Search Results (249)

Background/Objectives: Swimming requires precise motor control, sustained attention, and optimal cognitive–motor integration, making it an ideal model for investigating neural efficiency—the phenomenon whereby expert performers achieve optimal outcomes with reduced neural resource expenditure, operationalized as lower activation, sparser connectivity, and enhanced functional integration. This systematic review examined cognitive performance and neural adaptations in swimming athletes, investigating neuroimaging and behavioral outcomes distinguishing swimmers from non-athletes across performance levels. Methods: Following PRISMA 2020 guidelines, seven databases were searched (1999–2024) for studies examining cognitive/neural outcomes in swimmers using neuroimaging or validated assessments. A total of 24 studies (neuroimaging: n = 9; behavioral: n = 15) met the inclusion criteria. Risk of bias assessment used adapted Cochrane RoB2 and Newcastle–Ottawa Scale criteria. Results: Neuroimaging modalities included EEG (n = 4), fMRI (n = 2), TMS (n = 1), and ERP (n = 2). Key associations identified included the following: (1) Neural Efficiency: elite swimmers showed sparser upper beta connectivity (35% fewer connections, d = 0.76, p = 0.040) and enhanced alpha rhythm intensity (p ≤ 0.01); (2) Cognitive Performance: superior attention, working memory, and executive control correlated with expertise (d = 0.69–1.31), with thalamo-sensorimotor functional connectivity explaining 41% of world ranking variance (r² = 0.41, p < 0.001); (3) Attention: external focus strategies improved performance in intermediate swimmers but showed inconsistent effects in experts; (4) Mental Fatigue: impaired performance in young adult swimmers (1.2% decrement, d = 0.13) but not master swimmers (p = 0.49); (5) Genetics: COMT Val158Met polymorphism associated with performance differences (p = 0.026). Effect sizes ranged from small to large, with Cohen’s d = 0.13–1.31. Conclusions: Swimming expertise is associated with specific neural and cognitive characteristics, including efficient brain connectivity and enhanced cognitive control. However, cross-sectional designs (88% of studies) and small samples (median n = 36; all studies underpowered) preclude causal inference. The lack of spatially quantitative synthesis and visualization of neuroimaging findings represents a methodological limitation of this review and the field. The findings suggest potential applications for talent identification, training optimization, and mental health promotion through swimming but require longitudinal validation and development of standardized swimmer brain atlases before definitive recommendations. Full article

Cervical spinal cord injury causes severe functional impairment with limited spontaneous recovery, and while spinal cord stimulation has emerged as a promising neuromodulatory strategy, evidence for cervical applications remains fragmented. To address this gap, we conducted a systematic review synthesizing preclinical and clinical evidence on cervical spinal cord stimulation for functional rehabilitation following spinal cord injury. The review was registered on PROSPERO (CRD420251088804) and conducted in accordance with PRISMA guidelines, with PubMed, Embase, IEEE Xplore, and Web of Science searched from inception to July 2025 for animal and human studies of cervical spinal cord stimulation, including epidural, intraspinal, and transcutaneous approaches, reporting functional neurological outcomes. Risk of bias was assessed using the Cochrane RoB 2 and ROBINS-I tools, and due to substantial heterogeneity, results were synthesized narratively. Thirty-one studies comprising 119 animals and 156 human participants, met inclusion criteria. Across studies, outcome measures such as GRASSP, ISNCSCI, and dynamometry consistently demonstrated improvements in hand strength, dexterity, and voluntary motor activation. Several studies also reported gains in sensory and autonomic function, whereas respiratory outcomes were infrequently assessed. Adjunctive interventions, including cortical stimulation, brain–computer interface priming, and task-specific training frequently augmented recovery. Adverse events were generally mild, although overall risk of bias was predominantly serious. Overall, cervical spinal cord stimulation demonstrates preliminary assistive and therapeutic effects on motor recovery, with additional sensory, autonomic, and potential respiratory benefits. Full article

