Search Results (1,789)

Background/Objective: Huntington’s disease (HD) is an autosomal dominant neurodegenerative disorder characterized by motor dysfunction, cognitive impairment, and psychiatric symptoms. As the disease progresses, weight loss, cachexia, and musculoskeletal atrophy are common, reducing quality of life, decreasing their autonomy in their activities of daily living (ADLs), and increasing morbidity and mortality risk. To describe and compare energy expenditure (EE) during ADLs and resting conditions in individuals with HD and healthy controls, and to examine its associations with quality of life, cognitive status, motor function, and functional capacity. Methods: A cross-sectional observational study was conducted with 16 people with manifest HD and 10 healthy controls. Participants completed five ADLs: resting, dressing, combing hair, feeding, and walking under laboratory conditions. EE during ADLs was measured using a portable indirect calorimetry system. Results: Statistically significant between-group differences in EE were found only during feeding, with individuals with HD showing higher EE than controls (p = 0.021). In the exploratory correlation analysis, cognitive status was significantly associated with EE during dressing (p = 0.033). Conclusions: This exploratory study contributes to the limited evidence on EE during ADLs in adults with HD. The findings suggest that individuals with HD may expend more energy than healthy controls during specific daily activities, particularly feeding. However, these results should be interpreted with caution due to the small sample size and preliminary nature of the study. Larger, multicenter, and longitudinal studies are needed to confirm these findings and determine their clinical relevance. Full article

The AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, have undergone a substantial transformation from a static publication to a continuously refined digital resource. This transition reflects both the rapid evolution of medical knowledge and longstanding concerns regarding the usability, consistency, and reproducibility of impairment ratings. Central to this transformation was the establishment of the AMA Guides Editorial Panel in 2019, which introduced a structured governance framework and evidence-based methodology for ongoing refinement. Unlike prior editions that relied on periodic print revisions, AMA Guides Digital permits continuous updating of individual chapters as new scientific evidence and clinical practices emerge. This narrative review examines the historical evolution of the AMA Guides, the development of AMA Guides Digital, the governance and methodological contributions of the Editorial Panel, and major system-specific refinements implemented between 2021 and 2025. Particular emphasis is placed on the Mental and Behavioral Disorders chapter (2021), the Nervous System chapter (2023), the Musculoskeletal chapters (2024), and the Pulmonary chapter (2025). These developments demonstrate a broader shift toward transparency, methodological rigor, harmonization across body systems, and alignment with contemporary clinical practice while maintaining continuity with the foundational principles of the Sixth Edition. The transition to a continuously refined digital model represents a paradigm shift in impairment evaluation with important implications for clinical, occupational, and medicolegal practice. Full article

Objectives: Temporomandibular disorders (TMD) are common musculoskeletal conditions in adults. The repetitive neuromusculoskeletal demands of operatic singing, together with suboptimal technique, intensive training, and psychological strain, may be associated with TMD-related symptoms. Knowledge of TMD and awareness of warning signs may support appropriate health-seeking behaviours. This study aimed to assess self-reported TMD-related symptoms and selected aspects of TMD-related knowledge among Polish opera singers. Methods: An online cross-sectional survey was conducted in 2024 among 241 adult Polish classically trained singers, including professional opera singers and vocal students (90 men and 151 women; age range, 20–73 years). Data were collected using an author-developed questionnaire and the Fonseca Anamnestic Index (FAI), a self-report screening instrument for TMD-related symptoms and symptom severity. Results: FAI scores were within the lowest symptom category in 21.6% of participants, within the mild category in 50.6%, within the moderate category in 24.5%, and within the severe category in 3.3%. Overall, 87.1% rated their TMD-related knowledge as poor or sufficient, although 89.6% recognised that TMD may adversely affect vocal technique. Conclusions: Self-reported TMD-related symptoms were frequently observed in this study sample, and responses to individual questionnaire items indicated gaps in selected areas of TMD-related knowledge. A self-reported previous diagnosis of TMD was associated with greater FAI-assessed symptom severity, whereas self-assessed TMD knowledge was not. These findings may support further evaluation of targeted education and access to appropriate clinical assessment for classically trained singers. Full article

