Search Results (1,800)

Background: Ataxic symptoms are characterized by causing motor, balance and coordination disorders. Virtual reality-based interventions (VRBIs) including video games and exergames can improve ataxic symptoms. The aim of this systematic review with meta-analysis was to assess the effectiveness of VRBI on severity of ataxia, postural balance, mobility and manual dexterity in patients with ataxia. Methods: According to the PRISMA guidelines, we searched PubMed Medline, SCOPUS, WOS, CINAHL, PEDro and other sources for randomized controlled trials (RCTs) that assessed the effectiveness of VRBI, compared to others, on the severity of ataxia, balance, mobility and manual dexterity in patients with ataxia. The pooled effect was calculated using Cohen’s standardized mean difference (SMD) and a 95% confidence interval (95% CI). Results: With data from seven RCTs, providing data from 171 patients with ataxia, our meta-analysis elucidated that VRBI is effective in reducing the severity of ataxia (SMD = −0.43; 95% CI −0.84 to −0.03; p = 0.04) and increasing functional balance (SMD = 0.97; 95% CI 0.16 to 1.78; p = 0.02) and manual dexterity (SMD = −0.63; 95% CI −1.16 to −0.11; p = 0.018). Conclusions: Our findings suggest that VRBI could be a promising and effective therapeutic approach in reducing ataxia disability and increasing balance and manual dexterity in ataxic patients. Full article

Background: Children and adolescents with hearing loss frequently experience reduced participation in physical activity and impairments in balance and postural control, often associated with vestibular dysfunction and altered sensory integration. In this context, school-based motor interventions may represent an accessible strategy to support functional balance. The present study investigated the effects of a 12-week dance- and rhythm-based motor programme implemented within the school curriculum on static and dynamic balance in students with hearing loss. Methods: Twenty-five participants were randomly allocated to an experimental group (n = 15), which received the intervention in addition to standard curricular activities, or to a control group (n = 10), which continued with regular school-based physical activity only. Balance was assessed at baseline and post-intervention using stabilometric measures under eyes-open and eyes-closed conditions and the Pediatric Reach Test. Results: Stabilometric outcomes showed mixed patterns: improvements over time were observed in both groups under eyes-closed conditions, whereas under eyes-open conditions greater reductions in sway were detected in the control group. A significant Group × Time interaction emerged exclusively for backward reach performance and for the composite balance score, indicating a relative preservation of posterior dynamic balance and a more favourable multidimensional adaptation in the experimental group. Conclusions: These findings suggest that dance- and rhythm-oriented motor activities integrated into school settings may support specific, functionally relevant components of balance in students with hearing loss, although the results should be interpreted with caution due to the small sample size and the heterogeneity of the participants. Full article

Background: Joubert syndrome (JS) is a rare ciliopathy characterized by cerebellar and brainstem malformations and the molar tooth sign on magnetic resonance imaging. Motor impairment is primarily driven by axial hypotonia, impaired postural control, and disrupted respiratory-postural integration. Longitudinal reports describing structured neurorehabilitation with standardized functional outcomes remain limited. Case presentation: We report a female child with prenatally suspected vermian hypoplasia and postnatally MRI-confirmed Joubert syndrome. Subsequent molecular testing performed at the age of 3 years and 11 months identified heterozygous variants in the B9D2 gene associated with Joubert syndrome. Early development was marked by axial hypotonia, global motor delay, impaired trunk stabilization, sleep-disordered breathing, and early hip migration. At 2.5 years of age, following motor plateau under conventional therapy, a structured 12-month rehabilitation programme was introduced, combining Vojta-based reflex locomotion, respiratory therapy targeting thoraco-diaphragmatic synchronization, daily home-based practice, and supported standing. Results: After 12 months, gross motor function improved substantially, with GMFM-88 increasing from 12% to 52% (+40 percentage points). PEDI scaled scores improved across all domains, with mobility increasing from 8 to 40, self-care from 15 to 45, and social function from 25 to 50. Ataxia severity decreased from 22 to 15 on the modified Brief Ataxia Rating Scale, consistent with improved trunk stability and coordination. Postural and respiratory organization improved, reflected by a reduction in the subcostal angle from 137° to 90°, an increase in sacral slope from 5° to 10°, and increased expiratory pressure from 10 to 25 mmHg. Caregiver-reported assessment combined with structured clinical observation indicated improved functional visual performance, including enhanced visual attention, visuomotor coordination, and environmental visual interaction. Conclusions: Structured neurorehabilitation was associated with substantial functional improvement across motor, postural, and respiratory domains. These findings support the clinical relevance of mechanism-oriented neurorehabilitation and standardized longitudinal outcome assessment in Joubert syndrome. Full article