Background and Objectives: Although several meta-analyses have evaluated the effects of motor imagery (MI) on upper-limb recovery using the Fugl-Meyer Assessment for the Upper Extremity (FM-UE), evidence based on more specific (Action Research Arm Test, ARAT) and functional (Barthel Index, BI) outcomes remains scarce. This study examined the effect of MI combined with conventional rehabilitation therapy (CRT), which translates into meaningful improvements in upper-limb performance and functional independence after stroke, accounting for methodological quality and publication bias. Materials and Methods: A systematic review and meta-analysis were carried out in accordance with PRISMA recommendations, with prior registration in PROSPERO (CRD420251120044). Comprehensive searches were conducted across six electronic databases up to July 2025. The methodological rigor of the included studies was evaluated using the PEDro scale, and risk of bias was appraised with the Cochrane RoB 2 instrument. Random-effects models estimated pooled effect sizes (ESs) for the ARAT and BI, alongside analyses of heterogeneity, publication bias, and moderators. Results: Eleven RCTs (n = 425) were included. A small pooled improvement in ARAT was observed (ES = 0.25; 95% CI: 0.13–0.37; p < 0.001); however, this effect was rendered non-significant after correction for publication bias (ES = 0.08; 95% CI: −0.14–0.31). No significant differences were found for the BI (ES = 0.41; 95% CI: −0.35–1.18; p = 0.268), with substantial heterogeneity (I² = 96.6%). The mean PEDro score was 6.6, indicating moderate methodological quality. Conclusions: MI combined with CRT yields small and inconsistent effects on upper-limb recovery and no improvement in functional independence. Current evidence does not support its routine use in stroke rehabilitation. Well-designed, adequately powered randomized controlled trials employing standardized MI protocols are required to determine its true clinical relevance. Full article

Background: Irisin, an exercise-induced myokine, has emerged as a potent neuroprotective factor, though a systematic synthesis of its role across neurological disorders is lacking. This review systematically evaluates clinical and preclinical evidence on irisin’s association with neurological diseases and its underlying mechanisms. Methods: Following PRISMA 2020 guidelines, a systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library was conducted. The review protocol was prospectively registered in PROSPERO. Twenty-one studies were included, comprising predominantly preclinical evidence (n = 14), alongside clinical observational studies (n = 6), and a single randomized controlled trial (RCT) investigating irisin in cerebrovascular diseases, Parkinson’s disease (PD), Alzheimer’s disease (AD), and other neurological conditions. Eligible studies were original English-language research on irisin or FNDC5 and their neuroprotective effects, excluding reviews and studies without direct neuronal outcomes. Risk of bias was independently assessed using SYRCLE, the Newcastle–Ottawa Scale, and RoB 2, where disagreements between reviewers were resolved through discussion and consensus. Results were synthesized narratively, integrating mechanistic, pre-clinical, and clinical evidence to highlight consistent neuroprotective patterns of irisin across disease categories. Results: Clinical studies consistently demonstrated that reduced circulating irisin levels predict poorer outcomes. Lower serum irisin was associated with worse functional recovery and post-stroke depression after ischemic stroke, while decreased plasma irisin in PD correlated with greater motor severity, higher α-synuclein, and reduced dopamine uptake. In AD, cerebrospinal fluid irisin levels were significantly correlated with global cognitive efficiency and specific domain performance, and correlation analyses within studies suggested a closer association with amyloid-β pathology than with markers of general neurodegeneration. However, diagnostic accuracy metrics (e.g., AUC, sensitivity, specificity) for irisin as a standalone biomarker are not yet established. Preclinical findings revealed that irisin exerts neuroprotection through multiple mechanisms: modulating microglial polarization from pro-inflammatory M1 to anti-inflammatory M2 phenotype, suppressing NLRP3 inflammasome activation, enhancing autophagy, activating integrin αVβ5/AMPK/SIRT1 signaling, improving mitochondrial function, and reducing neuronal apoptosis. Irisin administration improved outcomes across models of stroke, PD, AD, postoperative cognitive dysfunction, and epilepsy. Conclusions: Irisin represents a critical mediator linking exercise to brain health, with consistent neuroprotective effects across diverse neurological conditions. Its dual ability to combat neuroinflammation and directly protect neurons, demonstrated in preclinical models, positions it as a promising therapeutic candidate for future investigation. Future research must prioritize the resolution of fundamental methodological challenges in irisin measurement, alongside investigating pharmacokinetics and sex-specific effects, to advance irisin toward rigorous clinical evaluation. Full article