Prolonged sitting is a common occupational exposure among administrative and office workers and is associated with increased postural muscle stiffness, fatigue, and musculoskeletal discomfort. This study aimed to evaluate whether a dedicated physiotherapeutic training programme can reduce biomechanical indicators of muscle overload in sedentary administrative staff. Forty-five female administrative employees were allocated to an intervention group (n = 22) or a control group (n = 23). The intervention group completed a four-week supervised physiotherapeutic programme comprising three 45 min sessions per week, including stretching, strengthening, and sensorimotor exercises targeting postural muscles. Muscle stiffness was assessed using myotonometry, while muscle fatigue was evaluated with surface electromyography based on median frequency slope analysis. The intervention effect was assessed using ANCOVA, with post-intervention values adjusted for corresponding baseline values. The intervention group showed significant reductions in muscle stiffness and fatigue, particularly in the upper trapezius and thoracic erector spinae, with moderate-to-large effect sizes. These findings indicate that targeted physiotherapeutic training can improve neuromuscular function and fatigue resistance in sedentary workers. Incorporating structured physiotherapeutic exercise into workplace health programmes may support musculoskeletal resilience and reduce the biomechanical consequences of prolonged sitting. Full article

Osteoporosis (OP) and osteoarthritis (OA) are two common degenerative musculoskeletal disorders associated with aging and are traditionally classified and managed as distinct disease entities. Emerging evidence suggests that OP and OA may share bidirectional associations and common biological mechanisms, and that under specific pathological conditions they may develop into a mutually reinforcing comorbid state. The comorbidity of osteoporosis and osteoarthritis (OP–OA) is not a simple superimposition of bone loss and cartilage degeneration; rather, it represents a disorder of the osteochondral unit centered on disruption of the subchondral bone microenvironment. Alterations in the structural strength, remodeling dynamics, vascular and neural status, and bone marrow lesions of subchondral bone collectively reshape the local microenvironment, thereby directly affecting mechanical signal transmission and cellular behavior within the joint. Focusing on the subchondral bone microenvironment as the central pathological nexus, this review systematically summarizes how mechanical imbalance, aberrant bone remodeling, inflammatory activation, metabolic dysregulation, and cellular senescence jointly remodel the local niche in OP–OA comorbidity. These microenvironmental changes further induce phenotypic remodeling and fate deviation of bone marrow mesenchymal stem cells, bone remodeling-related cells, osteoimmune cells, and chondrocytes. On this basis, we integrate the regulatory roles of developmental signaling, mechanotransduction pathways, and inflammatory–immune signaling networks, and propose that microenvironment-driven cell fate plasticity may serve as a key mechanistic hub promoting the initiation and progression of OP–OA comorbidity as well as the persistent destabilization of the osteochondral unit. This perspective may help overcome the limitations of current studies that address OP and OA separately, and may provide a theoretical framework for early identification and stratification, biomarker discovery, and combined precision-targeted interventions for this comorbid condition. Full article

Background/Objectives: Work-related musculoskeletal disorders (WMSDs) and occupational stress substantially affect workforce health and productivity. This systematic review aimed to synthesize evidence regarding the effectiveness of the Pilates method as a biopsychosocial intervention for employees, examining its impact on physical, psychological, and occupational outcomes. Methods: A systematic search was conducted across major electronic databases and search engines (PubMed, Scopus, Web of Science, PEDro, and Google Scholar) following PRISMA 2020 guidelines. The review protocol was prospectively registered in PROSPERO (CRD420261390771). Eligible studies included randomized controlled trials, quasi-experimental, and observational designs involving employees participating in Pilates programs. Outcomes were categorized into three domains: physical health, mental well-being, and occupational performance. Results: Twenty-three studies (n = 1179 participants) met the inclusion criteria. The evidence indicates that Pilates may reduce pain intensity and disability in workers with chronic low back or neck pain, with moderate certainty based on randomized controlled trials. Improvements in psychological outcomes, including anxiety and job-related stress, were also reported, although the certainty of evidence was lower. Occupational benefits included enhanced job satisfaction and, in limited cases, favorable cost-utility findings. Conclusions: Pilates appears to be a feasible multidimensional intervention for workplace health, with potential benefits across physical and psychosocial domains. Further high-quality trials are needed to clarify long-term effects, economic impact, and optimal implementation strategies within occupational settings. Full article