Background: Intrinsic foot muscle strengthening and orthotic devices such as toe spacers are commonly used to improve foot alignment and function. However, evidence regarding the combined effects of strengthening exercises and interdigital spacers remains limited. Objective: To examine whether adding a silicone toe spacer to a foot strengthening exercise program provides additional benefits compared with exercise alone. Design: Randomized controlled trial. Setting: University biomechanics laboratory. Participants: Twenty-five healthy adults (mean age 23.8 ± 1.3 years) without lower limb injury or neurological disorders were randomly allocated to one of two intervention groups. Interventions: Participants performed a six-week foot strengthening program (22 sessions). One group performed exercises alone, while the second group performed the same exercises while wearing a silicone interdigital toe spacer. Main outcome measures: The primary outcome was hallux valgus angle. Secondary outcomes included active and passive hallux range of motion (ROM), ankle dorsiflexion ROM (weight-bearing lunge test), navicular drop, and postural stability during single-leg stance assessed using center-of-pressure (CoP) measures. Results: Both groups demonstrated improvements over time in hallux valgus angle (p = 0.001, η² = 0.361), active hallux range of motion (p < 0.001, η² = 0.545), and ankle dorsiflexion (p < 0.001). However, no significant between-group differences were observed for the primary outcome or most secondary outcomes. A significant time × group interaction was observed only for passive hallux range of motion (p = 0.040, η² = 0.170), indicating greater improvement in the exercise-only group. Navicular drop and postural stability variables did not change significantly. Conclusions: A six-week foot strengthening program improved hallux alignment, hallux mobility, and ankle dorsiflexion in healthy adults. The addition of a silicone toe spacer did not provide additional short-term benefits compared with exercise alone. Full article

Clothing pressure influences the comfort, mobility, and welfare of dogs; however, quantitative evidence on how obesity affects localized garment pressure is limited. Using CLO 3D virtual fitting, we evaluated clothing pressure according to body condition (normal vs. obese), posture, and fabric type. We constructed normal and obese avatars for three breeds and simulated a short-sleeved T-shirt across six postures and three fabrics, yielding n = 108 simulation conditions (two body conditions × three breeds × six postures × three fabrics). Clothing pressure was quantified as ROI-averaged pressure (kPa) at four body regions (P1–P4). The overall mean pressure (averaged across P1–P4) increased from 16.69 ± 3.69 kPa (normal) to 19.56 ± 5.03 kPa (obese), with the highest pressures consistently observed at the chest (P2) and abdomen (P4). Region-specific ANOVA/GLM analyses (breed treated as a fixed factor) showed significant main effects of body condition, posture, fabric type, and breed on clothing pressure (all p < 0.001), while the three-way interaction (body condition × posture × fabric) was not significant (p > 0.05). These findings show that CLO 3D virtual fitting enables controlled, simulation-based comparisons of clothing pressure across body conditions; however, because no in vivo wear trials were conducted, the results should be interpreted as preliminary, and they require future experimental validation before practical application. Full article