Introduction: Stroke is a leading cause of adult-onset disability. Non-invasive brain stimulation (NIBS) techniques such as repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), and transcutaneous vagus nerve stimulation (tVNS) are promising adjuncts to upper limb rehabilitation. The use of functional neuroimaging through task functional MRI (fMRI) or functional near-infrared spectroscopy (fNIRS) allows the visualisation of cortical activation patterns associated with stroke-related impairment and recovery. The present study comprehensively reviews the evidence base for the effects of NIBS on clinical and functional neuroimaging outcomes after stroke. Methods: Systematic searches were carried out in MEDLINE and EMBASE via Ovid. Inclusion criteria were clinical trials of adults with stroke and arm weakness undergoing NIBS, with clinical measures of arm function and neuroimaging outcome measures that included either task fMRI or task fNIRS. Two authors independently carried out study screening, risk of bias assessments, and data collection for clinical and neuroimaging outcomes pre- and post-intervention. Results: A total of 17 studies (12 rTMS, 5 tDCS), including 495 participants, met the inclusion criteria. Fifteen studies used task fMRI and four used task fNIRS. Improvements in arm-related motor activity were observed following both rTMS and tDCS. Most studies reported increased activation in ipsilesional sensorimotor areas alongside reductions in contralesional activation. Discussion: rTMS and tDCS may improve upper limb recovery in people with stroke. The increase in the laterality index towards activation of the ipsilesional hemisphere suggests that these NIBS techniques may facilitate neural reorganisation and restoration of motor networks in the affected hemisphere. Full article

Background: Although parenting interventions are effective in improving parenting practices and child development, most are developed within Western cultural frameworks that may not align with South Asian collectivist values and family structures. The extent to which cultural adaptation influences the effectiveness of parenting interventions in South Asian populations remains unclear. Aim: To systematically review the effectiveness of parenting interventions on child developmental outcomes, parenting outcomes, and parental health among South Asian families, and to examine whether the depth of cultural adaptation, assessed using Bernal’s Ecological Validity Model (EVM), is associated with intervention effectiveness. Methods: A systematic review and meta-analysis were conducted. We systematically searched CINAHL, MEDLINE, Science Direct, PsychINFO, PubMed, and Cochrane library. Data were extracted from six electronic databases up to August 2023. Quality and risk of bias were appraised using the Revised Cochrane Risk of Bias Tool for Randomized Trials for the quantitative studies and the Critical Appraisal Skill Program (CASP) checklist for the qualitative studies. Results: Seventeen studies (fifteen quantitative, two qualitative) involving 8088 participants were included; ten studies contributed data to meta-analysis. Parenting interventions were associated with moderate improvements in parenting knowledge (SMD = 0.51, 95% CI 0.25 to 0.76) and small improvements in parental involvement (SMD = 0.36, 95% CI 0.00 to 0.72). Significant reductions in parental depression (SMD = −0.77, 95% CI −1.20 to −0.34) and disability symptoms (SMD = 0.82, 95% CI 0.68 to 0.96) were observed, though effects on post-natal depression (SMD = 0.15, 95% CI −1.00 to 1.30) and physical quality of life (SMD = −0.27, 95% CI −1.22 to 1.75) were non-significant. For children, large improvements were found in cognitive (SMD = 0.84–1.48), language (SMD = 0.79, 95% CI 0.25 to 1.33), and social development (SMD = 0.54, 95% CI 0.16 to 0.91), but not in emotional or motor development. Sensitivity analyses indicated larger effects for studies demonstrating deeper cultural adaptation. Qualitative findings highlighted maternal empowerment, improved mental wellbeing, and the importance of family support and culturally congruent facilitators for engagement. Overall certainty of evidence was rated as low due to high heterogeneity, risk of bias, and imprecision. Discussion: Culturally adapted parenting interventions show promising benefits for parenting practices, parental mental health, and child developmental outcomes among South Asian families, particularly when adaptations extend beyond surface-level changes. However, evidence quality is low and inconsistent, highlighting the need for more rigorous trials and clearer reporting of cultural adaptation to optimize effectiveness. Full article

