring sessions. The research employed a qualitative approach to explore the experiences of four female educators from diverse backgrounds who completed the training. Data was collected through semi-structured interviews, a knowledge assessment questionnaire, and field observations. The findings reveal that participants acquired significant technical and pedagogical competencies, shifted from initial insecurity to confident implementation, and began to see themselves as potential trainers and change agents within their schools. Given the small, purposefully selected sample and the specific regional context, these findings are context-rich rather than statistically generalizable. The study underscores how well-structured, practical, and context-aware training can foster continuing professional development in the field of educational robotics. Full article

Environmental sustainability is increasingly recognised as part of quality education, public health, and national development. However, sustainability education may unintentionally exclude students with disabilities when teaching materials, school activities, and environmental practices are not adapted to diverse learning and support needs. This study examined awareness, perceptions, preparedness, current practices, and barriers related to environmental sustainability among educators in the special education sector in Riyadh, Saudi Arabia. A cross-sectional survey was conducted among 432 educators and education-related professionals working in special education schools and general education schools with special education programmes in Riyadh. Data were collected using a structured self-administered questionnaire. Awareness, perceptions, preparedness, institutional support, current practices, and barriers were assessed using Likert-scale items and practice checklists. Descriptive statistics, chi-square tests, Cramér’s V, and multiple linear regression were used for analysis. Respondents showed moderate to high awareness of environmental sustainability, with a mean awareness score of 21.2 out of 30 (SD 4.9); 204 respondents (47.2%) had high awareness. Perceptions were generally favourable, with a mean perception score of 23.8 (SD 3.9), and 311 respondents (72.0%) classified as having high perception. Preparedness was positive but less consistent, with a mean score of 22.0 (SD 4.9); 239 respondents (55.3%) had high preparedness, while 176 (40.7%) had moderate preparedness. In regression analysis, preparedness was independently associated with perception score, special or inclusive education training, sustainability or climate education training, direct disability-related experience, and working in settings with structured sustainability activities. Educators in Riyadh’s special education sector generally recognise the relevance of environmental sustainability and support the inclusion of students with disabilities in sustainability-related learning and activities. Strengthening disability-inclusive sustainability education in special education settings will require integrated professional development, accessible teaching resources, curriculum guidance, leadership support, and whole-school sustainability planning. Full article

Background/Objectives: This systematic review examines psychological interventions for children with neurodevelopmental disabilities within a neurodiversity framework, emphasizing that variations in cognition, behavior, and neurological functioning represent natural forms of human diversity rather than deficits. Methods: A systematic literature search was conducted across the PubMed, PsycINFO, and Google Scholar databases for studies published between 2010 and 2025. Studies were included if they focused on children with autism spectrum disorder (ASD), learning or intellectual disabilities (LD/ID), or specific learning disabilities (SpLD), and evaluated psychological or behavioral interventions. Results: A total of 34 studies met the inclusion criteria after screening and full-text review. The findings indicate that traditional interventions, such as Applied Behavior Analysis (ABA) and Cognitive Behavioral Therapy (CBT), demonstrate effectiveness in improving adaptive behavior, emotional regulation, and cognitive functioning. However, more recent approaches, including Naturalistic Developmental Behavioral Interventions (NDBI), person-centered therapies, and gamified interventions, show greater alignment with neurodiversity principles by emphasizing individual strengths, autonomy, and environmental adaptation. Conclusions: Despite promising outcomes, the evidence base remains uneven, with a predominant focus on autism and limited high-quality studies addressing other neurodevelopmental conditions. The review highlights the need for more rigorous, inclusive, and longitudinal research, as well as the integration of neurodivergent perspectives in intervention design. Overall, the findings suggest that interventions incorporating individualized, strengths-based, and context-sensitive adaptations are associated with more consistent improvements in both functional outcomes and quality of life. Full article