Background: Informal sewing workers are widely exposed to ergonomic and workload-related risks but remain largely excluded from formal occupational health protection, particularly in low- and middle-income countries. This study evaluated integrated physical and mental workload risks associated with WMSDs among informal sewing workers to develop contextually feasible preventive guidelines based on the Hierarchy of Ergonomic Control. Methods: A mixed-methods study was conducted among 150 informal sewing workers in Ubon Ratchathani Province, Thailand. Quantitative data were collected using a structured questionnaire, the Rapid Upper Limb Assessment (RULA), the Nordic Musculoskeletal Questionnaire (NMQ), and the NASA Task Load Index (NASA-TLX). Associations between sociodemographic characteristics, ergonomic risks, and WMSDs were analyzed using chi-square tests and correlation analysis. Qualitative data were obtained through a focus group discussion with key stakeholders to develop ergonomic control strategies guided by the HEC framework. Results: The majority of participants were female and middle-aged, with widespread exposure to high-risk ergonomic conditions, including prolonged sitting, repetitive tasks, and awkward postures. A high prevalence of WMSDs was observed, particularly in the neck, shoulders, and back. Younger workers and those with lower educational attainment experienced significantly higher ergonomic risk exposure and WMSD prevalence. NASA-TLX results indicated that physical demand and performance pressure were the main contributors to overall workload. Application of the HEC framework showed that elimination and substitution controls were the most effective strategies for reducing ergonomic risks, followed by engineering controls, while administrative measures and personal protective equipment were less effective. Conclusions: Informal sewing workers face substantial ergonomic and mental workload risks that contribute to a high burden of WMSDs. Prioritizing higher-order ergonomic controls, integrating workload management, and implementing community-based ergonomic interventions are essential to improving occupational health and reducing inequities among informal workers. Full article

Background: Sensorimotor differences have frequently been reported in children with developmental dyslexia, but are often considered secondary or comorbid to phonological deficits. Within an embodied cognition perspective, reading acquisition emerges from dynamic interactions between bodily regulation, multisensory integration, and learning-related neural plasticity. Proprioception contributes to spatial orientation, motor coordination, and perceptual stabilization, while sleep-dependent processes play a critical role in the consolidation and automatization of cognitive and motor skills. Objectives: Building on early clinical observations, including the hypothesis proposed by Martins da Cunha, this review explores whether variations in proprioceptive processing and sensorimotor regulation may influence multisensory stability and the conditions under which reading skills develop in some individuals with dyslexia. Methods: This narrative synthesis integrates clinical observations and experimental paradigms examining proprioceptive function in children with dyslexia, including studies conducted in our laboratory over the past two decades. These investigations address postural regulation under varying attentional demands, laboratory measures of proprioceptive acuity, visuospatial localization tasks, multisensory interactions, and exploratory observations concerning sleep–wake regulation. Results: Across studies, children with dyslexia often show differences in proprioceptive processing associated with variations in postural regulation, visuospatial stability, and multisensory tasks. Laboratory measurements suggest reduced proprioceptive acuity in some individuals, with moderate correlations observed between proprioceptive sensitivity and reading-related measures. Additional observations suggest that nocturnal physiological regulation—including respiratory dynamics and sleep architecture—may interact with daytime sensorimotor stability and attentional functioning. Conclusions: Taken together, these findings support the hypothesis that variations in sensorimotor regulation across the sleep–wake cycle may influence the stability of multisensory processing and attentional conditions relevant for reading acquisition. Within this perspective, proprioception is not proposed as an alternative explanation for dyslexia but as a complementary dimension that may contribute to the heterogeneity of dyslexic profiles. Further longitudinal and controlled studies are required to clarify the relationships between sensorimotor regulation, sleep-dependent plasticity, and learning processes. Full article

