Search Results (3,993)

Background: In Peripheral Artery Disease (PAD), there is an association between risk factors, the location of atherosclerotic lesions, and outcomes. Methods: This is a retrospective single-center analysis of adult PAD patients admitted between 2018 and 2021 with a follow-up until the end of 2023. Lesions were allocated to “suprainguinal”, “infrainguinal-to-popliteal”, “infrapopliteal”, “two of three levels” and “all three levels” categories based on angiogram findings. The primary endpoint at the patient level was amputation-free survival and was major adverse limb events (MALEs) at the limb level. Results: A total of 2067 patients with 2633 affected limbs were analyzed, and 28.8% were female. At first admission, the median age was 68, and the most frequent PAD Fontaine stage was IIb (44.9%). Lesions were suprainguinal in 11.6%, infrainguinal-to-popliteal in 18.3%, infrapopliteal in 11.4%, two levels in 36.0%, and all three levels in 8.3%. Over 1020 days as the median follow-up, amputation-free survival was 67.6%, highest (92.5%) for suprainguinal lesions, and lowest (59.3%) for infrapopliteal lesions. At the patient level, the risk of major amputation or death was highest in infrapopliteal lesions and was equally likely in cases of two or three affected locations and was reduced in infrainguinal-to-popliteal lesions (Hazard Ratio, HR 0.62, 95% CI 0.44–0.87, p = 0.007) and suprainguinal lesions (HR 0.42, 95% CI 0.21–0.79, p = 0.008). At the limb level, compared to lesions in all three locations, the risk of MALEs was reduced in infrainguinal-to-popliteal lesions (HR 0.51, 95% CI 0.27–0.98, p = 0.044) and was equally likely in all other cases. Conclusions: Amputation-free survival was lowest in cases of infrapopliteal lesions or multi-level disease. At the limb level, isolated infrainguinal-to-popliteal lesions were associated with the lowest risk of MALEs. Full article

Background: Up to 40% of people with hypertension (HTN) develop mild cognitive impairment and Alzheimer’s disease during their lifetime. This study aimed to compare physical and cognitive performance in older adults, classified as non-HTN or with HTN, under single-task (ST) and dual-task (DT) conditions. Methods: In total, 46 individuals (71 ± 5.96 years), divided equally into non-HTN and HTN groups, participated. Normality of the data was tested using the Shapiro–Wilk test. In this cross-sectional study, groups were compared using the Mann–Whitney U test applied to non-parametric variables and the independent samples t-test applied to parametric ones. Physical and cognitive functions were evaluated using the Short Physical Performance Battery (SPPB), HandGrip Strength (HGS), Timed Up and Go (TUG), and the L-Test, both in ST and DT conditions (with arithmetic tasks). Results: Significant differences were observed between groups in MoCA and the physical performance of SPPB, TUG, and L-Test under ST. In the DT condition, differences were found in the physical performance of TUG, L-test, and SPPB total score as well as in different components such as the 3 m walk and the Sit to Stand (STS). Regarding physical–cognitive interference, there was a statistically significant difference in the SPPB dual task cost between the HTN and non-HTN groups. Conclusions: Individuals with HTN exhibit impairments compared to non-HTN individuals in physical performance under DT conditions as well as in physical–cognitive interference. Static balance and HGS appear unaffected; however, differences are evident in gait (TUG and L-Test) and lower-limb strength (STS). Full article