Objective: This study aimed to systematically evaluate the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on gait, motor function, and balance in patients with Parkinson’s disease (PD) and identify optimal stimulation parameters for clinical application. Methods: This systematic review and meta-analysis of randomized controlled trials (CTs) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Cochrane Central, Scopus, and Ovid-LWW were searched until December 2024 for RCTs evaluating the effects of rTMS on PD-related gait, balance, or motor outcomes. Nineteen studies (n = 547) met the inclusion criteria. Data on study characteristics, rTMS protocols (frequency, target area, pulses, session duration, number of sessions, and treatment duration), and outcome measures (freezing of gait questionnaire [FOG-Q], gait speed, Unified Parkinson’s Disease Rating Scale Part III [UPDRS-III], UPDRS total, and timed up and go [TUG] test) were extracted. Effect sizes (Hedges’ g) were pooled using inverse variance meta-analysis, heterogeneity was assessed using I², and publication bias was assessed using funnel plots and Egger’s regression. Results: rTMS produced significant improvements in gait freezing (FOG-Q: g = −0.74; 95% confidence interval [CI] [−1.05, −0.43]; p < 0.001), gait speed (g = 0.62; 95% CI [0.29, 0.95]; p < 0.001), and motor symptoms (UPDRS-III: g = −0.42; 95% CI [−0.70, −0.15]; p = 0.003). No significant effects were observed for UPDRS total (g = 0.18; p = 0.58) or balance (TUG, g = −0.29; p = 0.06). Egger’s test indicated publication bias for gait speed (p = 0.016); however, trim-and-fill imputed zero studies. Subgroup analyses indicated that high-frequency stimulation of the supplementary motor area (SMA) for ≥20 min over 10 sessions (total duration <2 weeks or ≥2 weeks) optimally improved gait speed, whereas low-frequency stimulation targeting M1 and SMA with >1000 pulses per session for 20 min over 10 sessions within <2 weeks most effectively improved the UPDRS-III scores. Conclusions: rTMS exerts moderate and significant benefits on gait and motor performance in PD, particularly when tailored protocols involving SMA or M1 stimulation are employed. High-frequency SMA protocols improve gait speed, whereas low-frequency M1/SMA protocols optimize motor symptom relief. These findings provide evidence-based guidance for rTMS implementation in PD rehabilitation. Full article

Background: Passing in lacrosse is a fundamental skill essential for both offense and defense, directly influencing game flow. Although the speed–accuracy trade-off is well recognized in motor control, its features in lacrosse passing—particularly regarding directional aspects and skill differences—remain unclear. This study quantified the relationship between pass speed, accuracy, bias, and consistency and examined directional effects and skill-level differences. Methods: Twenty-two female university players (skilled: n = 9; unskilled: n = 13) executed overhand passes to a 5 cm × 5 cm target from 11 m under three effort conditions: warm-up, game intensity, and full effort. Ball speed was derived from lateral video, and landing coordinates from posterior footage. Accuracy, bias, and consistency were assessed using radial error (RE), centroid error (CE), absolute CE (|CE|), and bivariate variable error (BVE). Directional patterns were analyzed through lateral and vertical components and the 95% confidence intervals of the major and minor axes of an error ellipse. A two-way analysis of variance was performed with condition as the within-subject factor and skill level as the between-subject factor. Results: Ball speed increased significantly across conditions. RE, |CE|, and BVE increased with speed, showing directional dependence: variability expanded mainly along the major axis, while the minor axis remained stable. Skilled players showed smaller RE and BVE, with differences most evident vertically and along the major axis. CE direction stayed consistent, indicating that reduced accuracy stemmed from greater bias magnitude and lower consistency rather than shifts in the mean landing point. Conclusions: Findings confirm a speed–accuracy trade-off in lacrosse passing, characterized by directional specificity and skill-related effects. Combining RE, CE, BVE, and ellipse-axis analyses clarified error structure, showing variability concentrated along the movement axis. These results support training focused on vertical control and timing and highlight the value of directional metrics for assessing lacrosse performance. Future research should include male athletes, advanced levels, and in-game scenarios to extend generalizability. Full article

