Search Results (1,861)

Neuromuscular hip dysplasia (NHD) is a common deformity in children with cerebral palsy (CP). Although some predictive factors of NHD are known, the prediction of NHD is in its infancy. We present a Clinical Decision Support System (CDSS) designed to calculate the probability of developing NHD in children with CP. The system utilizes an ensemble of three machine learning (ML) algorithms: Neural Network (NN), Support Vector Machine (SVM), and Logistic Regression (LR). The development and evaluation of the CDSS followed the DECIDE-AI guidelines for AI-driven clinical decision support tools. The ensemble was trained on a data series from 182 subjects. Inclusion criteria were age between 12 and 18 years and diagnosis of CP from two specialized units. Clinical and functional data were collected prospectively between 2005 and 2023, and then analyzed in a cross-sectional study. Accuracy and area under the receiver operating characteristic (AUROC) were calculated for each method. Best logistic regression scores highlighted history of previous orthopedic surgery (p = 0.001), poor motor function (p = 0.004), truncal tone disorder (p = 0.008), scoliosis (p = 0.031), number of affected limbs (p = 0.05), and epilepsy (p = 0.05) as predictors of NHD. Both accuracy and AUROC were highest for NN, 83.7% and 0.92, respectively. The novelty of this study lies in the development of an efficient Clinical Decision Support System (CDSS) prototype, specifically designed to predict future outcomes of neuromuscular hip dysplasia (NHD) in patients with cerebral palsy (CP) using clinical data. The proposed system, PredictMed-CDSS, demonstrated strong predictive performance for estimating the probability of NHD development in children with CP, with the highest accuracy achieved using neural networks (NN). PredictMed-CDSS has the potential to assist clinicians in anticipating the need for early interventions and preventive strategies in the management of NHD among CP patients. Full article

Background: Temporomandibular disorders are a generic term referred to clinical conditions involving the jaw muscles and temporomandibular joint with multifactorial pattern and genetic background. The aim of this observational study was to investigate the correlation between craniomandibular disorders and the presence of occlusal alterations. A clinical evaluation of the occlusal and articular status of the patients was carried out, integrating the latter with the electromyographic recording the activity of the masseter and temporalis muscles. Methods: A clinical observational study on 20 adults assessed temporomandibular disorders using DC/TMD criteria, anamnesis, clinical exams, occlusal and electromyographic analyses. Occlusion was evaluated morphologically and functionally. Electromyography tested static/dynamic muscle activity. Data were statistically analyzed using t-tests and Pearson correlation (p < 0.05). Results: Electromyographic analysis revealed significant differences between subjects with and without visual correction, suggesting that visual input influences masticatory muscle activity. Correlations emerged between occlusal asymmetries and neuromuscular parameters. These findings highlight clinical implications for mandibular function, muscle symmetry, and the potential for therapeutic rebalancing through targeted interventions. Conclusions: The study demonstrates a significant correlation between visual–motor integration and masticatory muscle efficiency. It emphasizes lateralized neuromuscular activation’s influence on occlusal contact distribution. Moreover, it identifies mandibular torsion–endfeel inverse correlation as a potential diagnostic marker for craniomandibular dysfunctions via surface electromyography. Full article

Objective: This study aimed to improve the understanding of the lives of patients with chronic neuropathic pain planned for invasive motor cortex stimulation (iMCS) and assess their expectations towards this intervention and its impact. Methods: Semi-structured face-to-face interviews were conducted until saturation of data was reached. Patients were recruited from one university medical center in the Netherlands. All interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis using iterative and inductive coding by two researchers independently. Results: Fifteen patients were included (11 females; mean age 63 ± 9.4 yrs). Analysis of the coded interviews revealed seven themes: (1) the consequences of living with chronic neuropathic pain; (2) loss of autonomy and performing usual activities; (3) balancing energy and mood; (4) intimacy; (5) feeling understood and accepted; (6) meaning of life; and (7) the expectations of iMCS treatment. Conclusions: This is the first qualitative study that describes the suffering of patients with chronic neuropathic pain, and their expectations prior to invasive brain stimulation. Significant themes in the lives of patients with chronic pain have been brought to light. The findings strengthen communication between physicians, caregivers, and patients. Practice Implications: The insights gathered from the interviews create a structured framework for comprehending the values and expectations of patients living with central pain and reveal the impact of symptoms due to the central pain. This knowledge improves the communication between physicians and caregivers on one side and the patient on the other side. Furthermore, the framework enhances the capacity for shared decision-making, particularly in managing expectations related to iMCS. Full article