Background/Objectives: Urban accessibility is a key determinant of participation for manual wheelchair users, yet accessibility experiences vary according to physical impairment, self-efficacy in wheeled mobility, and wheelchair mobility proficiency. This scoping review examined urban accessibility challenges in relation to these three dimensions. Methods: Following PRISMA-ScR guidelines, eight databases were searched for English-language peer-reviewed studies published from January 2015 to May 2025. Eligible studies addressed outdoor or urban mobility challenges among manual wheelchair users in relation to at least one dimension. Two reviewers independently screened records, assessed full texts, and extracted data using a standardized form. Findings were synthesized within an International Classification of Functioning, Disability and Health-informed framework. Fourteen studies were included. Results: The evidence base was methodologically diverse and fragmented; no study examined all three dimensions simultaneously, and wheelchair mobility proficiency received the least attention. Greater physical impairment was associated with more perceived barriers and higher effort. Self-efficacy influenced avoidance of or engagement in mobility tasks beyond physical functioning. Wheelchair mobility proficiency, supported by training, experience, and wheelchair fit, was associated with managing ramps, uneven surfaces, and other environmental demands, but was rarely assessed using standardized performance measures. Conclusions: Urban accessibility reflects interactions among physical functioning, self-efficacy, wheelchair mobility proficiency, assistive-device characteristics, and environmental conditions. Accordingly, urban mobility should be understood as a person–wheelchair–environment interaction rather than solely as an interaction between the individual and the built environment. Integrative studies using standardized measures and more systematic reporting of wheelchair fit and configuration are needed to inform impairment-inclusive urban planning, rehabilitation, and policy. Full article

Chikungunya poses a major clinical and public health challenge due to its wide range of manifestations and, consequently, frequent misdiagnoses. This pitfall may lead to compromised long-term outcomes when treatment is inadequate. This scoping review aims to summarize the clinical features, current management strategies, and long-term outcomes of chikungunya infection in adults. The review was designed and reported according to Joanna Briggs Institute (JBI) guidance and the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) framework. Three main databases—PubMed, ScienceDirect, and Wiley Online Library—were searched, and additional gray literature from international and national health agencies was consulted. Nineteen studies met inclusion criteria. Chikungunya in adults commonly begins as an acute febrile illness with prominent musculoskeletal symptoms, but may evolve into a chronic, disabling disease, substantially impairing quality of life. Treatment is largely symptomatic for the acute phase, whereas chronic infections require long-term multidisciplinary care, supported by preventive measures through public health interventions. In summary, while most patients recover with appropriate care, a significant number of patients experience persistent sequelae requiring rehabilitation, continued clinical follow-up, and targeted preventive and public health actions. Full article

Chronic non-cancer pain (CNCP) is a complex and highly prevalent condition among older adults that contributes to suffering and disability. It is frequently underestimated and normalized as part of aging. This scoping review aimed to identify and describe the consequences of CNCP on the daily lives of older adults. A scoping review was conducted following the Arksey and O’Malley framework and the PRISMA-ScR reporting guidelines. Searches were performed in five databases (CINAHL, Scopus, Web of Science, Embase, and PubMed) and in grey literature between January and February 2026. The protocol was registered in the Open Science Framework (OSF). The level of evidence was appraised using the Center for Evidence-Based Medicine criteria. Forty-four articles were included that met the established inclusion criteria. CNCP exerted a multidimensional negative impact. Physically, it was associated with increased frailty, higher risk of falls, and disability in activities of daily living. Psychologically, it correlated with anxiety, depression, and sleep disturbances. Socially, it contributed to isolation and created financial barriers that limited access to health services. CNCP represents a critical barrier to older adults’ wellbeing. Nursing should prioritize early detection and avoid the normalization of pain in clinical practice. Knowledge gaps remain regarding gender perspectives and mental health outcomes. Full article

Children with Down syndrome may experience developmental differences in communication, social participation, adaptive functioning and peer interaction. However, they also possess individual strengths, learning potential and adaptive capacities that can be enhanced through structured, responsive and contextually relevant early intervention. This study aimed to design and develop an Early Intervention Module for Social Skills of Children with Down Syndrome in Malaysian Taska OKU settings. A Design and Development Research approach was applied across three phases: needs analysis, module design and development, and usability evaluation. Phase 1 involved semi-structured interviews with teachers to identify contextual challenges, existing strengths, available practices and support needs in teaching social skills to children with Down syndrome. Phase 2 focused on module development through expert consensus using the Fuzzy Delphi Method. Phase 3 examined the usability of the developed module among teachers in real daycare settings. The findings from the needs analysis showed that teachers required a structured module that could support children’s social participation, communication, turn-taking, emotional expression and interaction with peers and adults. At the same time, the findings highlighted the importance of recognising children’s strengths, including their responsiveness to visual cues, enjoyment of routine-based activities, imitation skills and ability to participate when appropriate support is provided. The developed module consists of structured social skill domains, learning outcomes, teaching activities, visual support, play-based strategies, parental involvement components and progress monitoring tools. The usability evaluation indicated that the module was practical, understandable and relevant for use in Taska OKU settings. Teachers reported that the module supported clearer planning, more consistent implementation and better opportunities for children to participate socially. This study contributes to the development of a locally adapted early intervention module that is grounded in stakeholder input, expert consensus and inclusive education principles. The module also reflects strength-based and functioning-oriented terminology aligned with the International Classification of Functioning, Disability and Health framework. The findings suggest that contextually developed modules can support teachers and caregivers in enhancing the social participation of children with Down syndrome in Malaysian early childhood settings. Full article