Background/Objectives: Severe acquired brain injury (sABI) disrupts early rehabilitation because arousal fluctuates, trunk control is fragile, and agitation limits therapy tolerance; land-based practice is frequently constrained by fall risk and staffing. We aim to reframe aquatic therapy as a programmable multisensory environment to stabilize arousal and support axial alignment before conventional impairment targets are feasible. Here, programmable denotes the deliberate titration and reporting of water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support as intervention inputs. Methods: This perspective integrates principles from neurobehavioral assessment, motor control, and immersion physiology to propose the Arousal–Alignment–Action loop as a falsifiable model and to define manipulable aquatic inputs (water depth, turbulence or perturbation, temperature, body orientation, and flotation and manual support) as dosing parameters. We outline a pragmatic testing ladder (within-session micro-experiments, feasibility studies, and embedded evaluations) and a minimal outcomes and confounder set to support cumulative evidence. Results: The framework links state regulation to alignment and goal-directed behavior, specifies predictions that can fail, and highlights boundary conditions (sedation, autonomic instability, pain, recent surgery or wounds, and cervical or cardiopulmonary constraints). A minimal outcome package spanning arousal/responsiveness, trunk control, behavioral dysregulation, participation/tolerance, and basic physiology is proposed, with optional objective adjuncts for mechanism-oriented studies. Conclusions: Treating water as a measurable and titratable medium, rather than a generic modality, may reduce early intensity bottlenecks and improve implementability and comparability of aquatic neurorehabilitation research in medically stable sABI; however, the model is intended as hypothesis-generating until supported by stronger direct clinical evidence. Full article

Background: Motor decline associated with ageing compromises mobility, postural control and the ability, thereby increasing risk among older adults. Biomechanical characterization of movement, particularly using non-linear methods, offers a process-oriented approach capable of detecting subtle changes in motor coordination. The MIND&GAIT programme has previously demonstrated benefits in physical function in frail older individuals; however, its potential to improve motor coordination parameters that underpin fall risk remains insufficiently explored. Objectives: To analyse the impact of the MIND&GAIT program on motor coordination during sit-to-stand (STS) and walking tasks, two daily activities strongly associated with fall risk, using advanced non-linear and biomechanical metrics in institutionalized older adults. Methods: Fourteen institutionalized older adults (82.21 ± 7.14 years) participated. Three-dimensional acceleration and angular velocity were recorded using inertial sensors. Motor variability and predictability were quantified using the multivariate Lyapunov exponent (LyEM) and multivariate incremental entropy (MIE). STS (30 s) and walking-in-place (2 min) tasks were assessed pre- and post-intervention following a three-month, thrice-weekly programme. Results: Although no statistically significant differences emerged (ps > 0.05), trends were observed suggesting increases in LyEM during STS and in both MIE and LyEM during walking were found post-intervention. These exploratory findings may indicate enhanced motor complexity, stability and adaptability, features associated with reduced fall vulnerability. Conclusions: Despite the absence of statistical significance, the biomechanical trends observed suggest improvements in motor coordination patterns relevant to fall risk reduction in institutionalized older adults following the MIND&GAIT programme. These findings highlight the potential of structured exercise-based interventions for promoting safer movement behaviors in frail populations. Full article

This study compared collegiate sprinters from two common admission routes in China to identify pathway-associated differences that may inform subsequent training for athletes entering via the Physical Education College Entrance Examination pathway. Twenty male collegiate sprinters were allocated to a Sports Independent Enrollment group and a Physical Education College Entrance Examination group, with ten participants in each. Participants completed isokinetic knee testing, drop jump tests, static balance tests, and drop jump electromyography assessment. Isokinetic outcomes were largely comparable between groups, although the Sports Independent Enrollment group showed faster time to reach peak torque in the nondominant-side knee extensors. In drop jumps, the Sports Independent Enrollment group demonstrated higher reactive strength, shorter ground contact time, greater leg stiffness normalized to body weight, and shorter propulsion duration. Electromyography patterns differed between groups across movement phases. Balance differences were mainly observed under the single-leg eyes-closed condition in unadjusted comparisons, but none remained significant after false discovery rate adjustment. Overall, between-group differences were more evident in rapid force production and neuromuscular control than in the magnitude of isokinetic strength. These findings provide practical targets for designing subsequent training priorities for athletes entering through the Physical Education College Entrance Examination pathway. Full article