Background: Virtual reality (VR), often used with motion sensors, provides interactive tools for physiotherapy aimed at enhancing motor functions. This systematic review examined the effects of VR-based interventions, alone or combined with conventional physiotherapy (PT), on balance and gait in individuals with Parkinson’s disease (PD). Methods: Following PRISMA guidelines, eight randomized controlled trials (RCTs) published between January 2019 and April 2025 were included. Interventions lasted between 5 and 12 weeks and were grouped as VR alone or VR combined with PT. Methodological quality was assessed using the PEDro Scale. Results: Of the 31 comparisons for balance and gait, 30 were favored by the experimental group, with 12 reaching statistical significance. Secondary outcomes (function, cognition, and quality of life) showed mixed results, with 6 comparisons favoring the experimental group (3 statistically significant) and 4 favoring the control group (1 statistically significant). Overall, the studies showed fair to good quality and a moderate risk of bias. Conclusions: VR-based interventions, particularly when combined with PT, show promise for improving balance and gait in PD. However, the evidence is limited by the small number of studies, heterogeneity of protocols, and methodological constraints. More rigorous, long-term trials are needed to clarify their therapeutic potential. Full article

Motor vehicle crashes are a persistent cause of unintentional deaths in the United States. Scholarship on how manmade interventions and natural phenomena interact to effectuate such calamitous outcomes is longstanding. One manmade intervention of interest in the literature is daylight saving time (DST). Unfortunately, results on how the natural phenomena attributable to DST interact with driver behavior are inconsistent. To advance knowledge on DST-safety interactions, this study adopts a multilevel model approach to fatal motor vehicle crash outcomes in the contiguous United States. Results from a national analysis contextualize results from zonal analyses to unmask within- and between-time zone differences in DST-safety interactions. In the national analysis, motor vehicle crash fatalities decrease somewhat during DST (−0.10%). In the zonal analyses, motor vehicle crash fatalities decrease more so in the Central and Eastern time zones (−2.00% and −2.00%, respectively), but increase somewhat in the Pacific and Mountain time zones (+0.30%) during DST. The spatiotemporal context of the national analysis highlights specific policy implications from the zonal analyses to decrease the lethality of motor vehicle crashes. Specifically, interdictions to target alcohol and/or drug involvement in the northern latitudes of the Pacific and Mountain time zones during DST, the Central time zone at dawn or dusk before or after DST, and the northern latitudes in the Eastern time zone before or after DST are important. Generally, national DST-safety benefits mask zonal DST-safety costs in the Pacific and Mountain time zones. Full article

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising neuromodulatory tool for language rehabilitation in chronic aphasia. However, the effects of bi-hemispheric, multisite stimulation remain largely unexplored, especially in people with chronic and treatment-resistant language impairments. The goal of this study is to look at the effects on behavior and brain activity of an individualized language training program that combines bi-hemispheric multisite anodal tDCS with personalized language training for Albert, a patient with long-standing, treatment-resistant non-fluent aphasia. Methods: Albert, a right-handed retired physician, had transcortical motor aphasia (TCMA) subsequent to a left-hemispheric ischemic stroke occurring more than six years before the operation. Even after years of traditional treatment, his expressive and receptive language deficits remained severe and persistent despite multiple rounds of traditional therapy. He had 15 sessions of bi-hemispheric multisite anodal tDCS aimed at bilateral dorsal language streams, administered simultaneously with language training customized to address his particular phonological and syntactic deficiencies. Psycholinguistic evaluations were performed at baseline, immediately following the intervention, and at 1, 2, 3, and 6 months post-intervention. Resting-state fMRI was conducted at baseline and following the intervention to evaluate alterations in functional connectivity (FC). Results: We noted statistically significant enhancements in auditory sentence comprehension and oral reading, particularly at the 1- and 3-month follow-ups. Neuroimaging showed decreased functional connectivity (FC) in the left inferior frontal and precentral regions (dorsal stream) and in maladaptive right superior temporal regions, alongside increased FC in left superior temporal areas (ventral stream). This pattern suggests that language networks may be reorganizing in a more efficient way. There was no significant improvement in phonological processing, which may indicate reduced connectivity in the left inferior frontal areas. Conclusions: This case underscores the potential of combining individualized, network-targeted language training with bi-hemispheric multisite tDCS to enhance recovery in chronic, treatment-resistant aphasia. The convergence of behavioral gains and neuroplasticity highlights the importance of precision neuromodulation approaches. However, findings are preliminary and warrant further validation through controlled studies to establish broader efficacy and sustainability of outcomes. Full article

