Search Results (2,248)

Background/Objectives: Motor vehicle collision (MVC) cervical acceleration–deceleration (CAD) spine injuries are prevalent, costly, and complicated conditions. CAD injuries, or whiplash-associated disorders (WAD), present with neuromusculoskeletal signs and symptoms. In total, 50% of MVC WAD/CAD injuries result in chronic neck-related disability, of which 30% are moderate-to-severe. Poor recovery is associated with little-to-no recovery after 3 months. This study reports on health outcomes of patients with MVC/CAD injuries treated with Chiropractic BioPhysics^® (CBP^®) spinal rehabilitation beyond little-to-no recovery in neck pain (NP) and disability after 3-to-4 months. Methods: This multicenter retrospective consecutive series reports on patients who met inclusion/exclusion criteria from a records review from two private practices with advanced training in CBP^®. Results: In total, 51 patients (26 males), 18–74 years-of-age (mean age 42.8 ± 3.6 years), presented with post-MVC NP and disability. Pre-treatment radiographs revealed decreased cervical curvature (ARA C2-C7) measuring −10.3 ± 2.0° (ideal is −42.0°) and anterior head translation (Tz C2-C7) measuring 28.5 ± 2.0 mm (ideal is 0 mm). The pre-treatment NP numeric rating scale (NRS) scored 6.0 ± 1.0, and the neck disability index (NDI) scored 54.3 ± 9.3% (severe). Patients were treated using CBP^® for 64.5 ± 4.7 visits over 31.6 ± 3.7 weeks. Post-treatment radiographs revealed an improved ARA C2-C7 to −22.5 ± 2.3° and Tz C2-C7 to 15.9 ± 1.6 mm (p < 0.001). Subsequent 3-to-4-month re-exam showed little-to-no change in NP and disability outcomes. Post-treatment outcomes at a mean 18.5 weeks after the 3-to-4-month re-exam showed significant (p < 0.001) improvements in NP NRS to 1.1 ± 0.7 and NDI to 6.8 ± 5.5 (minimal). Conclusions: CBP^® improves cervical lordosis and posture, which may help improve moderate-to-severe WAD/CAD spine injuries beyond 3-to-4 months of little-to-no recovery. Full article

Background/Objectives: There is limited empirical evidence on the feasibility of inclusive, community-based exercise programs for older adults with long-term mobility disabilities. This pilot study investigated the feasibility and preliminary effectiveness of a community-based high-intensity functional training (HIFT) intervention. Methods: This single-group pre–post feasibility trial was delivered across four community-based HIFT facilities. Thirteen participants enrolled, and 10 (mean age 69.8 ± 6.7 years; 60% female) completed baseline assessments, two onboarding sessions, and thrice-weekly group-based workouts across 16 weeks. Physical function was assessed using the Canadian Occupational Performance Measure (COPM), Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, Modified Falls Efficacy Scale (MFES), and standardized tests of mobility, balance, and strength. Exploratory outcomes included body mass index (BMI), waist circumference, work capacity, and quality of life (QOL). Results: Recruitment, retention, and attendance rates were 38%, 77%, and 58% (80% including make-up sessions), respectively. The intervention was safe and well-tolerated, with one fall-related adverse event. Self-reported functional outcomes demonstrated small to large effects, with large improvements in participant-identified functional activities (d = 1.03–1.54) and fall efficacy (d = 0.97), and a small effect for standardized physical function (d = 0.36) Endurance improved substantially (d = 1.01), while mobility, balance, and strength outcomes reflected maintenance or small to moderate gains (d = 0.08–0.55). BMI remained stable (d = 0.05), work capacity increased with moderate to large effects (d = 0.61–1.43), and QOL improved modestly (d = 0.20). Exit interviews reinforced high acceptability, highlighting individualized adaptations, supportive trainers, and the group-based context as motivating contextual factors. Conclusions: A community-based HIFT program is feasible and acceptable for older adults with mobility disabilities. Full article

This study explored how mathematics teachers in Chinese special schools provide instructional support to primary-aged students with intellectual and developmental disabilities (IDD). The types, characteristics, and classroom implementation processes of such support were identified to address a gap in the literature regarding subject-specific instructional practices in special education settings. A qualitative research design using interpretative phenomenological analysis (IPA) was employed. Five mathematics teachers from special schools in Shanghai participated in the study. Data were collected through 15 video-recorded classroom observations and five semi-structured interviews. Thematic analysis was conducted to identify key patterns of instructional support. The analysis revealed five core domains of instructional support for students with IDD: (1) comprehension facilitation through simplified explanations, real-life connections, and visual scaffolding; (2) responding to tasks involving prompts, modeling, and hand-over-hand support; (3) maintaining attention using individual and collective cues; (4) sustaining motivation through praise, encouragement, and second-chance opportunities; and (5) regulating behavior such as verbal restraint, physical proximity, and attention redirection. The findings contribute to a deeper understanding of effective instructional support tailored to students with IDD. Full article