Background: Sedentary behavior is a major modifiable risk factor for chronic metabolic disorders, particularly type 2 diabetes mellitus (T2DM). Despite recommendations promoting regular physical activity (PA), adherence remains low. DIA/01 is a multidisciplinary study designed to promote healthy lifestyles for the prevention and management of T2DM, supporting healthcare systems. Methods: A total of 123 adults with T2DM diagnosed will be enrolled at the Diabetes Center of the University Hospital of Perugia throughout 2025. Inclusion criteria are age 25–80 years, ability to walk independently, being inactive, and BMI 18.5–40 kg/m². Exclusion criteria include severe cardiovascular, central nervous system, or musculoskeletal diseases contraindicating PA. Participants will be randomized into three groups: (1) standard care (SC); (2) SC plus theoretical PA counseling (TCPA); and (3) SC plus TCPA plus a 3-month supervised mixed exercise program. The assessment, conducted at baseline and at 6 and 12 months, includes total weekly PA (WPA) time, using IPAQ-SF and actigraphy. Moreover, glycated hemoglobin, sedentary time (ST), functional capacity, body composition, cardiometabolic risk factors, dietary adherence, perceived barriers and willingness to initiate PA, readiness to change, health-related quality of life, and sleep quality will be studied. This study is registered in the Clinical Trials Registry on 13 May 2026, with the identifier NCT07583355. Conclusions: Participants in groups (2) and (3) are expected to show greater improvements in WPA, reductions in ST, and favorable changes in metabolic and functional outcomes compared with SC. This approach may support long-term engagement in regular PA and contribute to improving the clinical management of T2DM. Full article

Shoulder injuries due to labor-related lifting tasks are widespread in manufacturing and logistics companies. Prolonged shifts and repetitive motions lead to muscle fatigue, significantly elevating the risk of both acute accidents and chronic musculoskeletal disorders. Many passive exoskeletons which use springs to provide lifting assistance have been commercialized, and many active exoskeletons have been researched. The drawback to passive exoskeletons is the larger the lifting force that they produce, the larger the force required to lower the arms. This contributes to tiring the user. Conversely, active exoskeletons require substantial energy to provide meaningful torque. Furthermore, they pose a safety risk; a sudden power failure could result in an instantaneous loss of support, potentially causing the user to drop a heavy load and sustain injury. This research project proposes a hybrid exoskeleton with a parallel elastic actuator that uses a motorized helical actuator which can be tuned to improve lifting performance. This paper evaluates the kinematics and statics of the proposed exoskeleton, details the design and implementation of the electrical control system, shows mechanism optimization of the mechanical advantage profile, and validates the concept through the construction and experimental testing of a functional prototype. Full article

Background/Objectives: Natural calcium carbonate materials such as Rügen chalk have a long history of use in balneology and rehabilitation, particularly for musculoskeletal disorders, yet their application remains largely confined to traditional, labour-intensive forms such as powders, suspensions, and packs, which limit usability and broader clinical translation. This study aimed to develop an alginate-based solid foam incorporating Rügen chalk and to evaluate how key formulation components influence its structural, mechanical, and thermal properties relevant for therapeutic use. Methods: Alginate–chalk foams were prepared by mechanical mixing of a sodium alginate–Rügen chalk paste with an amino acid-based surfactant, while in situ CO₂ generation from D–glucono–δ–lactone (GDL) induced calcium-mediated alginate gelation and foam stabilization. A central composite design with response surface methodology was used to assess the effects of alginate, chalk, and Perlastan^®–GDL content on foam pH, overrun, firmness, springiness, pore volume, sphericity, pore density, specific internal surface area, and heat-loss time. Foam microstructure was characterized by optical microscopy and microcomputed tomography (µCT), and the thermal conductivity and cooling behaviour of the selected formulation were compared with therapeutic peat. Results: Stable, elastic solid foams with a three-dimensional porous architecture were obtained across the investigated composition range. Foam overrun (30.8–57.1%) was primarily governed by sodium alginate and Rügen chalk concentrations, while firmness (7.4–15.2 N) increased predominantly with alginate content, and springiness remained high (70–78%), indicating good elastic recovery. Response surface modelling and ANOVA confirmed sodium alginate as the dominant factor influencing both mechanical and structural properties, with statistically significant effects on overrun, firmness, springiness, heat loss, porosity, and specific internal surface. µCT analysis revealed that all foam formulations were predominantly composed of fine, closed-cell pores, with over 96% of pores having volumes below 0.5 mm³ and a consistent median pore volume of 0.02 mm³. Structural differences between formulations were governed primarily by pore number and spatial distribution rather than pore size. Strong correlations were identified between µCT-derived parameters, particularly between specific internal surface, porosity, and pore density, confirming that internal architecture is controlled by pore population rather than individual pore dimensions. Thermal analysis demonstrated that the optimized formulation exhibited thermal conductivity comparable to therapeutic peat and maintained clinically relevant temperatures (35–45 °C) for more than one hour. Based on predefined performance criteria (overrun ≥ 50%, firmness ≤ 10 N, heat loss ≥ 120 s), formulation 7 was identified as optimal, combining favourable mechanical properties, structural uniformity and thermal retention. Conclusions: Alginate-based solid foams incorporating Rügen chalk constitute a feasible and tunable platform that combines efficient mineral loading, elastic porosity, and effective heat retention, offering a practical and modern alternative to conventional mineral-based therapeutic applications in balneology and rehabilitation. Full article