Shaken Baby Syndrome (SBS) is one of the primary causes of fatal head trauma in infants and young children, occurring in about 33 per 100,000 infants annually in the U.S., with mortality rates being between 15% and 38%. Survivors frequently endure long-term disabilities, such as cognitive deficits, visual impairments, and motor dysfunction. Diagnosing SBS remains difficult due to the lack of visible injuries and delayed symptom onset. Existing detection methods—such as neuroimaging, biomechanical modeling, and infant monitoring systems—cannot perform real-time detection and face ethical, technical, and accuracy limitations. This study proposes an inertial measurement unit (IMU)-based detection system enhanced with machine learning to identify aggressive shaking patterns. Findings indicate that wearable-based motion analysis is a promising method for recognizing high-risk shaking, offering a non-invasive, real-time solution that could minimize infant harm and support timely intervention. Full article

Genetic testing in amyotrophic lateral sclerosis (ALS) often reveals variants of uncertain significance (VUS), which are frequently omitted from diagnostic reports or reported with limited clinical interpretation. To address this gap, we developed a rapid functional assessment pipeline in collaboration with FILSLAN, the French ALS care network, combining in vitro and in vivo neurogenetic assays. We illustrate this approach through the reclassification of the SOD1 p.Val120Leu variant, identified in an ALS patient, as pathogenic. Functional studies demonstrated that this variant leads to cytoplasmic aggregation, reduced neurite outgrowth, and abnormal motor behavior in zebrafish. These results support the systematic use of functional assays to clarify the pathogenicity of uncertain variants, thereby improving diagnostic accuracy, preventing misdiagnosis, and enabling timely therapeutic interventions in ALS. Full article

Background/Objectives: Obesity in adolescence is associated with a deterioration in cognitive functions, with significant implications for psychophysical well-being and academic performance. Recent studies highlight the importance of integrated interventions that combine nutrition education and physical activity to promote the overall health of students. The present study aims to evaluate the efficacy of an integrated intervention based on nutritional education and conscious body movement in improving cognitive functions, perceived well-being and nutritional knowledge in lower secondary school students with indicators of overweight and obesity. Methods: A quasi-experimental design with randomization at the class level was adopted, involving 60 students divided into an experimental group and control group. The intervention was divided into twelve weeks of activities, divided between nutritional education modules and physical activity courses. Standardized tests for the assessment of cognitive functions (Digit Span Forward, Digit Span Backward, Stroop Test, Trail Making Test B), motor tests (6-Minute Walk Test, Sit and Reach Test) and a food knowledge questionnaire were administered before and after the intervention. Results: The experimental group showed significant improvements compared to the control group in all cognitive, motor, and nutritional knowledge measures, indicating the effectiveness of the integrated intervention in promoting cognitive and physical well-being. Conclusions: The findings support the role of school as a generative environment of integrated well-being, suggesting the need to develop and implement curricular programs that integrate nutrition education and physical activity to counteract the negative effects of obesity on cognitive function in adolescents. Full article

