Search Results (99)

Laparoscopy is one of the most widely used surgical techniques in clinical practice. However, its practice is associated with medium- and long-term musculoskeletal disorders in surgeons. In this context, robot-assisted surgery has emerged as a promising approach for mitigating ergonomic constraints while enhancing control and precision during laparoscope manipulation. Despite these advances, existing research predominantly focuses on robotic control strategies, whereas the study of human–robot interaction in the operating room remains comparatively underexplored. This paper presents a proof-of-concept framework for workspace-aware posture adaptation in collaborative surgical robotics. The proposed approach combines vision-based human activity recognition with reinforcement learning to control the shoulder–elbow–wrist redundant angle of a seven-degree-of-freedom manipulator holding a laparoscope. Based on the detected interaction context, the system distinguishes between controlling, observing, cutting, and blocked states. During the observation and cutting phases, the controller allows the robot’s posture to be reconfigured so that it tilts away from the human operator while maintaining the position of the laparoscope; when the surgeon moves away, the robot gradually returns to its default configuration. Two reward formulations, dense and fuzzy, are compared. Real-world experiments show that both approaches learn the desired reflexive behavior, while the fuzzy reward yields improved training stability and more consistent real-system performance, increasing workspace availability around the surgeon. Full article

Competency in musculoskeletal (MSK) ultrasound requires learners to relate probe manipulation to spatial reasoning, image projection, and the appearance of characteristic artefacts, which remains challenging during early training due to the limited spatial context provided by conventional instructional resources. This study investigates whether reconstructing real MSK ultrasound examinations in an immersive extended reality (XR) environment is perceived as useful for early familiarisation with probe handling and image interpretation. The proposed system reproduces ultrasound acquisitions using synchronised ultrasound video, six-degree-of-freedom probe tracking, and surface scans acquired from cadaveric specimens, enabling the reconstruction of spatially accurate probe trajectories with each ultrasound frame linked to a corresponding position and orientation. Within the XR environment, users can interactively explore these trajectories or observe automated playback in which the recorded probe motion is presented together with the corresponding ultrasound sequence. An exploratory evaluation with healthcare professionals was conducted to assess perceived usefulness and clarity of spatial relationships. The results indicate that participants perceived spatially coherent playback of real ultrasound examinations in XR as a potentially useful aid for understanding probe–image relationships. These findings suggest the feasibility of this approach as a complementary resource for introductory MSK ultrasound training. Full article

Background: Congenital heart diseases are the most common congenital malformations, affecting 4 to 9 per 1000 children, with increasing global prevalence. As surgical mortality rates decline, the focus has shifted toward improving the quality of life and perioperative outcomes for pediatric patients. Multidisciplinary rehabilitation, including osteopathic care, is increasingly incorporated into recovery programs. Osteopathic manipulative treatment combines manual techniques with lifestyle guidance to alleviate postoperative pain and promote recovery. This project report describes the impact of osteopathic manipulative treatment (OMT) on pain and somatic dysfunctions in hospitalized pediatric cardiac patients, using validated pain assessment tools. It presents a retrospective analysis of data collected as part of a humanitarian volunteer project. Methods: The project report follows a retrospective descriptive study design, using patient note forms from children aged 0–18 years undergoing cardiac surgery at the Sri Sathya Sai Sanjeevani Center in India between October 2023 and March 2024. A total of 29 experienced osteopaths recorded pain assessments at three time points—pre-surgery, post-surgery, and pre-discharge—using age-appropriate pain scales (FLACC, Wong-Baker Faces, and Numerical Rating Scale). Somatic dysfunctions were evaluated and classified using ICD-10 M99 codes. Data analysis involved descriptive statistics and pre-post comparisons using statistical software (Excel and OPENEPI). Results: The study included 564 children (60.5% male, mean age 5.8 ± 4.3 years). The most common congenital defects were ventricular septal defects (38.5%) and tetralogy of Fallot (21.6%). The average hospital stay was 15.9 ± 11.1 days. Significant reductions in pain scores were observed from the Intensive Care Unit to the postoperative ward (p < 0.001). Similarly, somatic dysfunction severity decreased significantly across hospitalization phases (p < 0.001). The thoracic region and rib cage were the most frequently affected areas. No adverse events related to osteopathic manipulative treatments were reported. Conclusions: This project report indicates that osteopathic manipulative treatment is safe and feasible for pediatric patients undergoing surgery for congenital heart disease. Pain scores and somatic dysfunction severity decreased during hospitalization. However, the lack of a control group, the heterogeneity of the patient population, and the short observation period limit the ability to draw causal conclusions. These findings provide a descriptive framework for integrating OMT into multidisciplinary pediatric cardiac care. Future studies should involve prospective, multicenter designs with control groups and longer follow-up periods to assess clinical, functional, developmental, and quality-of-life outcomes. Full article