Background: Primary spinal gliomas are rare in the pediatric population. Separately, FGFR1 genomic aberrations are also uncommon in spinal cord tumors. We report a case of a previously well adolescent who presented with progressive symptoms secondary to an intramedullary tumor with unique radiological and molecular characteristics. Case Presentation: A previously well 17-year-old male presented with worsening mid-back pain associated with lower limb long-tract signs. Magnetic resonance imaging (MRI) of his neuro-axis reported a long-segment intramedullary lesion with enhancing foci and a multi-septate syrinx containing hemorrhagic components from C4 to T12. The largest enhancement focus was centered at T7. Additional MRI sequences observed no intracranial involvement or vascular anomaly. He underwent an emergent laminoplasty and excision of the thoracic lesion. Intraoperative findings demonstrated a soft, grayish intramedullary tumor associated with extensive hematomyelia that had multiple septations. Active fenestration of the latter revealed blood products in various stages of resolution. Postoperatively, the patient recovered well, with neurological improvement. Final histology reported a circumscribed low-grade glial neoplasm. Further molecular interrogation via next-generation sequencing panels showed activating FGFR1 p.K656E and V561M missense alterations. The unique features of this case are presented and discussed in corroboration with a focused literature review. Conclusions: We highlight an interesting case of an intramedullary tumor with unusual radiological and pathological findings. Emphasis is on the importance of tissue sampling in corroboration with genomic investigations to guide clinical management. Full article

Background/Objectives: This study examines the effect of the 2024 update to the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, on lower limb impairment determinations in comparison to the 2008 edition. It also explores the broader influence of these changes on regulatory, economic, and adjudicative considerations relevant to physician application and interpretation. Methods: Two experienced evaluators independently reviewed 23 standardized lower limb case scenarios, applying both the 2008 and 2024 methodologies. Each assessment was based solely on clinical history, physical examination findings, and diagnostic test results. Impairment values were then calculated and analyzed for consistency across editions. Results: The 2024 lower limb impairment framework produced outcomes that closely mirrored those of the 2008 edition, with intraclass correlation coefficients of 0.9962 for the lower limb and 0.9951 for whole-person impairment, underscoring the strong consistency between editions. Conclusions: The revised 2024 edition for lower limb assessment enhances procedural clarity and integrates improved diagnosis-based impairment tools without disrupting prior impairment values. These refinements are intended to improve utility for clinical and nonclinical stakeholders, ensuring reliable evaluations while minimizing systemic disruption. Full article

Spinal cord injury (SCI) often results in long-term locomotor impairments, and strategies to enhance functional recovery remain limited. While epidural electrical stimulation (EES) has shown clinical promise, our understanding of the mechanisms by which it improves function remains incomplete. Here, we use genetic tools in an animal model to perform neuromodulation and treadmill rehabilitation in a manner similar to EES, but with the benefit of the genetic tools and animal model allowing for targeted manipulation, precise quantification of the cells and circuits that were manipulated, and the gathering of extensive kinematic data. We used a viral construct that selectively transduces large diameter afferent fibers (LDAFs) with a designer receptor exclusively activated by a designer drug (hM3Dq DREADD; a chemogenetic construct) to increase the excitability of large fibers specifically, in the rat contusion SCI model. As changes in locomotion with afferent stimulation can be subtle, we carried out a detailed characterization of the kinematics of locomotor recovery over time. Adult Long-Evans rats received contusion injuries and direct intraganglionic injections containing AAV2-hSyn-hM3Dq-mCherry, a viral vector that has been shown to preferentially transduce LDAFs, or a control with tracer only (AAV2-hSyn-mCherry). These neurons then had their activity increased by application of the designer drug Clozapine-N-oxide (CNO), inducing tonic excitation during treadmill training in the recovery phase. Kinematic data were collected during treadmill locomotion across a range of speeds over nine weeks post-injury. Data were analyzed using a mixed effects model chosen from amongst several models using information criteria. That model included fixed effects for treatment (DREADDs vs. control injection), time (weeks post injury), and speed, with random intercepts for rat and time point nested within rat. Significant effects of treatment and treatment interactions were found in many parameters, with a sometimes complicated dependence on speed. Generally, DREADDs activation resulted in shorter stance duration, but less reduction in swing duration with speed, yielding lower duty factors. Interestingly, our finding of shorter stance durations with DREADDs activation mimics a past study in the hemi-section injury model, but other changes, including the variability of anterior superior iliac spine (ASIS) height, showed an opposite trend. These may reflect differences in injury severity and laterality (i.e., in the hemi-section injury the contralateral limb is expected to be largely functional). Furthermore, as with that study, withdrawal of DREADDs activation in week seven did not cause significant changes in kinematics, suggesting that activation may have dwindling effects at this later stage. This study highlights the utility of high-resolution kinematics for detecting subtle changes during recovery, and will enable the refinement of neuromechanical models that predict how locomotion changes with afferent neuromodulation, injury, and recovery, suggesting new directions for treatment of SCI. Full article