Racket sports are very popular not only in professional sports but also among recreational players. As a result, their impact on the field of education has grown significantly in recent years. Table tennis (TT) offers significant advantages in terms of skill acquisition and health improvement. Nevertheless, its application within physical education (PE) curricula remains undetermined. The aim of this systematic review was to analyze the use of TT as educational content in the subject of PE in primary school. The PRISMA 2020 methodology was used to conduct the systematic review. Six databases (ERIC, Pubmed, ScienceDirect, Scopus, Sport Discus, and Web of Science) were used during the search process. The search cutoff date was December 31, 2024. After applying the eligibility criteria, 3595 articles were found. Only seven studies were selected for the final analysis and the data included 1526 students from primary school. The results indicate that TT is rarely used in primary education during PE classes. Research indicates interest among teachers and students in playing it during PE. Furthermore, due to the benefits, motivation, and interest this sport generates, educational experiences have been developed, such as roundtable discussions, table top tennis, balloon TT, and TT triathlon. A lack of materials, facilities, and teacher training for teaching this sport is notable. The teaching experiences analyzed in this review confirm that TT is a highly versatile and interesting sport as a subject matter in school PE. The use of TT allows for innovative, comprehensive, and inclusive PE, thanks to the sport’s multiple possibilities. Given its adaptability and low entry barrier, TT could serve as an effective tool for increasing children’s physical activity levels, improving motor skills, and fostering social–emotional development. However further research is needed to quantify its impact on health outcomes such as cardiovascular fitness or obesity prevention. Full article

Background/Objectives: Legislative changes in educational systems have influenced how student learning is understood and promoted. In physical education (PE), there has been a shift from behaviorist models to more holistic approaches. In this context, physical literacy (PL) is presented as an emerging pedagogical model in school PE, aimed at fostering students’ motor competence in a safe, efficient, and meaningful way. The aim of this study is to analyze the origins, foundations, methodological elements, and educational value of PL, highlighting its potential to promote holistic and inclusive learning as the basis for an emerging PL model. Methods: A narrative review was conducted through a literature search in the Web of Science, PubMed, Scopus, and SportDiscus databases up to June 2025, focusing on scientific literature related to PL and PE. The analysis included its historical background, philosophical and theoretical foundations, and the key methodological elements and interventions that support its use as a pedagogical model. Results/Discussion: The findings indicate that the PL model can be grounded in key principles, such as student autonomy, teacher training, connection with the environment, inclusion, and collaboration. Additionally, motivation, enjoyment, creativity, and continuous assessment are identified as essential components for effective implementation. Moreover, this model not only guides and supports teachers in the field of PL but also promotes comprehensive benefits for students at the physical, cognitive, affective, and social levels, while encouraging increased levels of physical activity (PA). Conclusions: PL is understood as a dynamic and lifelong process that should be cultivated from early childhood to encourage sustained and active participation in PA. As a pedagogical model, PL represents an effective tool to enhance student learning and well-being in PE classes. Full article

Background/Objectives: Metabolic dysfunction-associated steatotic liver disease (MASLD) represents a major global health challenge characterized by complex adipose–liver interactions mediated by adipokines and hepatokines. Despite rapid field evolution, a comprehensive understanding of research trends and translational advances remains fragmented. This study systematically maps the scientific landscape through bibliometric analysis, identifying emerging domains and future clinical translation directions. Methods: A comprehensive bibliometric analysis of 1002 publications from 2004 to 2025 was performed using thematic mapping, temporal trend evaluation, and network analysis. Analysis included geographical and institutional distributions, thematic cluster identification, and research paradigm evolution assessment, focusing specifically on adipokine–hepatokine signaling mechanisms and clinical implications. Results: The United States and China are at the forefront of research output, whereas European institutions significantly contribute to mechanistic discoveries. The thematic map analysis reveals the motor/basic themes residing at the heart of the field, such as insulin resistance, fatty liver, metabolic syndrome, steatosis, fetuin-A, and other related factors that drive innovation. Basic clusters include metabolic foundations (obesity, adipose tissue, FGF21) and adipokine-centered subjects (adiponectin, leptin, NASH). New themes focus on inflammation, oxidative stress, gut microbiota, lipid metabolism, and hepatic stellate cells. Niche areas show targeted fronts such as exercise therapies, pediatric/novel adipokines (chemerin, vaspin, omentin-1), and advanced molecular processes that focus on AMPK and endoplasmic-reticulum stress. Temporal analysis shows a shift from single liver studies to whole models that include the gut microbiota, mitochondrial dysfunction, and interactions between other metabolic systems. The network analysis identifies nine major clusters: cardiovascular–metabolic links, adipokine–inflammatory pathways, hepatokine control, and new therapeutic domains such as microbiome interventions and cellular stress responses. Conclusions: In summary, this study delineates current trends and emerging areas within the field and elucidates connections between mechanistic research and clinical translation to provide guidance for future research and development in this rapidly evolving area. Full article