Exoskeleton knee-assistance (EKA) systems are wearable robotic technologies designed to rehabilitate and improve impaired mobility of the lower limbs. Clinical exercises are conducted on disabled patients based on physically demanding tasks which are prescribed by expert physicians. In order to carry out good tracking of the desired tasks, efficient controllers must be designed. In this study, a novel control framework is introduced to improve the robustness characteristics and tracking precision of EKA systems. The control approach integrates a super-twisting sliding mode controller (STSMC) with a nonlinear disturbance observer (NDO) to ensure robust and precise tracking of the knee joint trajectory. An evaluation of the proposed system is conducted through numerical simulations under the influence of external disturbances. The findings reveal considerable enhancements to trajectory tracking accuracy and disturbance rejection when compared to conventional STSMCs and sliding mode perturbation observer (SMPO)-based STSMCs. Full article

Knee osteoarthritis (KOA) is a leading cause of disability in older adults, characterized by persistent pain and reduced physical function. Beyond localized joint pathology, many individuals with knee osteoarthritis experience multisite pain and live with multiple comorbidities, reflecting a heterogeneous and multifactorial pain condition. Prognostic models based primarily on biomedical variables have shown limited ability to explain long-term outcomes, partly due to insufficient integration of pain chronicity, comorbidity count and psychosocial determinants such as treatment expectations and pain self-efficacy. While exercise and education are commonly recommended as primary non-surgical treatments, people often respond to them very differently. This study protocol describes a secondary longitudinal observational analysis of data from the EPIPHA-KNEE two-arm, multicentre randomized controlled trial. The primary outcomes will be knee OA pain intensity and physical function, assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire at baseline, 3, 6 and 12 months. Baseline prognostic factors will include pain duration, pain distribution, comorbidity count and patient expectations, including treatment expectations and pain self-efficacy. Linear mixed-effects models will be used to examine longitudinal associations between these predictors and pain and function trajectories, with particular emphasis on predictor-by-time interactions to characterize differential patterns of change over time. The planned analyses aim to improve understanding of how clinical characteristics and expectancy-related factors jointly shape 12-month pain and physical function trajectories in older adults with knee osteoarthritis receiving education and exercise-based care, thereby informing prognostic stratification within non-surgical management. Full article

Brain diseases such as ischaemic stroke, Alzheimer’s disease (AD), and glioma were characterized by high mortality and disability rate, and oxidative stress remains a major obstacle in treatment. Plasma–nanomedicine synergistic treatment technology provides a very attractive treatment strategy based on complementarity. This technology integrates cold atmospheric plasma (CAP) with nanomedicine. CAP produces active substances that regulate oxidative stress, while nanomedicine is specially designed for targeted delivery, controlled release, and microenvironmentally responsive activation of therapeutic agents. This integration generates new therapeutic functions and significantly improves the overall therapeutic effect. Despite the broad prospects of this emerging technology, researchers in the fields of medicine, physics, or pharmacy have not yet paid much attention to it. To fill this research gap, this review describes the physicochemical properties and biological effects of CAP and summarizes the latest advances in plasma nanomedicine strategies in the field of brain disease intervention, and reviews the four major nanomedical categories—metal-based, inorganic non-metallic, polymer-based and hydrogel systems—and their clinical applications in the treatment of brain tumors, strokes and neurodegenerative diseases in conjunction with CAP. Finally, we highlight a number of key challenges—limited resources of special CAP equipment, incomplete understanding of the mechanism, obstacles to transformation application—and put forward the future research direction to promote the development of accurate, safe, and clinical transformation value plasma–nanomedicine therapy for brain diseases. Full article

People with developmental disabilities, who represent about 2% of the global population, encounter diverse functional and cognitive challenges that adversely impact their navigation and accessibility experiences in the built environments. Historically, accessibility standards predominantly focused on physical barriers, with less attention given to sensory and cognitive barriers. This multipart study delves into barriers faced by individuals with intellectual/developmental disabilities in the built environment. The first part reviews the state of existing literature on developmental disabilities. The second part captures insights from individuals with intellectual/developmental disabilities as they navigate various public buildings. The final part synthesizes the collected information, including lessons learned from autism-friendly architectural and other design requirements, to assess the current state of development of the Canadian accessibility standard, CSA/ASC B651:23, in meeting the needs of people with developmental disabilities. The study culminates in recommendations aimed at enhancing the accessibility standard for the built environment, specifically in addressing sensory and cognitive barriers faced by people with developmental disabilities. Full article