Accurate and accessible motor function quantification is important for monitoring the movement disorders’ progression. Manual muscle testing models and wearable sensors can be costly or reduce degrees of freedom. Artificial intelligence, especially human pose estimation (PE), offers promising alternatives. This work aims to compare the accuracy of a 2D PE tool for the Finger Tapping Test (FTT) with a 3D infrared motion capture system (MoCap). PE tracked three anatomical landmarks (wrist, thumb, index finger), while reflective markers were placed at corresponding locations on both tools to measure wrist-centered angles. Different trials of slow and rapid FTT sessions were statistically analyzed by rank correlation analysis, Friedman, Bland–Altman, and Kruskal–Wallis to assess agreement and repeatability. PE and MoCap measurements showed no significant differences (p > 0.05), with high reliability (ICC 0.87–0.91), low variability (CV 6–8.6%), and negligible effect size. Bland–Altman slopes indicated minor amplitude-dependent bias, while RMSE (2.92–4.48°) and MAPE (6.38–8.22%) errors occurred in slow and rapid conditions. These results demonstrate that 2D PE provides a reliable, accessible, and low-cost alternative for quantifying finger movement. The findings suggest that PE can serve as an assistive method for monitoring motor function. Future studies can be population-level studies with patients with neurological disorders. Full article

Introduction. The proliferation of immersive virtual reality (VR) technologies has transformed the way individuals interact with digital environments, offering unprecedented opportunities in fields ranging from entertainment and education to healthcare and mental health interventions. Immersive VR is increasingly being implemented in motor and cognitive programs in neurorehabilitation, where patient safety and treatment adherence are critical. Despite its relevance, the conceptualization and measurement of cybersickness (CS) remain fragmented across disciplines, with various assessment tools developed in isolation, targeting different symptom domains, populations, and use contexts. Aim. The aim of this systematic review is to identify, categorize, and critically appraise all existing instruments and scales developed to measure CS associated with immersive VR use. The secondary objectives involve examining the psychometric properties of the identified instruments to provide robust evidence for clinicians in assessing CS associated with VR, thereby supporting future scale development and standardization. Additionally, a further objective is to evaluate the specific applicability of these instruments and scales for measuring CS within neurorehabilitation settings, given the growing use of immersive VR in clinical practice with neurological populations. Methods. This systematic review was conducted in accordance with the Guideline for reporting systematic reviews of outcome measurement instruments (PRISMACOSMIN). The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Data extraction was performed independently by the two reviewers, and discrepancies were resolved by consensus or consultation with a third reviewer. To assess the psychometric robustness of existing CS assessment instruments used in virtual reality settings, we applied the methodology proposed by the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) initiative for systematic reviews of patient-reported outcome measures (PROMs). The evaluation was structured across three steps: Assessment of risk of bias; Quality of measurement properties and Summary of evidence; and Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Results. Nine assessment instruments were included in this review. Following our analysis, the CSQ-VR and VRNQ received a Grade A recommendation, as they met sufficient criteria for both internal consistency and structural validity with high methodological quality. Few instruments have reported validations in specific clinical populations related to neurorehabilitation, including individuals with neurological conditions such as brain injury, multiple sclerosis (MS), migraine-associated vestibulopathy, vestibular disorders or cognitive impairment, indicating a critical gap in scale generalizability across clinical contexts. Conclusions. Despite the increasing use of immersive VR, few CS assessment tools have been designed and validated, reaching the CSQ-VR and VRNQ a Grade A recommendation. Among the nine identified assessment instruments, only the SSQ, MSAQ, CSQ-VR, VRNQ MSSQ and SEQ have been employed in samples with neurological disorders. There is a critical need for standardized CS VR-specific tools with robust psychometric properties to ensure safe and effective implementation in neurorehabilitation settings. Full article