Background: Dystonic cerebral palsy (DCP) is a complex, disabling manifestation of secondary dystonia, which significantly impacts motor function, quality of life, and well-being. Conventional pharmacologic therapies frequently do not relieve symptoms sufficiently. Deep brain stimulation (DBS) of the globus pallidus internal segment (GPi) has gained increasing attention as a neuromodulatory therapy for refractory dystonia. Still, the experience of the effect of GPi DBS treatment in adults with DCP has, until recently, been limited. Methods: We performed a retrospective, two-center case series of 11 adult patients with medically refractory DCP who underwent bilateral GPi-DBS. The clinical outcomes were evaluated based on the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS), the Functional Independence Measure (FIM), the Gross Motor Function Classification System (GMFCS), and the Caregiver Burden Scale (CBS). The assessments were done preoperatively and at 1-year follow-up. Changes in continuous variables were analyzed using paired t-tests. Results: At the 1-year follow-up, the mean BFMDRS score improved from 69.6 ± 27.6 to 54.3 ± 36.5 (p = 0.001), indicating a significant reduction in overall dystonia severity. Functional independence also improved, demonstrated by the rise in FIM scores from 65.3 ± 33.9 to 79.2 ± 43.4 (p = 0.006). Although GMFCS levels did not change in most patients (p = 0.125), the burden on caregivers decreased significantly, with CBS scores falling from 35.7 ± 18.8 to 32.0 ± 17.1 (p = 0.015). There were no surgical complications. Conclusions: In adults, bilateral GPi-DBS is a safe and effective intervention for DCP, improving motor control and increasing functional independence while decreasing caregiver burden. These findings lend support to its role in the multidisciplinary management of DCP. Full article

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

Background/Objectives: Fatigue and cognitive impairment are common issues for People with Multiple Sclerosis (PwMS), affecting over 80% and 40–65%, respectively. The relationship between these two debilitating conditions is complex, with cognitive deficits exacerbating fatigue and vice versa. This study investigates the effects of a multimodal intervention combining cognitive rehabilitation and neuromodulation to alleviate fatigue and enhance cognitive performance in PwMS. Methods: The research employed multiple baselines across the subjects in a Single-Case Experimental Design (mbSCED) with a cohort of three PwMS diagnosed with Relapsing–Remitting MS. The intervention protocol consisted of a baseline phase followed by a four-week treatment involving transcranial direct current stimulation (tDCS) and cognitive training using RehaCom^® software (version 6.9.0). Fatigue levels were measured using the modified Fatigue Impact Scale (mFIS), while cognitive performance was evaluated through standardized neuropsychological assessments. Results: The multimodal protocol exhibited high feasibility and acceptability, with no dropouts. Individual responsiveness outcomes varied, with two PwMS showing significant decreases in fatigue and improvements in cognitive performance, particularly in the trained domains. Their motor performance and quality of life also improved, suggesting that the treatment had indirect beneficial effects. Conclusions: This study provides preliminary evidence for the potential benefits of integrating neuromodulation and cognitive rehabilitation as a personalized therapeutic strategy for managing fatigue and cognitive impairments in MS. Further research is needed to delineate the specific contributions of each intervention component and establish standardized protocols for clinical implementation. The insights gained may lead to more effective, tailored treatment options for PwMS. Full article