Background: Knee osteoarthritis causes considerable pain and disability. Telerehabilitation has emerged as a promising treatment option, especially after the Coronavirus Disease 2019 pandemic, but it still faces challenges regarding solid scientific evidence about its multiple benefits. This systematic review aimed to analyze the reported beneficial effects of telerehabilitation based on therapeutic exercise for the management of knee osteoarthritis. Methodsː PubMed, PEDro, Web of Science and Cochrane Library databases were used to identify eligible studies. This review followed the PRISMA guidelines and was registered at PROSPERO (n° CRD42024579836). The selected studies underwent a qualitative assessment using the Modified Jadad Score. Results: Ten studies, including a total of 1354 participants, were included. From the selected studies, a wide variety of outcome measures emerged to evaluate the efficacy of telerehabilitation in the relief of pain and its clinical consequences. Seven studies specifically assessed pain, with four showing significant improvements in pain reduction in the intervention group compared with the control group. Telerehabilitation was found to be more effective or non-inferior to traditional rehabilitation in relieving pain, as reported across various pain scales. Limitations include the heterogeneity of interventions, the exclusion of non-recent studies, and the exclusive focus on therapeutic exercise. Conclusionsː The results of this systematic review suggest that telerehabilitation provides pain relief, improves physical function, and enhances quality of life, while preliminary evidence indicates potential cost-related advantages. However, some studies did not find TR to be superior to control interventions, highlighting mixed evidence. Additional high-quality studies are required to better support this promising rehabilitation approach. Full article

Access to health care is a fundamental human right established in various legal frameworks worldwide. However, increasing evidence indicates that individuals with physical disabilities in rural Ethiopia continue to face barriers and disparities in accessing health care, leading to unmet needs and worsening health. Guided by Critical Disability Theory and Intersectionality Theory, this instrumental case study explored the barriers to accessing primary health care (PHC) for adults with physical disabilities in rural Ethiopia and examined how disability intersects with poverty, gender, and rurality to shape exclusion. Following purposeful sampling, we conducted 14 interviews and one focus group discussion (n = 7) with adults with physical disabilities, supplemented by PHC facility infrastructure observation. Using reflexive thematic analysis, we identified intersecting barriers across four domains: physical and environmental barriers, socioeconomic marginalization, socio-cultural stigma and attitudinal barriers, and systemic weaknesses in health service delivery. This revealed that disability-related barriers are rooted in structural ableism and intersecting inequities, underscoring the urgent need for inclusive policies and disability-inclusive practices. Such practices include enforcing accessibility standards, expanding community-based health insurance to cover disability-specific needs, supporting transportation, and providing disability-specific training for health professionals. Implementing these practices is essential to advancing disability rights and ensuring equitable health access in Ethiopia. Full article

Background: Conservative treatment of chronic musculoskeletal pain includes exercise, manual therapy, medications, physical agents/modalities, and Therapeutic Patient Education (TPE). Research on TPE has predominantly focused on spinal pain, so we do not know the extent and scope of clinical research in other areas, particularly lower extremities. This review aimed to map current research on this topic. Methods: We searched PubMed, PEDro, CINAHL, PsycINFO, and Cochrane Library up to 1 April 2024. We included RCTs on adults with chronic lower limb musculoskeletal pain, written in English, French, Spanish, or Italian. Results: Fifty-two records concerning knee osteoarthritis (n.33), hip and knee osteoarthritis (n.8), hip osteoarthritis (n.3), chronic knee pain (n.3), patellofemoral pain (n.3), and gluteal tendinopathy (n.2) were included. TPE was delivered through self-management, disease-specific information, pain education, and the management of physical activity, load, diet, stress, and sleep. Interventions were both individual- and group-based; delivery methods included in-person intervention, telephone/video calls, and web tools/apps. TPE combined with exercise seemed to be more effective than exercise alone, information/little education, or usual care. The effects of TPE as a stand-alone intervention appeared uncertain. Conclusions: There is considerable variability in TPE in terms of teaching topics, providers, administration methods, and dosage of interventions. Future studies should investigate the effects of TPE in young adult populations and in ankle conditions. They should also investigate the effects of TPE on pain intensity versus pain interference with activities, by deepening TPE effects on disability and quality of life. Full article