Background: Proprioceptive deficits, commonly quantified as joint position sense error (JPSE), are frequently reported in musculoskeletal conditions. Articular manual therapy may influence afferent input and sensorimotor integration. This review synthesised the effects of joint mobilization and/or high-velocity low-amplitude (HVLA) thrust manipulation on quantitative proprioception outcomes in humans. Methods: PubMed, Scopus, CINAHL, and MEDLINE Complete were searched (from inception to November 2025) for randomized or sham-controlled trials assessing proprioception after eligible articular manual therapy. Searches were limited to English-language publications. Risk of bias was assessed using Risk of Bias 2 (RoB 2). Random-effects meta-analysis (Hedges’ g) was conducted when outcomes and time points were comparable; pooling was possible for only one outcome/time-point comparison. Certainty of evidence was assessed using GRADE. Results: Database searches yielded 483 records; after duplicate removal, 371 records were screened. Eighteen full-text articles were assessed for eligibility, of which 11 were excluded, resulting in seven randomized clinical trials (2018–2025; total n = 350) evaluating spinal or peripheral mobilization/manipulation. No eligible randomized or sham-controlled trials meeting the prespecified criteria were identified before 2018. In chronic mechanical neck pain, cervical thrust manipulation improved cervical JPSE versus sham with large partial eta-squared effects (η²p = 0.23–0.36). Cervical mobilization improved left rotation JPSE (4.15 → 1.65° vs. 4.01→3.74°). In patellofemoral pain, lumbopelvic manipulation produced immediate reductions in knee JPSE at 60° (6.58 → 4.48° vs. 5.91 → 6.05°). Only one outcome/time-point was suitable for meta-analysis (knee JPSE at 60° flexion in patellofemoral pain; two trials), showing no statistically significant pooled effect (Hedges’ g = −0.21, 95% CI −1.36 to 0.94; I² ≈ 83%). Remaining outcomes could not be pooled due to heterogeneity and incompatible reporting. Conclusions: Evidence from seven randomized trials indicates that articular manual therapy (mobilization and/or HVLA thrust manipulation) can improve quantitative proprioceptive outcomes immediately post-intervention, particularly JPSE in neck and patellofemoral pain; however, effects are condition- and outcome-specific, and confidence is limited by heterogeneity and the predominance of narrative synthesis with sparse poolable data. Future adequately powered trials should standardize proprioception protocols, include longer follow-up, and report data to enable robust meta-analysis. Full article

The global opioid crisis necessitates innovative non-pharmacological interventions for pain management and addiction recovery. This comprehensive narrative review synthesizes evidence from approximately 75 studies supporting manual therapy’s modulation of endogenous opioid systems and explores potential applications in addiction treatment. Manual therapy interventions, including massage and joint manipulation, demonstrate significant neurochemical effects, with controlled studies showing 16% increases in plasma β-endorphin levels (p = 0.025) persisting approximately one hour following treatment. These effects appear mediated through periaqueductal gray-rostral ventromedial medulla descending pathways, with naloxone reversibility studies confirming opioid-mediated mechanisms. The endogenous opioid system undergoes profound dysregulation during addiction, creating therapeutic opportunities for interventions capable of stimulating natural opioid release without exogenous substances. Clinical applications in addiction recovery may include withdrawal symptom management, craving reduction, and restoration of dysregulated reward pathways. Manual therapy’s demonstrated safety profile, accessibility, and compatibility with existing treatment modalities position it as an ideal complementary intervention for comprehensive addiction programs. However, significant methodological limitations in existing studies necessitate cautious interpretation. Rigorous randomized controlled trials specifically examining manual therapy’s effects in addiction recovery populations represent the highest research priority. Manual therapy as an endogenous opioid modulator represents a promising frontier in addiction medicine but warrants rigorous scientific investigation before potential clinical integration into evidence-based treatment protocols. Full article