Background and Objectives: Chronic nonspecific neck pain (NSNP) is among the most common musculoskeletal disorders. Global postural re-education (GPR) might be effective in decreasing neck pain (NP) and dysfunction and improving forward head posture (FHP) by recovering muscle chains and reducing postural alteration. Deep neck flexor activation (DNF) might also decrease NP and improve FHP by improving DNF endurance. This study aimed to compare the effects of GPR versus DNF activation on pain, dysfunction, FHP, and DNF endurance. Materials and Methods: Forty-six physiotherapy students with chronic NSNP participated in this non-randomized comparative study and were allocated into two equal groups based on their availability and preference regarding session duration. Group A underwent GPR exercises combined with active neck exercises, whereas group B received DNF activation in addition to active neck exercises. All participants were assessed pre- and post-intervention for pain intensity using a visual analog scale (VAS), neck disability using the Arabic version of the neck disability index (NDI), FHP via a photometric method with Kinovea software, and DNF endurance using pressure biofeedback. Results: A significant effect of both treatments was reported on reducing pain intensity, improving the FHP and enhancing the neck functional status with no substantial differences between both groups. A significant improvement in DNF endurance was observed in both groups, with substantially higher values between groups in favor of the DNF group. Conclusions: Both GPR and DNF activation exercises were associated with reductions in pain and improvements in neck disability among physiotherapy students with chronic NSNP and FHP. Also, both CVA and DNF endurance improved, with more improvement observed in DNF endurance in the DNF group compared with the GPR group. Full article

Background/Objectives: Promoting postural health in children requires not only adequate knowledge but also the implementation of health-promoting behaviors in the school environment. Teachers play a key role in this process; however, the extent to which their knowledge is reflected in everyday practice remains unclear. The study aimed to analyze and compare the levels of knowledge among preschool, early school, and physical education teachers regarding postural health in children and adolescents, including postural abnormalities, ergonomics, the selection of corrective exercises, and behaviors that promote correct body posture. Methods: A cross-sectional study was conducted on a sample of 153 teachers in Poland: 24 preschool (P), 53 early school education (EE), and 76 physical education (PE) teachers. The self-report Teachers’ Body Posture Literacy Questionnaire (TBPLQ) was used to assess knowledge regarding postural abnormalities. Results: PE achieved the highest TBPLQ scores, with significant differences observed mainly in comparison with EE (r = 0.30–0.50, p < 0.001). Across all groups, teachers performed best in recognizing postural abnormalities and worst in selecting appropriate corrective exercises. Although knowledge levels were relatively high, only weak correlations were found between knowledge and postural hygiene-promoting behaviors. The largest behavioral differences concerned the use of appropriate sportswear during physical education classes (η² > 0.14). Conclusions: Teachers demonstrated relatively high levels of knowledge regarding posture health. However, a clear knowledge–behavior gap was identified. Knowledge was only partially translated into proactive health-promoting actions, particularly regarding corrective interventions and communication with parents. The results suggest the need for educational initiatives for teachers focusing on proactive health-promoting and postural hygiene behaviors. Full article

