Search Results (242)

Objectives: Fear of falling (FoF) is a common psychological phenomenon in later life and is often accompanied by avoidance behavior and activity restriction. Although FoF is associated with anxiety, depressive symptoms, reduced self-efficacy, and fear of loss of autonomy, older adults with FoF may differ substantially in the configuration of these characteristics. The present study aimed to identify data-derived profiles of older adults based on FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy, and to examine profile-specific psychological predictors of FoF and avoidance behavior. Methods: The main analytical sample included 217 older adults aged 60–97 years (M = 76.45, SD = 10.14) with Mini-Mental State Examination scores of 20 or higher. Latent profile analysis was conducted using FoF, avoidance behavior, self-efficacy, and fear of loss of autonomy. Anxiety components, depressive symptoms, coping strategies, pain catastrophizing, and loneliness-related indicators were examined in class-specific regression models. The stability of the class solution was tested across different MMSE cut-off scores. Between-class comparisons were conducted for functional, fall-related, socio-demographic, and psychological indicators. Results: A three-class solution was selected and interpreted as adaptive, vulnerable, and maladaptive profiles. The profile structure remained relatively consistent across MMSE cut-off scores, including in the broader sample with MMSE ≥ 15. The classes did not differ significantly in postural balance or number of falls, suggesting that the profiles could not be fully explained by objective fall-risk indicators. Significant between-class differences were found for age, daily pain level, and state social defense. Class-specific regression models suggested that psychological variables associated with FoF and avoidance behavior differed across profiles. Pain appraisal and emotion-related coping were more relevant in the adaptive profile, phobic anxiety and anxious appraisal of future events in the vulnerable profile, and anxiety-related, depressive, interpersonal, and coping-related factors in the maladaptive profile. All reported associations remained significant after false discovery rate correction. Conclusions: FoF and avoidance behavior are related but not identical phenomena and vary across data-derived psychological profiles. A profile-oriented approach may provide a more differentiated understanding of activity restriction in older adults and help identify profile-specific targets for psychological support. Full article

Background and Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder in which gait and balance disturbances substantially increase the risk of falls and loss of independence. Pharmacological treatment alleviates several motor symptoms but has limited effects on postural instability. Backward walking (BW), a demanding locomotor task, has recently been investigated as both an assessment tool and a rehabilitation strategy in PD. The purpose of this focused systematic review is to analyse the benefits and limitations of retro walking in relation to the gait parameters and balance control of PD patients. Materials and Methods: A structured literature search (2015–2025) was conducted across multiple databases in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Eligibility criteria, screening procedures, and qualitative synthesis methods were predefined. Nine studies (including two randomized controlled trials) met the inclusion criteria. Methodological quality was assessed using PEDro and ROBINS-I tools, and the certainty of evidence was evaluated using GRADE. Results: The research results indicate within-group improvements in balance and gait parameters following BW training. Some of the included studies also suggest that BW may be a sensitive marker of balance deficits and fall risk. However, the evidence is limited by small sample sizes, heterogeneity of interventions, and a predominance of non-randomized designs. Conclusions: Current evidence regarding BW in PD remains preliminary. While BW may be considered as a supplementary component of rehabilitation, its specific efficacy cannot be clearly distinguished from general exercise effects. Further high-quality randomized controlled trials with standardized protocols and long-term follow-up are required. Full article

Balance loss in older adults often leads to severe consequences, and wearable exoskeletons may help restore postural stability. This paper presents a novel hip cable-driven exoskeleton designed to support balance recovery. The proposed postural control strategy implemented on the device is based on maintaining balance by reducing the center of mass displacement from its equilibrium condition. Loss of balance is analyzed using multibody human models both with and without the exoskeleton. Simulation results evaluating static and dynamic balance demonstrate the effectiveness of the proposed control strategy and support its feasibility for implementation in a real system. The simulations presented in this study will be compared with experimental results from human subjects in future work. Full article