Soft tissue manipulation (STM) is widely used by physical therapists, massage therapists, athletic trainers, and osteopathic physicians to manage musculoskeletal pain, yet its biological mechanisms remain poorly understood. Preclinical studies indicate that STM can alter immune cell behavior in animal models, increasing anti-inflammatory cytokines (IL-4, IL-10) and reducing chemokines such as RANTES/CCL5. Single-cell transcriptomic analyses suggest mechanical treatment may reprogram stromal cells and shift immune cell recruitment in aged or inflamed tissues. However, many of these mechanistic findings have yet to be confirmed in human studies. Early clinical trials show massage therapy can modify circulating leukocytes and reduce cytokine responses, but direct tissue-level evidence in human subjects remains limited. This narrative review summarizes existing insights and emphasizes the need for future clinical investigations targeting populations with chronic inflammation, repetitive-use injuries, post-surgical fibrosis, or age-related muscle decline. We advocate for studies incorporating tissue or fluid sampling, cytokine profiling, and molecular assays such as flow cytometry or transcriptomics to characterize STM’s immunological effects in people. Rather than simply easing symptoms, STM may act as a precision mechanical stimulus that recalibrates immune tone and promotes tissue repair. Bridging basic science with clinical research will be essential to establish STM as a biologically informed, mechanobiology-based therapeutic strategy. Full article

(1) Background: With the increasing incidence of cancer, the need for handling cytotoxic drugs has also grown. However, manipulating these drugs exposes healthcare professionals to significant risks, including occupational exposure to hazardous chemicals. Therefore, it is important to adopt protective measures, including personal protective equipment (PPE) and correct ergonomic practices, to ensure safe drug preparation and minimize health risks for the operators. However, while chemical exposure and PPE have been extensively addressed in the literature, the combined impact of ergonomic practices and protective measures remains insufficiently emphasized, representing a critical gap this review aims to address. Accordingly, the objective of this literature review was to analyze the ergonomic and individual protection practices during the handling of cytostatic drugs and all the implications that bad ergonomic practices and/or poor individual protection have on the operator’s health; (2) Methods: In order to perform this integrative review, a structured literature search was conducted using online databases (Web of Science^®, Google Scholar^®, and PubMed^®) from January 2005 to June 2025. (3) Results: A total of 19 articles were analyzed, with 17 focusing on PPE and 17 on ergonomics. The findings emphasize that PPE, such as gloves, masks, gowns, sleeves and safety glasses, plays a critical role in the safe handling of cytotoxic drugs, particularly when combined with other safety measures. Additionally, maintaining correct ergonomic posture is important in preventing musculoskeletal disorders; (4) Conclusions: This review emphasizes the significance of integrating appropriate PPE use with sound ergonomic procedures. Although PPE is still the secondary line of defense against occupational exposure, ergonomic issues must also be addressed to avoid chronic musculoskeletal problems. Continuous training, rigorous attention to safety procedures, and ergonomic enhancements should be prioritized by healthcare facilities as a key element of occupational safety programs to reduce the short-term and long-term health hazards for personnel handling dangerous drugs. Full article