Accessible and inclusive community environments support physical activity and health equity for people with disabilities, yet gaps in design, maintenance, and communication limit safe, independent use. This statewide cross-sectional audit assessed park accessibility and usability and playground safety in publicly accessible, non-fee-based Delaware community parks with playgrounds. Fifty stratified sites were evaluated using the Community Health Inclusion Index and the America’s Playgrounds Safety Report Card by trained raters with strong interrater reliability. Descriptive analyses summarized accessibility, usability, communication, and safety features by county, with exploratory urban-suburban/micropolitan contrasts. Most sites provided wide, smooth paths, shade, and strong playground visibility, but foundational accessibility varied. Only 30% had a nearby transit stop, fewer than 10% of crossings included auditory or visual signals. Curb-ramp completeness was inconsistent, with detectable warnings frequently absent. Restrooms commonly lacked low-force doors or operable hardware, and multi-use trails often had obstacles or lacked wayfinding supports. Playground accessibility features were present at approximately two-thirds of sites, and 62% were classified as safe, although 10% were potentially hazardous or at-risk. Higher playground accessibility scores were strongly associated with lower life-threatening injury risk. Overall, gaps in transit access, pedestrian infrastructure, amenities, and communication support limit equitable, health-supportive park environments and highlight priority improvement areas. Full article

Background/Objectives: Cerebral palsy (CP) is the most common cause of physical disability in childhood. While gait improvements are often observed during childhood, it remains unclear whether these gains are sustained into adulthood. This study aimed to evaluate the long-term evolution of gait outcomes from childhood to adulthood in individuals with CP who received orthopedic care early in life. Methods: This retrospective study included 83 adults with cerebral palsy (44 unilateral/uCP, 39 bilateral/bCP; GMFCS I–III) who underwent clinical gait analysis in childhood and again as adults (minimum 4 years between visits, n = 249 CGA). Gait was assessed using the modified Gait Profile Score (mGPS) and normalized walking speed (NWS). The effects of life stage (childhood, adolescence, early adulthood, and adulthood) were analyzed using Kruskal–Wallis tests with post hoc comparisons. Individual clinical transitions were quantified from early adulthood to adulthood, with a minimal clinically important difference (MCID) change in mGPS (1.6°) and NWS (0.20 s⁻¹) for improvement or decline. Results: Longitudinal analysis revealed that while group-average mGPS improved from childhood to adulthood, NWS declined significantly for all patients (p < 0.01). However, individual trajectories from early adulthood to adulthood diverged by CP type. Those with bCP GMFCS II and III had a more frequent clinical decline in mGPS (4/14, 29%), with minimal potential for improvement (1/14, 17%). In contrast, individuals with uCP had less frequent decline (1/17, 6%) and a greater improvement (3/17, 18%). Conclusions: While significant improvements in gait quality are achieved by early adulthood, substantial clinical decline occurs during adulthood in bCP (GMFCS II–III) patients. These findings highlight the need for lifelong monitoring, with re-evaluation regarding the need for surgical interventions from early adulthood to adulthood in bCP patients with greater motor impairments. Full article

Background: Multiple sclerosis (MS) involves complex physical, cognitive and behavioral challenges that collectively affect quality of life. Integrating lifestyle components such as sleep optimization, dietary behaviors, stress management, and self-management strategies into rehabilitation may enhance outcomes beyond traditional approaches. This scoping review aimed to map rehabilitation interventions that combine psychomotor, cognitive, lifestyle-focused, or multimodal elements and assess quality of life in adults with MS. Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidelines, which guided the identification, screening, and selection of studies. Screening and data extraction were conducted independently by two reviewers. From 135 records, nine primary studies and four secondary evidence sources were included. Results: Most studies involved adults with mild-to-moderate disability and predominantly relapsing–remitting multiple sclerosis. Physical or motor rehabilitation interventions were examined in five studies, while two studies evaluated multimodal rehabilitation programs, one study focused on cognitive rehabilitation, and one study investigated lifestyle-oriented or self-management-integrated approaches. Quality of life was assessed in all included studies, with improvements reported across multiple domains. Fatigue-related outcomes were reported in four studies, sleep-related outcomes in three studies, and digitally delivered or hybrid rehabilitation interventions were implemented in three studies, indicating an emerging trend toward technology-supported rehabilitation approaches. Conclusions: Contemporary MS rehabilitation is moving toward multidimensional, holistic models that integrate lifestyle components. Standardized outcomes, inclusion of more diverse MS phenotypes, and rigorous evaluation of integrated frameworks are required to strengthen the evidence base and inform clinical practice. Full article