With growing global life expectancy, age-related physical problems, including balance impairments, are becoming more prevalent, increasing the risk of falls, mobility limitations, and loss of independence. This review summarizes current evidence on how balance may be influenced and improved by training modalities including reactive, strength-based, and functional exercises, through neuromuscular adaptations relevant to postural control and functional stability in older adults. Emerging evidence suggests that gut microbiota may influence neuromuscular health via neuroimmune, metabolic, and mitochondrial pathways across the gut–muscle–brain axis. However, most studies focus on muscle metabolism, inflammation, and systemic physiological processes rather than direct assessments of balance or postural control. Gut dysbiosis has been associated with sarcopenia and impaired physical function, although evidence linking microbiota alterations to balance outcomes remains limited and mainly observational. Exercise has beneficial effects on neuromuscular function and gut microbial composition, including increased diversity and metabolite production. While exercise-induced neuromuscular adaptations are well supported experimentally, little direct evidence shows the contribution of gut-related mechanisms to balance regulation. Overall, neuromuscular and gut-related processes seem to be associated with balance capacity in older adults; however, further mechanistic and interventional studies are required to clarify the role of the gut–muscle–brain axis for balance. Full article

Postural sway derived from center-of-pressure (CoP) trajectories is widely used to assess balance and fall risk in older adults, but conventional linear metrics mainly quantify sway magnitude and may overlook temporal organization. Guided by the loss-of-complexity hypothesis, we re-examined associations between fall history and linear and non-linear CoP metrics in an open-access dataset. Quiet-standing trials under eyes-open and eyes-closed conditions were analyzed in adults ≥60 years (fallers n = 19; non-fallers n = 57). To reduce confounding, propensity score matching was performed using age, sex, body mass index, activities of daily living level, illness status, number of medications, disability status, and orthosis/prosthesis use. Linear and non-linear indices, including recurrence quantification analysis, detrended fluctuation analysis, fractal dimension, multiscale entropy, stabilogram diffusion analysis, and sway density measures, were examined. After matching, no CoP metric differed significantly between groups. However, SHAP-based exploratory analysis suggested that non-linear features related to temporal structure and multiscale organization contributed more prominently to model output than conventional magnitude-based metrics. Given the limited sample size, these findings should be interpreted as exploratory and hypothesis-generating. Full article

In intelligent excavator applications, traditional excavator posture recognition methods face two major challenges: limited recognition accuracy and insufficient computing resources on edge devices. To address these issues, this study proposes an excavator posture recognition method based on an improved Real-Time Detection Transformer (RT-DETR). First, a new backbone network is designed based on the Reparameterized Vision Transformer to improve feature utilization efficiency while reducing computational demands. Next, the overall architecture is optimized by introducing lightweight Dynamic Upsamplers, which reduce information loss during upsampling and enhance multi-scale feature fusion. In addition, a Cross-Attention Fusion Module is adopted to strengthen local feature extraction while retaining the global modeling capability of the Transformer, thereby improving the discrimination between foreground and background. Finally, a Multi-Scale Fusion Network is introduced to further enhance the multi-scale feature representation ability of RT-DETR. Experimental results show that the proposed method achieves a mean average precision (mAP) of 94.29% for small object detection, which is 7.96% higher than that of the baseline RT-DETR, while reducing the number of model parameters by 34.95%. Compared with YOLO-series models, the proposed method improves mAP by 8.62% to 12.75%. These results indicate that the proposed method outperforms existing methods in both detection accuracy and computational efficiency and provides an efficient and feasible solution for real-time excavator posture recognition. Full article