Background: Scar impairments impose a significant economic burden and negatively impact an individual’s well-being and quality of life. However, there is a lack of standardization in physical therapy interventions for scar management. Objective: This study aimed to provide a comprehensive overview of studies addressing non-invasive physical therapy interventions for scar management. Methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis. Six databases were searched, and additional studies were retrieved through gray literature and the reference lists of included articles. All studies considering non-invasive physical therapy interventions for scar management were included. No restrictions were applied regarding time, context or publication type. Results were illustrated using descriptive statistics and summarized in an infographic. Results: Out of 13,419 initial records, 92 studies met the inclusion criteria. Most articles were narrative reviews (n = 41) followed by randomized controlled trials (RCT) (n = 18). The most reported interventions were pressure therapy (n = 41), physical therapy modalities (n = 37), silicone-based products (n = 29) and massage (n = 20). Conclusions: Scar management involves a wide range of physical interventions. However, research has predominantly focused on adults, particularly those with burns, with limited attention given to pediatric or non-adult populations. Furthermore, there is significant variability in the application parameters, scar localization and size. Examining the included study designs, most of the research presented reduced sample sizes and lacked control groups. Notably, almost half of the studies were based on expert opinions. Future high-quality research is needed to identify evidence-based interventions for the clinical management of scars. Full article

Aging, a state of progressive decline in physiological function, is an important risk factor for chronic diseases, ranging from cancer and musculoskeletal frailty to cardiovascular and neurodegenerative diseases. Understanding its cellular basis is critical for developing interventions to extend human health span. This review highlights the crucial role of in vitro models, discussing foundational discoveries like the Hayflick limit and the senescence-associated secretory phenotype (SASP), the utility of immortalized cell lines, and transformative human induced pluripotent stem cells (iPSCs) for aging and disease modeling and rejuvenation studies. We also examine methods to induce senescence and discuss the distinction between chronological time and biological clock, with examples of applying cells from progeroid syndromes and mitochondrial diseases to recapitulate some signaling mechanisms in aging. Although no in vitro model can perfectly recapitulate organismal aging, well-chosen models are invaluable for addressing specific mechanistic questions. We focus on experimental strategies to manipulate cellular aging: from “steering” cells toward resilience to “reversing” age-related phenotypes via senolytics, partial epigenetic reprogramming, and targeted modulation of proteostasis and mitochondrial health. This review ultimately underscores the value of in vitro systems for discovery and therapeutic testing while acknowledging the challenge of translating insights from cell studies into effective, organism-wide strategies to promote healthy aging. Full article

Sport-related injuries are common presentations to primary care and hospital settings. Australian osteopaths practice mainly in private clinical settings in which the frequency of sport-related injury presentations, and how these injuries are managed, is unknown. The objective of the study was to describe the demographic, practice, and clinical management characteristics of Australian osteopaths who report often treating sport-related injuries. The study is a secondary analysis of data derived from the Australian osteopathy practice-based research network. Respondents indicated the frequency treating sports-related injuries in addition to other demographic, practice, and patient management characteristics. Backward logistic regression identified significant characteristics associated with often treating sport injuries. Over half (51%) of a nationally representative sample of Australian osteopaths reported treating sport-related injuries often. Those osteopaths who treat sports injuries often were likely to be male (p < 0.01) and utilise exercise prescription (OR2.34) and sports taping (OR5.99). Australian osteopaths who often treat sports-related injuries provide advice to patients and use exercise prescription more frequently than osteopaths who do not treat these injuries often. The data in the current work begin to explore how osteopaths manage sports-related injuries and highlights how they may be able to provide sports injury care for both recreational and elite sport populations. Full article

Spontaneous quadriceps tendon rupture is a very rare occurrence, notably for bilateral simultaneous ruptures. Its occurrence is commonly linked to an underlying condition that may weaken the tendons leading to rupture. We report the case of a 68-year-old Caucasian male afflicted with long-term gout who presented a bilateral simultaneous quadriceps tendon rupture (BSQTR). We showcase the clinical presentation, the surgical intervention, rehabilitation program, dynamic sonographic monitoring, and home-based rehabilitation techniques of this injury, which aimed to improve activities of daily living (ADL) and quality of life (QoL). The patient was included in a 9-week post-surgical rehabilitation program and a home-based rehabilitation program with subsequent pain management and gait reacquisition. The outcome measures included right and left knee active range of motion (AROM), pain intensity measured on Visual Analogue Scale (VAS), functioning measured through ADL score, and gait assessment on Functional Ambulation Categories (FAC). All endpoints were measured at different time points, scoring significant improvement at discharge compared to baseline (e.g., AROM increased from 0 degrees to 95 degrees, while VAS decreased from 7 to 1, ADL score increased from 6 to 10, and FAC increased from 1 to 5). Moreover, some of these outcomes continued to improve after discharge, and the effects of home-based rehabilitation program and a single hip joint manipulation were assessed at 6-month follow-up. Musculoskeletal ultrasound findings showed mature tendon structure, consistent dynamic glide, and no scarring. Full article