Muscle onset detection is a fundamental problem in electromyography signal analysis, human–machine interaction, and rehabilitation assessment. In medical and biomedical applications, slow muscle activation onset processes are widely encountered in scenarios such as rehabilitation training, postural regulation, and fine motor control. Such processes are typically characterized by slowly varying amplitudes, long temporal durations, and high susceptibility to noise interference, which poses significant challenges for accurate identification of onset timing. To address these issues, a lightweight temporal attention method for slow muscle activation onset detection is proposed and systematically validated under multimodal experimental settings. The proposed method takes surface electromyography signals as the primary input, while synchronously acquired optical motion image data are incorporated into the experimental design and result analysis, thereby aligning with the common joint use of optical imaging and physiological signals in medical and biomedical research. From a methodological perspective, the proposed framework is composed of lightweight temporal feature encoding, a slow activation-aware temporal attention mechanism, and noise suppression with stable decision strategies. Under the constraint of low computational complexity, the ability to model progressive activation signals is effectively enhanced. Experiments are conducted on a dataset containing multiple types of slow activation movements, and model performance is evaluated using five-fold cross-validation. The results demonstrate that under regular signal-to-noise ratio conditions, the proposed method significantly outperforms traditional threshold-based approaches, classical machine learning models, and several deep learning baselines in terms of onset detection accuracy, recall, and precision. Specifically, onset detection accuracy reaches approximately $92\%$, recall is around $90\%$, and precision is approximately $93\%$. Meanwhile, the average onset detection error and detection delay are reduced to about $41\mathrm{ms}$ and $28\mathrm{ms}$, respectively, with the false positive rate controlled at approximately $2.2\%$. Stable performance is further maintained under different noise levels and cross-subject settings, indicating strong robustness and generalization capability. Full article

Martial arts have evolved from self-defense practices into structured competitive sports that demand high levels of neuromotor control, where improper execution remains a major source of injury. This study evaluates lower-limb control during the execution of the karate lateral kick using videogrammetry biomechanical analysis. Three participants were recorded during regular training sessions and selected according to their level of expertise. Each participant performed lateral kicks at three predefined distances (close, comfortable, and long), selected based on common training practice and individual biomechanical considerations. Videogrammetry data were generated using Kinovea version 0.9.5 software to extract sagittal ankle trajectories. Statistical analyses were carried out in MATLAB version 2025b using spatial coordinates to obtain kinematic data on the practitioner’s performance. The results revealed skill-dependent differences in movement control, characterized by temporal evolution of kinematic variables and their corresponding time–frequency representations. Novice practitioners exhibited limited control during the raising and recovery phases, despite reaching the target. In contrast, expert practitioners demonstrated consistent posture, controlled acceleration during impact, and stable limb trajectories during descent. These observations provide a foundation for data-driven classification of kick execution quality and outline potential applications in supervised learning, real-time feedback systems, and injury risk reduction during karate training. Full article

Background: Objective assessment of postural control is central to the clinical evaluation of vestibular disorders. Although force-platform-based posturography is considered the gold standard, its use may be limited by cost and infrastructural requirements. Wearable inertial measurement units (IMUs) represent a promising alternative; however, their clinical validation should account for intrinsic differences in measurement paradigms rather than strict metric equivalence. Objective: To preliminarily evaluate the within-session reliability of a wearable IMU-based medical device for balance assessment (Gravity), and its agreement with established static (SBP) and computerised dynamic posturographic systems (CDP) in healthy subjects. Methods: Sixty-three healthy adults were enrolled in two independent method comparison studies: a wearable IMU-based balance system versus a static stabilometric platform (GRAVITY vs. SVEP; n = 42) and a wearable IMU-based balance system versus computerised dynamic posturography (Gravity vs. EquiTest; n = 21). Gravity measurements were obtained simultaneously with reference systems across standardised sensory conditions. Within-session reliability and method agreement were assessed. Results: Within-session reliability of Gravity was outcome-dependent. Length-based components demonstrated higher repeatability (ICC (single) = 0.25–0.35; ICC (average) = 0.41–0.52), with narrower limits of agreement (LoA = ±9–12%) and lower measurement error (SEM = 3.3–4.3%). In comparison with SBP, length-based measures exhibited narrower limits (LoA = ±12–17) and more consistent relationships. Comparison with CDP revealed moderate agreement for composite and preferential scores (LoA: −2.20–7.07; −5.54–8.12). Conclusions: Gravity sensor may represent a clinically meaningful, outcome-dependent performance, with superior reliability and comparability for length-based postural measures compared with area-based measures. The device could provide balance assessments compatible with both static and dynamic posturographic systems, accounting for physiological variability. These findings support the potential clinical use of wearable IMU-based posturography, particularly in settings where conventional force-platform systems are not readily available, and warrant further validation in larger, more clinically diverse populations. Full article

Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function is associated with independence in activities of daily living (ADLs) in people with motor-incomplete tetraplegia. Methods: Eleven (n = 11) individuals with motor-incomplete tetraplegia (AIS C–D; neurological levels C4–T1; injury duration ≥ 1 year), recruited through convenience sampling from five specialist rehabilitation centres, participated in an exploratory cross-sectional pilot study designed to generate hypotheses rather than test them. U.E. function was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, selected for its ability to capture pain and task-related functional difficulty in the elbow, wrist, and hand; its application in this neurological population is considered exploratory. Independence in ADLs was evaluated using the Spinal Cord Independence Measure III (SCIM III). Given the small sample, all analyses were primarily descriptive and along with bivariate associations (Spearman correlations). Regression findings are reported strictly for exploratory purposes. Results: The median age was 50 years (interquartile range [IQR] 43–55). A strong negative correlation was observed between PRTEE total score and SCIM III (r_s = −0.76). In an exploratory univariate analysis, each 1-point increase in PRTEE total score was associated with a 1.3-point lower SCIM III score (β = −1.3, 95% CI −2.34 to −0.26, p = 0.02). Age also showed a positive association (β = 1.31, 95% CI 0.04 to 2.58, p = 0.05) with SCIM III; however, this finding is highly likely to reflect a statistical artefact of the small and unrepresentative sample. Multivariable regression was not conducted as a primary analysis due to insufficient statistical power. All findings should be treated as strictly exploratory and hypothesis-generating. Conclusions: Self-reported U.E. function appears to be associated with ADL independence in motor-incomplete tetraplegia. U.E. capacity may contribute to functional tasks requiring postural stability and mobility-related activities, but no predictive inferences can be made from this underpowered, convenience sample. Future studies with larger cohorts and performance-based measures are needed to confirm these preliminary observations and clarify the role of U.E. function in rehabilitation planning. Full article

Introduction: Apert syndrome is a rare genetic disorder characterized by craniofacial anomalies and limb malformations, often accompanied by neurodevelopmental abnormalities that can considerably affect motor development. Aim: The aim of this study was to document the progress in motor development of a girl with Apert syndrome, with an emphasis on assessing functional needs and evaluating the effects of a multidisciplinary rehabilitation approach. Materials and Methods: Motor functions were evaluated using the Gross Motor Function Measure (GMFM-88) at 16 and 24 months of age. Rehabilitation consisted of an intensive physiotherapy program, Dynamic Movement Intervention (DMI), delivered in monthly cycles over eight months. The therapeutic approach focused on developing postural control, transitional positions, and functional mobility while stimulating sensorimotor integration and neuroplasticity. Results: The initial GMFM score was 29.00%, and the final assessment score reached 68.68%, representing a relative improvement of 136.83%. The most considerable progress was observed in sitting, crawling, and kneeling, with initial improvements in standing. Despite the limitations of this study, the results suggest a positive effect of early, intensive, and individualized rehabilitation combined with active family involvement. Conclusions: The outcomes highlight the importance of early assessment, continuous monitoring of motor development, and a multidisciplinary rehabilitation approach in children with Apert syndrome, with the GMFM serving as a valuable tool for evaluating gross motor function. Full article