Background: Complications developing in individuals with Type 2 Diabetes Mellitus (T2DM) lead to functional impairments and losses in postural balance; however, changes in cognitive functions are also observed and are often overlooked. Dual-task exercises allow simultaneous engagement of balance and cognitive functions. Therefore, this study aimed to investigate the effects of dual-task exercise training on cognitive functions, balance, and functional status in individuals with T2DM. Methods: In this study, 40 individuals diagnosed with T2DM were randomly assigned to three groups: the dual-task exercise group (DTEG, n = 13), the single-task exercise group (STEG, n = 13), and the control group (CG, n = 14). Over eight weeks, balance exercises were administered to the STEG, while simultaneous balance and cognitive exercises were applied to the DTEG, twice weekly under the supervision of a physiotherapist. Participants in the control group received no intervention. Dual-task performance, cognitive functions, balance, and functional status were assessed at baseline and at the end of eight weeks. Dual-task performance was defined as the primary outcome. Results: After the intervention, for the primary outcome, dual-task performance (TUG single-task condition and TUG dual-task condition), both exercise groups showed greater improvements than controls. Both exercise groups also demonstrated significant improvements in balance, functional status, and cognitive outcomes compared to the control group. In the between-group comparisons, both exercise groups showed significant improvements in several cognitive functions compared with the control group (p < 0.05). In addition, the MoCA total score was significantly higher in the DTEG compared with the other groups. Conclusions: Both dual-task and single-task exercises improve cognitive function, balance, and functional status in individuals with T2DM. Full article

Background: Children and adolescents with hearing loss frequently experience reduced participation in physical activity and impairments in balance and postural control, often associated with vestibular dysfunction and altered sensory integration. In this context, school-based motor interventions may represent an accessible strategy to support functional balance. The present study investigated the effects of a 12-week dance- and rhythm-based motor programme implemented within the school curriculum on static and dynamic balance in students with hearing loss. Methods: Twenty-five participants were randomly allocated to an experimental group (n = 15), which received the intervention in addition to standard curricular activities, or to a control group (n = 10), which continued with regular school-based physical activity only. Balance was assessed at baseline and post-intervention using stabilometric measures under eyes-open and eyes-closed conditions and the Pediatric Reach Test. Results: Stabilometric outcomes showed mixed patterns: improvements over time were observed in both groups under eyes-closed conditions, whereas under eyes-open conditions greater reductions in sway were detected in the control group. A significant Group × Time interaction emerged exclusively for backward reach performance and for the composite balance score, indicating a relative preservation of posterior dynamic balance and a more favourable multidimensional adaptation in the experimental group. Conclusions: These findings suggest that dance- and rhythm-oriented motor activities integrated into school settings may support specific, functionally relevant components of balance in students with hearing loss, although the results should be interpreted with caution due to the small sample size and the heterogeneity of the participants. Full article

To address the challenges of low accuracy and poor robustness in industrial crayfish weight estimation caused by variable postures, this paper proposes a lightweight method that integrates pose awareness. First, a multi-task perception model, Crayfish-YOLO, is developed based on the YOLOv8s-Seg framework. By reconstructing the backbone with MobileNetV3 and integrating Coordinate Attention (CA), CARAFE upsampling, and the Wise Intersection over Union (Wise-IoU) loss function, the model is significantly compressed while enhancing its ability to output high-fidelity pixel-level masks and pose categories. Second, a pose-adaptive weight estimation strategy is proposed, which leverages perceived pose information to dynamically invoke the optimal regression model from a pre-constructed heterogeneous model library. Using seven core geometric features extracted from the segmentation masks, the system achieves precise weight estimation. Experimental results on a self-built dataset show that Crayfish-YOLO reduces parameters by 75.2% compared to YOLOv8s-Seg, while core segmentation accuracy (mAP_50~95 (Seg)) improves by 1.1%. The integrated end-to-end system achieves a Mean Absolute Error (MAE) of 2.1 g and a mean coefficient of determination (R²) of 0.92, significantly outperforming comparative algorithms. This research provides an efficient visual perception and estimation solution for the automated grading of crayfish and similar non-rigid aquatic products. Full article

Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function is associated with independence in activities of daily living (ADLs) in people with motor-incomplete tetraplegia. Methods: Eleven (n = 11) individuals with motor-incomplete tetraplegia (AIS C–D; neurological levels C4–T1; injury duration ≥ 1 year), recruited through convenience sampling from five specialist rehabilitation centres, participated in an exploratory cross-sectional pilot study designed to generate hypotheses rather than test them. U.E. function was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, selected for its ability to capture pain and task-related functional difficulty in the elbow, wrist, and hand; its application in this neurological population is considered exploratory. Independence in ADLs was evaluated using the Spinal Cord Independence Measure III (SCIM III). Given the small sample, all analyses were primarily descriptive and along with bivariate associations (Spearman correlations). Regression findings are reported strictly for exploratory purposes. Results: The median age was 50 years (interquartile range [IQR] 43–55). A strong negative correlation was observed between PRTEE total score and SCIM III (r_s = −0.76). In an exploratory univariate analysis, each 1-point increase in PRTEE total score was associated with a 1.3-point lower SCIM III score (β = −1.3, 95% CI −2.34 to −0.26, p = 0.02). Age also showed a positive association (β = 1.31, 95% CI 0.04 to 2.58, p = 0.05) with SCIM III; however, this finding is highly likely to reflect a statistical artefact of the small and unrepresentative sample. Multivariable regression was not conducted as a primary analysis due to insufficient statistical power. All findings should be treated as strictly exploratory and hypothesis-generating. Conclusions: Self-reported U.E. function appears to be associated with ADL independence in motor-incomplete tetraplegia. U.E. capacity may contribute to functional tasks requiring postural stability and mobility-related activities, but no predictive inferences can be made from this underpowered, convenience sample. Future studies with larger cohorts and performance-based measures are needed to confirm these preliminary observations and clarify the role of U.E. function in rehabilitation planning. Full article

Duchenne muscular dystrophy (DMD) causes progressive skeletal, respiratory and cardiac muscle weakness in affected males. Most DMD patients develop scoliosis following loss of ambulation. This narrative review describes recommendations for the management of scoliosis in DMD patients using a review of the current literature evidence and a consensus review by the DMD Care UK Spinal Surgery Working Group. Advances in medical treatments have improved life expectancy for DMD patients. Spinal bracing is not effective in preventing the deterioration of scoliosis. Seating and wheelchair adaptations can provide postural support. The multidisciplinary assessment of patients with DMD requiring treatment for scoliosis is reviewed, with particular focus on bone, cardiac and respiratory health. The indications, surgical techniques, and type of spinal instrumentation for surgical management for progressively severe scoliosis with or without pelvic obliquity are discussed. Anaesthetic techniques, intraoperative neuromonitoring, perioperative care, and postoperative management in the ICU are discussed for the optimal management of DMD patients undergoing surgery to correct spinal deformity. Finally, regional and holistic functional assessments, patient satisfaction and long-term health, quality of life, and life expectancy for DMD patients undergoing treatment for spinal deformity are reviewed. Full article

Background: Balance impairment and falls are a major health concern in older adults. Beyond vestibular and visual factors, growing evidence indicates that age-related hearing loss contributes to postural instability through altered multisensory integration. However, interventions addressing the interaction between auditory input and postural control remain limited. This study examined whether integrating Taopatch^® nanotechnology, based on localized photobiomodulation, into conventional hearing aids could influence postural control in individuals with hearing loss. Methods: Forty experienced hearing aid users (mean age 77.3 ± 15.6 years) completed five postural assessments using a SensorMedica^® baropodometric platform. Four sessions employed a placebo patch identical in appearance to the active device, and the fifth used Taopatch^®. Static and stabilometric parameters were analyzed under open- and closed-eye conditions. Results: Significant improvements were observed with the Taopatch^®-integrated device. Sway path length (−8%, p = 0.002), mean velocity (−8%, p = 0.002), and low-frequency sway (−30%, p = 0.04) decreased, indicating smoother and more efficient postural control. A lateral redistribution of plantar load and an increase in contact surface area (up to +15%) were also found. These effects were less evident without visual input. Conclusions: Preliminary findings suggest that localized photobiomodulation integrated into hearing aids may positively influence postural stability in older adults with hearing impairment, possibly by supporting sensory integration processes. Further controlled studies are needed to confirm these effects and clarify the underlying mechanisms. Full article