Musculoskeletal pain is a major cause of disability and long-term analgesic use, increasing interest in safe non-pharmacological interventions. This focused narrative review examines light-emitting diode (LED)-based photobiomodulation (PBM) for musculoskeletal pain, integrating molecular, mechanistic, clinical, and translational evidence. Red and near-infrared LED-PBM may act through mitochondrial and non-mitochondrial photoacceptors, modulation of ATP production, reactive oxygen species, nitric oxide, calcium signaling, inflammatory pathways, oxidative stress responses, and extracellular matrix repair. Clinical evidence suggests a potential benefit in selected conditions, particularly temporomandibular disorders, fibromyalgia, cervical and myofascial pain, tendon and plantar fascia disorders, knee osteoarthritis, and mild-to-moderate peripheral nerve compression, while findings for non-specific low back pain remain inconsistent. The reviewed literature indicates that therapeutic response depends less on emitter identity alone than on wavelength, irradiance, radiant exposure, treatment geometry, target depth, timing, disease phenotype, and protocol quality. LED-based PBM appears generally well tolerated and clinically promising as an adjunct to rehabilitation, but current evidence is limited by heterogeneous devices, incomplete dosimetry, variable comparators, and short follow-up. Future studies should prioritize standardized reporting, depth-aware dosing, phenotype-based recruitment, biomarker-linked outcomes, and direct laser–LED comparisons under dosimetrically matched conditions. Full article

Musculoskeletal disorders involving bone, cartilage, tendon, and joint tissues represent a leading cause of disability worldwide, and conventional surgical and graft-based interventions are limited by donor site morbidity, incomplete integration, and finite durability. Despite substantial preclinical progress, translation into reliable clinical benefit has remained inconsistent. This narrative review synthesizes recent advances in bioengineered approaches to bone and joint repair, emphasizing how materials design and regenerative strategy selection influence translational feasibility. Advances in scaffold-based systems highlight the role of material composition, architectural organization, and structure–function matching in supporting musculoskeletal regeneration. Regenerative platforms including stem cell therapies, extracellular matrix-derived constructs, and smart materials are evaluated for biological performance, manufacturability, and regulatory feasibility. Early translational and clinical studies demonstrate encouraging outcomes across selected musculoskeletal indications; however, variability in efficacy and adoption highlights persistent barriers to broader implementation. Key challenges include scalable manufacturing, cost and reimbursement uncertainty, and heterogeneity in clinical infrastructure, factors that may also influence access to advanced regenerative therapies. Future innovations should emphasize manufacturability and real-world evidence generation that align with practical clinical pathways. Full article

In today’s manufacturing industry, work-related musculoskeletal disorders (WMSDs) remain among the most prevalent occupational health issues. Collaborative robots (cobots) represent a promising technology to address this challenge. Consequently, ergonomics assessment in human–robot collaboration (HRC) has gained increasing attention in recent years. This study investigates the feasibility of using a coupled digital twin system consisting of a digital human model (DHM) and a cobot digital twin to assess detailed ergonomic parameters such as muscle activations and joint reaction forces in an HRC task. Selected parameters are used to develop an ergonomics map that condenses the effects of human–robot interaction into a single scalar value for each working position in the coronal plane in front of the user. The ergonomics mapping approach is presented, key influencing factors are identified, and critical workspace design implications are discussed. Full article

In equine veterinary medicine, there is a lack of correlation between the structural severity of orthopaedic disease and the perceived severity of presenting signs, resulting in a variable influence on performance, pain and disability. Across equine industries, there is selective pressure through breeding for specific traits, such as the “speed” gene (MSTN) in racing thoroughbreds and the “gait keeper” gene (DMTR3) in pacing breeds, potentially resulting in genetic predispositions that lead to an increased risk of musculoskeletal disorders. With advancements in molecular sequencing techniques, researchers have been able to identify various genes (e.g., ECA, RUNX, and ADAME1) as well as biomarkers influencing performance and the development of orthopaedic disease. In combination, these techniques could be applied clinically in the future to improve welfare and disease management through advanced characterization and treatments to delay the onset of orthopaedic disease. Full article