This study aimed to test the reliability of seven functional performance tests in amateur trail runners, including ankle mobility, balance, hopping, and countermovement jump (CMJ) tests. The sample consisted of 35 runners who were evaluated in two sessions separated by 7 to 14 days, which varied due to participants’ scheduling constraints. Relative reliability was assessed using the Intraclass Correlation Coefficient (ICC, which indicates consistency between repeated measures), the Standard Error of Measurement (SEM, which reflects measurement precision), and the Minimal Detectable Change (MDC, which represents the smallest real change beyond measurement error). The results show high reliability in almost all tests. The Lunge Test obtained an ICC of 0.990 and 0.983 for distance, and 0.941 and 0.958 for angular measurements in both legs. The Hop Tests showed moderate reliability with ICC above 0.7 In contrast, the Y Balance Test demonstrated lower reliability, with ICC values ranging from 0.554 to 0.732. The CMJ test showed good reliability, with an ICC ranging from 0.753 to 0.894, an SEM between 5.79% and 11.3%, and an MDC ranging from 15.54% to 31.44%, making it useful for assessing lower limb explosive strength. Both tests presented comparatively higher error values, which should be considered when interpreting individual changes. These findings support the use of these tests as valid and reliable tools for evaluating ankle dorsiflexion, balance, functional symmetry, and lower limb explosive strength in amateur trail runners, prior to training programs or injury prevention strategies, provided that standardized protocols and validated measuring instruments are used. Full article

Background and Objectives: Sarcopenia is a progressive loss of skeletal muscle mass and function in elderly adults, posing a significant risk of frailty, falls, and morbidity. The current study designs and evaluates SarcoNet, a novel artificial neural network (ANN)-based classification framework developed in order to classify Sarcopenic from non-Sarcopenic subjects using a comprehensive real-time dataset. Methods: This pilot study involved 30 subjects, who were divided into Sarcopenic and non-Sarcopenic groups based on physician assessment. The collected dataset consists of thirty-one clinical parameters like skeletal muscle mass, which is collected using various equipment such as Body Composition Analyser, along with ten kinetic features which are derived from video-based gait analysis of joint angles obtained during walking on three terrain types such as slope, steps, and parallel path. The performance of the designed ANN-based SarcoNet was benchmarked against the traditional machine learning classifiers utilised including Support Vector Machine (SVM), k-Nearest Neighbours (k-NN), and Random Forest (RF), as well as hard and soft voting ensemble classifiers. Results: SarcoNet achieved the highest overall classification accuracy of about 94%, with a specificity and precision of about 100%, an F1-score of about 92.4%, and an AUC of 0.94, outperforming all other models. The incorporation of lower-limb joint kinetics such as knee flexion, extension, ankle plantarflexion and dorsiflexion significantly enhanced predictive capability of the model and thus reflecting the functional deterioration characteristic of muscles in Sarcopenia. Conclusions: SarcoNet provides a promising AI-driven solution in Sarcopenia diagnosis, especially in low-resource healthcare settings. Future work will focus on improving the dataset, validating the model across diverse populations, and incorporating explainable AI to improve clinical adoption. Full article