Background/Objectives: Lower limb amputation (LLA) negatively affects the physical and psychological health of individuals, leading to a lower quality of life and sedentary lifestyle. The objective of this scoping review is to search for evidence regarding physical activity interventions in individuals with LLA, investigating improvements in specific outcomes related to quality of life and performance. Methods: PRISMA guidelines—extension for scoping reviews—were used to structure the study. The research was conducted between 26 July 2023 and 30 September 2023; it was structured by defining two PICO questions (P = amputation, I = physical exercise, O1 = quality of life, and O2 = performance) through Pubmed, Cochrane, and Pedro databases. The study included subjects with LLA of any etiology, in prosthetic or pre-prosthetic phase, practicing non-competitive physical activity. The results were then subjected to both qualitative and quantitative analysis. Results: Of the 615 studies identified, 18 were included in the review. They consisted of 6 systematic reviews (SR), 5 RCTs, 4 case–control studies, 1 case report (CR), and 2 cross-sectional (CS). Physical activity (PA) interventions were extremely heterogeneous and were, therefore, categorized into 6 modalities: surveys were the most reported strategies (57%), followed by personalized training (23%), strength training (13%), endurance training (13%), combined training (2%), and gait training (5%). Due to the heterogeneity of the studies, the variety of interventions proposed and the different outcomes registered, there is no evidence that one approach is more effective than another, while each group showed benefits on different specific outcomes. In total, five outcome categories were identified: quality of life was the most frequently analysed (42%), followed by cardiovascular fitness (20%), muscular fitness (14%), gait parameters (13%), functionality and disability (11%). Conclusions: PA represents a valuable strategy for improving performance and quality of life in individuals with LLA, offering a variety of interventions. Although there is no evidence that one strategy is better than the others, each activity has proven to be effective on specific outcomes, therefore, the choice must depend on the patient’s necessities. The preferred option should be the personalization of the training according to individual needs, coupled with long-term planning and remote monitoring. Creating meeting places and supporting occasions for sports activities could be a valid option. Further research could help to clarify the benefits of such interventions and enhance the understanding of how to optimize the management of LLA patients. Full article

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder. It is estimated that AF affects over 52 million people worldwide, with its prevalence expected to double in the next four decades. AF significantly increases the risk of stroke and heart failure, contributing to 340,000 excess deaths annually. Beyond these life-threatening complications, AF results in limitations in physical, emotional, and social well-being causing significant reductions in quality of life and resulting in 8.4 million disability-adjusted life-years per year, highlighting the wide-ranging impact of AF on public health. Moreover, AF is increasingly recognized for its association with cognitive decline and dementia. AF is a chronic and progressive disease characterized by rapid and erratic electrical activity in the atria, often in association with structural changes in the heart tissue. AF is often initiated by triggered activity, often from ectopic foci in the pulmonary veins. These triggered impulses may initiate AF via: (1) sustained rapid firing with secondary disorganization into fibrillatory waves, or (2) by triggering micro re-entrant circuits around the pulmonary venous-LA junction and within the atrial body. In each instance, AF perpetuation necessitates the presence of a vulnerable atrial substrate, which perpetuates and stabilizes re-entrant circuits through a combination of slowed and heterogeneous conduction, as well as functional conduction abnormalities (e.g., fibrosis disrupting tissue integrity, and abnormalities in the intercalated disks disrupting effective cell-to-cell coupling). The re-entry wavelength, determined by conduction velocity and refractory period, is shortened by slowed conduction, favoring AF maintenance. One major factor contributing to these changes is the disruption of the extracellular matrix (ECM), which is induced by atrial fibrosis. Fibrosis-driven disruption of the ECM, especially in the heart and blood vessels, is commonly caused by conditions such as aging, hypertension, diabetes, smoking, and chronic inflammatory or autoimmune diseases. These factors lead to excessive collagen and protein deposition by activated fibroblasts (i.e., myofibroblasts), resulting in increased tissue stiffness, maladaptive remodeling, and impaired organ function. Fibrosis typically occurs when cardiac fibroblasts are activated to myofibroblasts, resulting in the deposition of excessive collagen and other proteins. This change in ECM interferes with the normal electrical function of the heart by creating irregular, fibrotic regions. AF and atrial fibrosis have a reciprocal relationship: AF promotes fibrosis through fibroblast activation and extracellular matrix buildup, while atrial fibrosis can sustain and perpetuate AF, contributing to higher rates of AF recurrence after treatments such as catheter ablation or cardioversion. Full article