Objectives: This study investigated the effects of trunk extension-based inspiratory muscle strengthening on respiratory function, balance, and gait in patients with stroke. Methods: Thirty stroke patients were randomly assigned to the study group (n = 15) or control group (n = 15). The study group performed inspiratory muscle strengthening exercises in a trunk extension posture, while the control group received conventional inspiratory muscle training. Both groups trained five times per week for six weeks. Outcome measures included maximal inspiratory pressure (MIP), maximal inspiratory flow rate (MIFR), maximal inspiratory volume (MIV), peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV₁), Berg Balance Scale (BBS), weight distribution ratio (WDR), limits of stability (LOSs), Timed Up and Go (TUG), gait velocity, cadence, and stride length. Results: The study group showed significantly greater improvements in respiratory parameters (MIP, MIFR, MIV, PEF, FEV₁) and functional outcomes (WDR, LOS, BBS, TUG, gait velocity, cadence, stride length) compared to the control group. Conclusions: Trunk extension-based inspiratory muscle strengthening effectively improves respiratory function, balance, and gait in stroke patients, and may serve as a valuable addition to stroke rehabilitation programs. Full article

Background/Objective: Auditory and vestibular (AV) symptoms can be considered functional neurological disorders (FND) when they do not arise from structural abnormalities. These symptoms can arise as expressions of underlying neuropsychological or psychiatric conditions, yet they may also play a role in precipitating or maintaining such disorders. This systematic review aimed at exploring the prevalence of AV symptoms in post-traumatic stress disorders (PTSD) as well as to understand if they correlate with each other. Methods: We conducted a systematic review of the literature including PubMed, Scopus and Google Scholar. Articles in English published between 1985 and 2025 were screened using the following keywords: “Tinnitus”, “Ghost sound”, “Dizziness” “Vertigo”, “Persistent Postural Perceptual Dizziness”, “PPPD”, “Hearing concerns”, “Hyperacusis”, “Diplacusis”, “Auditory hallucination(s)”, “Audio and Vestibular symptom” and “Post Traumatic Stress Disorders” or “PTSD”. Risk of bias was used to evaluate the quality of the articles. Results: We found 18 studies analysing specifically these symptoms in PTSD, including a total of 598,654 subjects. We identified 123.006 patients with PTSD (20.5% of the entire analysed sample) suffering from AV symptoms, in particular tinnitus (33.8%) and a combination of hearing loss and tinnitus (29%). A very small separate percentage suffered from auditory hallucinations (0.3%) or vertigo/dizziness (0.8%). Magnetic resonance imaging studies have identified hyperactivation in various brain areas both in PTSD and in the presence of AV symptoms, with amygdala hyperactivation emerging as the most common finding. Conclusions: Based on the results of this systematic review, patients with PTSD suffer from AV symptoms in 20.5% of cases. MRI studies conducted separately on patients with PTSD and tinnitus, vertigo or dizziness showed a hyperactivation of the amygdala in all these conditions. We speculate that amygdala hyperactivation might explain the coexistence of and the relationship between PTSD and AV symptoms. Full article

Background: Children’s behavior and lifestyle are changing rapidly, potentially exceeding the capacity of physiological adaptation. Contemporary lifestyles may negatively affect spinal development and contribute to dysfunction and premature degeneration. Despite the increasing prevalence of postural changes, cervical spine disorders in adolescents remain under-researched. Methods: This narrative review is based on a comprehensive search of PubMed/MEDLINE and Scopus. The search strategy included a broad review of anatomical and biomechanical literature from the past 25 years and a focused review of studies from the last 15 years to reflect recent generational changes. Results: The immature spine has distinct structural and biomechanical characteristics that increase susceptibility to maladaptive responses to unbalanced forces. High screen time is associated with sedentary behavior and increased consumption of ultra-processed foods, which may affect metabolic health and musculoskeletal development. Childhood and adolescent obesity are increasingly prevalent and may influence spinal development, including through myosteatosis. Data on the consequences of cervical and lumbar lordosis loss in adolescents remain limited. Although degenerative spinal disorders are well recognized in adults, their identification in younger populations may be inadequate. Conclusions: Modern lifestyle factors pose a growing risk to children’s spinal health through complex interactions among behavioral, metabolic, and biomechanical mechanisms. The developing spine’s vulnerability and the coexistence of multiple, interrelated risk factors support the need for integrated preventive strategies rather than single-factor interventions. Future studies should focus on models capturing these interactions and their long-term consequences. Full article