The aim of the study was to determine correlations between performance of vertical jumps and dolphin kick sprints, and between the results of a dry-land butterfly arm pull test and butterfly arms-only swimming. The study recruited competitive junior male swimmers (15.9 (0.7) years, 179.3 (5.3) cm body height, 64.6 (4.3) kg body mass). On dry land, we measured jump height, lower-limb work and power, as well as peak velocity, power, and force in the butterfly arm pull test. In swimming tests, time, velocity, power, force, and work were assessed during the dolphin kick and butterfly arms-only trials. Pearson’s correlation coefficients and the coefficients of determination were calculated between measurements. The findings showed correlations between swimming velocity and power recorded during the dolphin kick test with jump height, work and power measured in the jump tests (maximum r = 0.90, r² = 0,81, p < 0.05). The best correlations between the results of the jump tests and swim variables were determined for the CJ30s test. The butterfly arm pull test was not associated with all parameters measured by the butterfly arms-only test. Our study demonstrates that targeted dry-land training programmes using exercises like vertical jumps can enhance competitive swimmers’ performance and offer coaches an accessible means of tracking athlete progress. Moreover, such simple drills may serve as a cost-effective approach for early evaluation of strength and power potential and for preventing musculoskeletal injuries, all without requiring pool access or specialized underwater equipment. However, the small and homogeneous sample (n = 12, junior males only) and the absence of reliability analyses limit the generalizability of the results. Full article

Finding the causative mutations for musculoskeletal system development and health status is of a higher priority for all sport horse breeders’ associations. Of the regulating proteins involved in animal ossification, 15 gene polymorphisms were chosen to be identified as connected with the nine fetlock and 14 hock bone structures measurements of 198 horses. All measurements were taken using X-rays of the limbs, which were available at the beginning and end of the horse training. The analysis of variance (GLM, SAS program) was performed taking into account identified training and horse-connected characteristics, and gene polymorphism. The larger size of the bone structure was achieved in the fetlock for the heterozygotes of COL9A2, AOAH1, BMPER, HYAL3, and ELMO1. The heterozygotes were superior to homozygotes in the hock for the following genes: COL9A2, HYAL3, ANLN, and HYAL1. The lower homozygote values were obtained for GG in CPVL in fetlock measurements, TT for HYAL3 in fetlock, TT for ANLN in fetlock, CC for FRZB in the hock, TT for MATN in the hock, and TT for COL5A2 in the hock than their opposite homozygote and heterozygote variants. COL9A2 and HYAL3 are expressed in the same way for most of the bone structures in both joints. Full article

Lower limb functional degeneration has become prevalent, notably reducing the core strength that drives motor control. Squats are frequently used in lower limb training, improving overall muscle strength. However, performing continuously with improper techniques can lead to dynamic knee instability. It worsens with little to no motivation to perform these power training motions. Hence, it is crucial to have a gaming-based exercise tracking system to adaptively enhance the user experience without causing injury or falls. In this work, 28 healthy subjects performed exergame-based squat training, and dynamic kinematic features were recorded. The five features acquired from a depth camera-based inertial measurement unit (IMU) (1—Knee shakiness, 2—Knee distance, and 3—Squat depth) and an Anima forceplate sensor (4—Sway velocity and 5—Sway area) were assessed using a Spearman correlation coefficient-based feature selection method. An input vector that defines knee instability is used to train and test the Long Short-Term Memory (LSTM) and Support Vector Machine (SVM) models for binary classification. The results showed that knee instability events can be successfully classified and achieved a high accuracy of 96% in both models with sets 1, 2, 3, 4, and 5 and 1, 2, and 3. The feature selection results indicate that the LSTM network with the proposed combination of input features from multimodal sensors can successfully perform real-time tracking of knee instability. Furthermore, the findings demonstrate that this multimodal approach yields improved classifier performance with enhanced accuracy compared to using features from a single modality during lower limb therapy. Full article