Background and Objectives: Children with mild intellectual disability (MID) frequently experience difficulties during dental treatment due to increased sensitivity to environmental stimuli and limited cooperation. Sensory-adapted dental environments (SADE) have been proposed as a strategy to improve the dental experience of patients with neurodevelopmental conditions; however, evidence regarding their effectiveness in children with MID remains limited. This randomized clinical trial aimed to evaluate the effects of a sensory-adapted dental environment on pain-related behaviors and treatment cooperation during professional oral hygiene procedures in children with MID and moderate dental anxiety. Materials and Methods: A randomized clinical trial was conducted at the IRCCS Oasi Research Institute (Troina, Italy). A total of 200 children were screened for eligibility. Following the application of the predefined inclusion and exclusion criteria, 160 children (76 males and 84 females; age range: 6–7 years) with a diagnosis of mild intellectual disability (MID) and moderate dental anxiety, assessed using the Corah Dental Anxiety Scale (DAS), were enrolled. Participants were randomly assigned to either a sensory-adapted dental environment (SADE; n = 80) or a regular dental environment (RDE; n = 80). All participants underwent a single session of professional oral hygiene using an ultrasonic scaler. Pain-related behaviors were assessed using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale, whereas cooperation during treatment was evaluated using the Frankl Behavior Rating Scale. Owing to the non-normal distribution of the outcome variables, between-group comparisons were performed using the Mann–Whitney U test. Statistical significance was set at p < 0.05. Results: Participants treated in the SADE showed significantly lower FLACC scores compared with those treated in the RDE (3.10 ± 1.86 vs. 5.05 ± 2.36, p < 0.001), indicating reduced pain-related behaviors during treatment. Moreover, children in the SADE group demonstrated significantly higher Frankl scores than those in the RDE group (2.78 ± 0.48 vs. 2.41 ± 0.84, p = 0.006), reflecting improved cooperation. Sex-stratified analyses confirmed significantly lower FLACC scores in both males and females treated in the SADE. No significant Group × Sex interaction was observed for either outcome, suggesting that the beneficial effects of sensory adaptation were independent of sex. Conclusions: SADE significantly reduced pain-related behaviors and improved cooperation during professional oral hygiene procedures in children with mild intellectual disability and moderate dental anxiety. These findings support the implementation of sensory-adapted strategies in pediatric dental settings to improve treatment experiences and facilitate dental care for children with neurodevelopmental disorders. Full article

As traffic automation grows, research into communication between automated vehicles (AVs) and pedestrians is increasing. Since communication is particularly challenging for persons with intellectual disability (PID), we investigated which gestures are used during street crossings and whether they differ between PID and persons with no diagnosed disability (PnDD). We conducted a virtual reality study with $N=70$ participants ($n=38$ PID, $n=32$ PnDD), observing participants’ movement and gestures in a road-crossing scenario and having them rate their presence, user experience, and the AV’s behavior. PID descriptively gestured less often than PnDD (33.3% vs. 18.8% of trials without a gesture), though this difference was not statistically significant. The increased learning effect of using gestures improves crossing time for PID. We identified three primary gestures (Greet, Barrier, Stop) that both groups equally favored. Our work contributes to making bidirectional communication with AVs more inclusive by providing insights into gestures used by PnDD and PID and identifying indicators of subconscious learning effects when using gestures. Full article