Background/aim: Vitamin D (VitD) has been implicated in neuroprotection, yet its role in Parkinson’s disease (PD) remains unclear. This systematic review and meta-analysis aimed to evaluate the association between VitD status, supplementation, and vitamin D receptor (VDR) gene polymorphisms with PD risk and outcomes. Methodology: Following PRISMA guidelines, we searched PubMed, Scopus, and Google Scholar through August 2025 for observational studies, clinical trials, and genetic association studies. Primary outcomes included serum VitD levels in PD versus healthy controls (HCs), prevalence of VitD insufficiency/deficiency, and effects of VitD supplementation on motor symptoms. Secondary outcomes assessed associations between VDR polymorphisms and PD susceptibility. Data were synthesized using random- and fixed-effects models, with heterogeneity and publication bias evaluated. PROSPERO (CRD420251133875). Results: Sixty-three studies (n ≈ 10,700 participants) met inclusion criteria. PD patients exhibited significantly lower VitD levels (SMD = −0.46; 95% CI: −0.51 to −0.41) and higher odds of insufficiency (OR = 1.52) and deficiency (OR = 2.20) compared to HC. Cohort data suggested sufficient VitD may reduce PD risk (HR = 0.83). Supplementation yielded modest, non-significant improvements in motor outcomes. Among 20 genetic studies, FokI (rs2228570) was most consistently associated with PD, while other VDR SNPs showed variable or null associations. Conclusions: VitD deficiency is common in PD and may influence disease risk and motor function. Current evidence indicates limited benefit of supplementation for motor outcomes, and genetic associations remain inconsistent. Full article

Background: Numerical cognition and motor performance rely on overlapping brain systems, yet the extent of their reciprocal interaction remains unclear. This systematic review explores how number processing influences motor execution and how motor activity shapes numerical cognition, emphasizing the neural mechanisms underlying these associations. Methods: A comprehensive search of Scopus, PubMed, MEDLINE, SPORTDiscus, PsycINFO, and SpringerLink, as well as journal citations and conference proceedings (up to August 2025), identified experimental studies examining the interplay between numerical cognition and motor performance in healthy adults. Both randomized and non-randomized designs were included. Two reviewers independently screened, extracted data, and assessed study quality following PRISMA and Cochrane Risk of Bias guidelines. Results: Twelve studies met the inclusion criteria. Most showed that numerical stimuli facilitated motor responses, with congruent number–movement pairings yielding faster reactions and more efficient kinematics. Mental calculation often enhanced motor output (e.g., force, jump height), though interferences emerged under high cognitive load. Conversely, motor actions consistently biased numerical judgments, aligning with spatial–numerical associations. Conclusions: Evidence suggests a predominant pattern of facilitation, likely reflecting shared networks between cognitive and motor resources. These findings advance theoretical understanding and highlight promising translational applications in education, sport, and neurorehabilitation. Full article