Background: Lower limb amputation (LLA), due to non-traumatic causes such as vascular diseases and diabetes, significantly impacts patients’ physical, psychological, and social well-being. While multidisciplinary rehabilitation programs commonly address physical and functional recovery, psychological and subjective experiences related to limb loss remain less explored. Thus, this preliminary study aimed to investigate the psychological and behavioral adaptation processes in patients undergoing rehabilitation following lower limb amputation. Methods: A preliminary observational study with a mixed-method approach based on quantitative and qualitative data triangulation was conducted. This approach involves integrating multiple data sources and methodologies—in this case, quantitative psychometric measures and qualitative interviews via the prospective of amputees and those who use prostheses—to enhance the validity and depth of the research findings. Results: Fourteen inpatient amputees and fourteen inpatient prosthesis users (years: 66.6 ± 2.5 for amputee and 61.5 ± 1.9 for prosthesis users, male amputees: 85.7%, male prosthesis users: 100%) of a research hospital in the North of Italy were assessed using validated psychometric tools (GAD-7, PHQ-9, PID-5-BF, BIS, ASonA) alongside semi-structured interviews analyzed through the Interpretive Description approach. Key themes highlighted illness acceptance, prosthesis adaptation, body image, medication and behavioral adherence, anxiety, depression, quality of life, denial, optimism, and social support. Overall, anxiety–depressive symptomatology tended to decrease with the prosthesis, and pharmacological and behavioral adherence improved, as did the disease acceptance. Body image was fairly preserved in all patients despite some fears of others’ judgment with respect to the prosthesis. Interestingly, there was poor agreement between quantitative and qualitative data in both the amputee’ and prosthesis users’ groups: while the former returned a partial and neutral picture, a more multifaceted picture emerged from the interviews collected. Conclusions: These findings underline the importance of integrating quantitative psychometric evaluations with qualitative methods to comprehensively understand patients’ adaptive experiences. Such combined insights are essential to inform tailored psychological interventions throughout the rehabilitation journey. Full article

Background/Objectives. Patient-Reported Outcome Measures (PROMs) capture patients’ perspectives about their health status, quality of life, and medical care outcomes. LIMB-Q Kids is a validated PROM designed to assess health-related quality of life (HRQL) in children with lower limb differences. It evaluates physical, social, and psychological function; symptoms related to the leg, hip, knee, foot and ankle; leg-related distress, appearance, and school-related concerns. It has now been translated and culturally adapted from English to other languages. The aim of this study was to translate and culturally adapt LIMB-Q Kids to Hebrew. Methods. Following international guidelines, two independent forward translations from English to Hebrew were produced and reconciled into a single version. A backward translation was then compared with the original to identify discrepancies. This draft underwent cognitive debriefing interviews (CDIs) with 11 children (ages 8–15) having lower limb differences to assess comprehension and cultural relevance. Results. CDIs revealed general issues including lengthy or unclear text, high-level language, cultural unfamiliarity and duplication of descriptors. Specific to Hebrew, issues included gender inflections and the need for vowel diacritics to support younger, less proficient readers. Revisions to 14 items were made. Conclusions. A translation and cultural adaption (TCA) process led to a linguistically validated and culturally adapted Hebrew version of LIMB-Q Kids. It can now be used for the clinical follow-up of children with lower limb differences including pre- and post-operatively, and as an aid to decision-making for surgery. Full article

Introduction: 3D-printing is an emerging technology in the field of prosthetics, offering advantages such as cost-effectiveness, ease of customization, and improved accessibility. While previous reviews have focused on limited aspects, the aim of this systematic review is to provide a comprehensive evaluation of the clinical outcomes of 3D-printed prostheses for both upper and lower limbs. Methods: A search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across six databases (PubMed, Web of Science, EBSCO, Scopus, Cochrane Library, and Sage). Studies on 3D-printed prostheses in human rehabilitation that focused on the clinical outcomes of the device were included, while studies lacking clinical data, 3D printing details, or focusing on traditional manufacturing methods were excluded. Finally, the risk of bias was assessed using the modified Downs & Black Checklist. Results: A total of 1420 studies were identified, with 11 meeting the inclusion criteria. The included studies assessed different 3D-printed prosthetic types and upper and lower limb prostheses. The main clinical outcomes analyzed were functional performance, design and material integrity, and overall effectiveness of 3D-printed prostheses. Studies on upper limb prostheses reported improved dexterity, range of motion (ROM), and user satisfaction, despite some durability limitations. Lower limb prostheses showed enhancements in comfort, gait parameters, and customization, particularly in amphibious and partial foot designs. Conclusions: 3D-printed prostheses show potential to improve functional performance, patient satisfaction, fit, and implementation feasibility compared to conventional methods. However, limitations such as small sample sizes, variability in assessment tools, and limited high-quality evidence highlight the need for further research to support broader clinical adoption. Full article