Background and objectives: Cerebrovascular strokes and transient ischemic attacks (TIAs) remain leading causes of global mortality and long-term disability. Emerging evidence suggests that pre-existing structural brain frailty—driven by chronic cerebral small vessel disease (CSVD)—critically limits neuroplastic compensation and determines overall recovery potential. This systematic review aims to synthesize current evidence evaluating brain frailty as an independent determinant of functional and cognitive outcomes. Methods: Following PRISMA and Cochrane SWiM guidelines, a comprehensive literature search was conducted across PubMed, Web of Science, Embase, and Scopus. Methodological quality was evaluated using the Newcastle–Ottawa Scale (NOS). Due to anticipated clinical and methodological heterogeneity, data were synthesized via a structured narrative approach. A total of 15 studies comprising more than 18,000 participants met the inclusion criteria, including prospective cohorts, retrospective cohorts, registry analyses, pooled cohort studies, and post hoc analyses of randomized controlled trials. Results: Structural disconnection burden emerged as one of the strongest predictors of post-stroke cognitive impairment, demonstrating remarkably large effect sizes at both 6 months (OR 9.96, 95% CI 2.21–52.40) and 36 months (OR 12.27, 95% CI 2.80–63.40). Additionally, blood–brain barrier (BBB) leakage was significantly associated with longitudinal cognitive decline (β −3.62 to −0.16, p < 0.001). Pre-existing brain frailty was also consistently associated with poorer functional recovery following acute ischemic stroke, even among patients undergoing advanced reperfusion strategies such as endovascular thrombectomy or intravenous thrombolysis. Conclusions: Brain frailty should be integrated into clinical prognostic frameworks as a key marker for predicting long-term cognitive function and functional independence in stroke patients. However, the substantial methodological and clinical heterogeneity observed across the included literature must be acknowledged as a key limitation of the current evidence base. Large-scale, prospective, multicenter longitudinal studies are required to better standardize brain frailty metrics and validate their utility in clinical practice. Full article

Background: Today, most students with autism spectrum disorder (ASD) are included in general education settings. Teachers are at the forefront in implementing inclusive practices and supporting these students’ learning. Their self-efficacy and willingness can determine the success of including students with ASD. In Hong Kong, little is known about the perspectives of in-service teachers working with students with ASD in classrooms. Methods: In this study, we measured teachers’ self-efficacy and willingness to implement inclusive practices for students with ASD and explored the relationship between them. Factors contributing to teachers’ self-efficacy and willingness were also investigated. Quantitative data were collected from 446 in-service teachers who participated in a professional development course about supporting students with disabilities at a university in Hong Kong. Results: The results reveal that Hong Kong teachers expressed a moderate level of self-efficacy and willingness in implementing inclusive practices for students with ASD. The results indicate that contact with students with ASD, principal support, and resource availability are predictors of teachers’ self-efficacy and willingness to implement inclusive practices. However, knowledge of inclusive legislation and policy is a predictor of self-efficacy but not willingness. Additionally, age influences teachers’ self-efficacy in inclusive practices, while gender affects their self-efficacy in inclusive practices and collaboration. Conclusions: These findings offer implications and suggestions to policymakers and school principals on supporting teachers in implementing inclusive education and promoting sustainable inclusive practices for students with ASD. These stakeholders should foster supportive environments that encourage positive interactions with students with ASD while providing targeted professional development in assessment and legislative knowledge. Full article

Social media have become central tools for government communication; however, they also present significant accessibility challenges for people with disabilities, particularly those with visual impairments. This study analyzes inclusive communication and digital accessibility practices in the official Facebook accounts of six Ecuadorian public institutions. A mixed-methods approach was employed, combining documentary analysis, a focus group with visually impaired users, and content analysis of 2429 Facebook posts published between 2023 and 2025. The analysis was conducted using four dimensions: propositional communication, copywriting, images, and videos. The results show that most publications only partially comply with accessibility criteria. While progress was identified in the use of clear and accessible language in textual content, significant deficiencies persist in multimedia content, particularly in the lack of alternative text, subtitles, and audio descriptions. The study concludes that inclusive communication in Ecuadorian public institutions remains fragmented and is not yet implemented as a cross-cutting public communication policy. Full article

The Spanish audiovisual industry has experienced unprecedented growth, offering new employment opportunities. In this context, the aim of the present work is to analyse the perceptions of experts on the motivations and barriers that affect the employment of disabled people in this industry. This research adopts a sequential mixed-method design, combining a focus group with a two-round Delphi technique, and involved participants working in audiovisual companies, specialised job portals, disabled people associations, and research. The results indicate that despite the prior limited experience with people with disabilities, audiovisual companies show a positive attitude towards their employment. Nevertheless, barriers persist related to a lack of confidence in their work performance and their ability to adapt to the demands of the position. Likewise, remote work, digital technologies, and artificial intelligence are perceived as facilitators of inclusion, although their effectiveness depends on provision of adequate training and accessibility. These findings suggest that from an expert’s perspective, the inclusion of disabled people in the audiovisual sector depends on organisational factors, accessibility conditions, and adequate training. Full article