Background/Objectives: Anterior cruciate ligament (ACL) injuries frequently lead to long-term quadriceps impairments despite surgical repair. There is growing evidence that these deficits are caused in part by alterations in the central nervous system. Thus, transcranial neuromodulation (TNM) could be valuable in ACL rehabilitation. To systematically review randomized controlled trials (RCTs) assessing the effects of TNM on neurophysiological, functional, and safety outcomes in patients with ACL injury or reconstruction. Methods: We conducted searches on PubMed, Scopus, Web of Science, and Cochrane. We considered all original studies evaluating TNM, including transcranial current stimulation (tCS) and transcranial magnetic stimulation (TMS), in patients with ACL reconstruction or injury. Measures of corticospinal excitability, safety, balance, and muscle strength were assessed. We employed the Cochrane RoB 2 method to assess the risk of bias. Results: Seven studies comprising 129 participants (64 TNM, 65 controls) were included. Most studies applied transcranial direct current stimulation (tDCS) over the primary motor cortex contralateral to the ACL injury in conjunction with physical rehabilitation. Single-session protocols demonstrated minimal effects, whereas repeated sessions resulted in improvements in corticospinal excitability, quadriceps strength, and balance. No serious adverse events were reported; minor effects included transient headache or scalp tingling. The risk of bias was assessed as low to moderate across the studies. Conclusions: TNM appears to be safe and may enhance functional recovery in individuals with ACL injuries when administered in multiple sessions alongside standard rehabilitation. Further high-quality trials are necessary to determine optimal protocols and long-term outcomes. Full article

Antidepressant drugs (ADDs) are one of the most widely prescribed pharmaceuticals globally and are widely detected in the environment. They are designed to target monoamine neurotransmission—a highly conserved pathway between humans and animal species. Monoamines are particularly involved in the regulation of a wide array of key biological functions in molluscs, an ecologically important group of animals. Despite this, the target-specific effects of environmental concentrations of different classes of ADDs in molluscs remain poorly understood. The present study seeks to understand the target-specific effects of environmental concentrations of different classes of ADDs in molluscs through a systematic review of the literature. This study, following our published systematic review protocol, analyzed 51 studies after deduplication and screening of 1156 identified records. Included studies reported on a range of outcomes, including reproductive, (loco)motor, developmental, behavioral, immuno-modulating and neurophysiological effects. Data synthesis was performed with a harvest plot of exposures, effect direction and risk of bias. We found evidence (weak to moderate) for (i) immunosuppression, resulting from tissue serotonin level elevation, (ii) larval development impairment, and (iii) acetylcholinesterase inhibition, at environmental concentrations of ADDs. Most study outcomes, in addition to data-deficient outcomes, were inconclusive due largely to methodological limitations such as the use of wild-derived species with minimal or no acclimation (65.38% of included studies), lack of proper controls and replicates, and unrealistic exposures, affecting the reliability of existing data. Although the observed effects—particularly immunosuppressive ones—provide critical insight into the ecological risks posed by ADDs, their impacts at environmentally relevant concentrations remain poorly characterized for most endpoints. Given the ecological importance of molluscs, further studies addressing the identified methodological and research gaps are urgently needed to better characterize the hazards posed by environmental concentrations of ADDs. Full article

Background: In recent years, extended reality has gained traction in people with multiple sclerosis (MS) for their ability to deliver engaging, task-specific, and multisensory therapeutic experiences. Aim: This systematic review investigates the application of Mixed Reality (MR) and Augmented Reality (AR) technologies in neurorehabilitation for individuals with MS. Method: A comprehensive systematic review was conducted across seven databases and seven eligible studies were identified involving MR/AR interventions targeting motor and cognitive functions, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Data extraction was performed independently by the two reviewers and discrepancies were resolved by consensus or consultation with a third reviewer. Participants were predominantly diagnosed with relapsing-remitting MS and presented mild to moderate disability. Technologies ranged from head-mounted displays to home-based AR platforms, with interventions addressing gait, upper-limb coordination, and dual-task performance. Outcome measures were mapped to the ICF framework, encompassing body function, activity, participation, and contextual factors. Results: Findings suggest short-term improvements in gait parameters, grip strength, and motor coordination, with enhanced engagement and usability reported. Methodological quality was moderate, with small sample sizes and heterogeneous protocols limiting generalizability. Risk of bias varied across study designs. Despite promising results, further research is needed to validate long-term efficacy, optimize cognitive load, and standardize intervention protocols. Conclusions: MR and AR may serve as effective complements to conventional and VR-based rehabilitation, particularly in personalized, task-oriented training for MS populations. Full article