Background: Neuromuscular training is widely implemented in professional football to enhance performance and reduce injury risk. Although unstable surfaces are commonly used for proprioceptive and rehabilitation purposes, limited evidence supports their effectiveness in improving sport-specific force production and stability in elite athletes. This study aimed to compare the effects of multicomponent neuromuscular training performed on stable versus unstable surfaces on unilateral force production, mobility, and agility in elite male soccer players. Methods: Twenty-seven professional male soccer players from the Spanish first division were randomly assigned to either a stable surface group (SSG; n = 14) or an unstable surface group (USG; n = 13). Both groups completed a 10-week intervention in addition to their regular training routines. Pre- and post-intervention assessments included dorsiflexion range of motion (DFt), Y-Balance Test (YBT), single-leg countermovement jump (SLCMJ), single-leg hop for distance (SLH), side-hop (SH), Speedy Jump (SpJ), Agility T-test (TT), and the Lower Extremity Functional Test (LEFT). A two-way repeated-measures ANOVA and Hedges’ g effect sizes were used for statistical analysis. Results: The SSG showed significant improvements in most performance variables, including DFt, YBT, SLH, SH, SpJ, TT, and LEFT (percent change range: 1.6% to 9.8%; Hedges’ g ranging from 0.52 to 2.57). The USG showed limited improvements, with significant changes only in LEFT (percent change = 1.18%; Hedges’ g = 0.53). Notably, the stable surface group demonstrated enhanced force production and agility, particularly in the non-dominant limb. Conclusions: Multicomponent neuromuscular training on stable surfaces appears more effective than training on unstable surfaces for improving unilateral strength, mobility, and agility in elite soccer players. These findings suggest that stable surface training may provide superior performance benefits and should be considered a priority in high-performance environments. Full article

Background: High-performance tennis exposes players to repetitive high-load strokes and abrupt directional changes, which substantially increase musculoskeletal injury risk. This systematic review synthesized evidence on epidemiology, risk factors, and physiotherapy-led preventive strategies in elite adolescent and adult players. Methods: Following a PROSPERO-registered protocol, MEDLINE, Web of Science, and Scopus were searched (2011–2024) for observational studies reporting epidemiological outcomes in high-performance tennis. Methodological quality was appraised with NIH tools, and certainty of evidence was graded with GRADE. Results: Thirty-seven studies met inclusion criteria: 16 in adolescents, 18 in adults, and 3 mixed. Incidence ranged from 2.1 to 3.5 injuries/1000 h in juniors and 1.25 to 56.6/1000 h in adults. Seasonal prevalence was 46–54% in juniors and 30–54% in professionals. Lower-limb trauma (48–56%) predominated, followed by lumbar (12–39%) and shoulder overuse syndromes. Across age groups, abrupt increases in the acute-to-chronic workload ratio (≥1.3 in juniors; ≥1.5 in adults) were the strongest extrinsic predictor of injury. Intrinsic contributors included reduced glenohumeral internal rotation, scapular dyskinesis, and poor core stability. Three prevention clusters emerged: (1) External load control, four-week “ramp-up” strategies reduced injury incidence by up to 21%; (2) Kinetic-chain conditioning, core stability plus eccentric rotator-cuff training decreased overuse by 26% and preserved shoulder mobility; and (3) Technique/equipment adjustments, grip-size personalization halved lateral epicondylalgia, while serve-timing modifications reduced shoulder torque. Conclusions: Injury risk in high-performance tennis is quantifiable and preventable. Progressive load management targeted kinetic-chain conditioning, and tailored technique/equipment modifications represent the most effective evidence-based safeguards for adolescent and adult elite players. Full article