Background/Objectives: Bruxism has been associated with dysregulation of the autonomic nervous system (ANS). Visceral manual therapy (VMT) has shown beneficial effects on the vagal tone and modulation of ANS activity. This study aimed to evaluate the immediate and short-term effects of VMT in individuals with clinically based bruxism. Methods: A single-blind randomized controlled trial was conducted including 24 individuals with clinically based bruxism. Participants received two sessions of either VMT or a sham placebo technique. Outcome measures included heart rate variability (HRV), both normal-to-normal intervals (HRV-SDNN), and the root mean square of successive normal-to-normal intervals (HRV-RMSSD), as well as muscle tone and stiffness and pressure pain thresholds (PPTs). Measurements were made at T1 (baseline), T2 (post-first intervention), T3 (pre-second intervention), T4 (post-second intervention), and T5 (4-week follow-up). Results: A significant time*group interaction was observed for HRV-SDNN (p = 0.04, η² = 0.12). No significant changes were found for muscle tone or stiffness. PPTs significantly increased at C4 after the second session (p = 0.049, η² = 0.16) and at the left temporalis muscle after the first session (p = 0.01, η² = 0.07). Conclusions: The findings suggest that two sessions of VMT may lead to significant improvements in HRV-SDNN compared to the placebo, suggesting a modulatory effect on autonomic function. No consistent changes were observed for the viscoelastic properties of the masticatory muscles. Isolated improvements in pressure pain sensitivity were found at C4 and the left temporalis muscle. Further research with larger sample sizes and long-term follow-up is needed to determine the clinical relevance of VMT in the management of signs and symptoms in individuals with bruxism. Full article

Introduction: Spinal thrust manipulation has been found useful for improving pain and mobility in musculoskeletal conditions of the thoracic spine. This case report highlights the importance of incorporating high-velocity low-amplitude (HVLA) thrust manipulation to the mid-thoracic rib articulations in a patient experiencing thoracic spine pain associated with an acute onset of osteomyelitis at levels T7–T9. Detailed Case Description: A 49-year-old female who was recovering from osteomyelitis of the thoracic spine 4 months prior was referred to physical therapy by her neurosurgeon. Her osteomyelitis infection resulted in a bone-on-bone interaction between T7 and T9, resulting in significant thoracic spine pain. Severe restrictions in active range of motion (AROM) were found in extension and right and left rotation. At initial evaluation, the patient’s pain intensity score was 8/10 (NPRS, 0–10), the disability score was 46/50 (NDI, 0–50), and the patient-specific functional scale score was 3/10 (PSFS, 0–10). Initially, interventions included grades I-IV posterior to anterior (PA) mobilizations of the thoracic spine from levels T2 to T9, mobilization with movement of the thoracic spine for extension and rotation bilaterally, scapular stabilization, and thoracic mobility exercises. Treatment progressed to HVLA thrust manipulation techniques targeting the costotransverse articulations of ribs 2–9. Discussion: Following the initial eight treatment sessions over 4 weeks, minimal improvement was observed for pain (NPRS from 8/10 to 6/10), disability (NDI from 46/50 to 34/50), and thoracic extension AROM (13°). However, during visits 9–16, the addition of HVLA thrust manipulation targeting the costotransverse articulations resulted in significant improvements in pain, disability, and AROM. The patient was subsequently discharged after 16 visits and able to return to a full workday as a teacher without any thoracic pain or ROM restrictions. At the 6-month follow-up, the patient outcomes remained, and she was working with no restrictions. Conclusion: The addition of HVLA thrust manipulation targeting the mid-thoracic rib articulations to a program of non-thrust mobilization and exercise appeared useful for improving pain, disability, and range of motion in a patient recovering from osteomyelitis of the thoracic spine. Full article