Search Results (106)

Spasticity is a common and disabling consequence of upper motor neuron lesions, and its follow-up relies largely on clinical scales that may not fully reflect daily-life mobility. This prospective single-arm exploratory pilot study examined wearable-derived daily-life mobility metrics around a scheduled botulinum neurotoxin type A (BoNT-A) injection cycle and assessed their associations with established clinical measures. Thirteen patients with focal spasticity secondary to stroke (n = 11) or multiple sclerosis (n = 2) underwent baseline and 6-week follow-up assessment using the Modified Ashworth Scale (MAS), Motricity Index (MI), the Timed Up and Go test (TUG) and a multi-sensor wearable monitoring system. Device-derived outcomes included gait impairment, gait speed, stride length, angular velocity, and lack of movement. Clinical scales generally changed in the expected post-treatment direction, with reduced MAS scores and descriptive or directional improvements in MI scores and TUG performance. Wearable metrics captured descriptive changes in daily mobility, notably a reduction in lack of movement. Furthermore, in exploratory pooled analyses, selected gait-related metrics tended to be associated with TUG performance and lower-extremity MAS. These findings highlight the potential of wearable telemonitoring to complement conventional clinical scales by providing objective, real-world data, supporting its further validation as a tool for longitudinal spasticity management and neurorehabilitation. These device-derived metrics should be interpreted as mobility-related digital biomarkers rather than direct surrogate measures of spasticity. Full article

Falls represent a severe public health issue and a primary cause of impairment across both geriatric and adults clinical populations, underscoring the importance of early and tailored prevention. Research evidence shows that technology-assisted rehabilitation may enhance balance and reduce fall risk; however, long-term real-world evidence remains limited. This retrospective study evaluated the impact of personalized balance training by hunova^® robotic platform on fall risk in a heterogeneous clinical cohort (n = 355; mean age 58.24 ± 19.63 years) comprising neurological and orthopedic conditions. Fall risk was assessed using the Silver Index, a sensor-based robotic posturographic score to predict 12-month fall probability at baseline (T0), after 6 weeks (T1), and at 6 months (T6). Robotic rehabilitation was provided to 162 patients (TREAT-G), while 193 served as a control group (NOTREAT-G). TREAT-G demonstrated a significant reduction in fall risk over time (p = 0.036), with improvements from T0–T1 (p < 0.001) and T0–T6 (p = 0.009). Domain-specific analysis showed significant increases in limits of stability, sit-to-stand, and gait speed (p < 0.001). Significant time × group interactions were observed for limits of stability (p = 0.004) and sit-to-stand (p < 0.001). Based on the occurrence of falls in the previous six months, the sample was then divided into ‘Fallers’ (at least one fall) and ‘No-Fallers’ (no falls). Subgroup analysis revealed significant improvements in ‘Fallers’ (p = 0.016) and ‘No-Fallers’ (p = 0.034) following treatment in contrast to untreated patients—both ‘Fallers’ and ‘No-Fallers’. These results indicate that tailored robot-assisted therapy with hunova^® significantly reduces risk of fall and improves long-term dynamic balance. This study supports the clinical integration of robotic assessment and therapy as a robust tool for proactive fall prevention in diverse clinical settings. Full article

This study investigated whether baseline sleep quality influences the effects of a 12-week multicomponent exercise program on sleep quality and physical function in community-dwelling older adults. Twenty-five older adults were classified according to baseline sleep quality using the Pittsburgh Sleep Quality Index into a Good Sleep (GS, n = 8) group and a Poor Sleep (PS, n = 17) group. The exercise program was performed three times per week for 12 weeks, with each 60 min session consisting of warm-up, multicomponent exercise, and cool-down. Outcome measures included sleep quality (PSQI), physical performance assessed by the Short Physical Performance Battery, and health-related fitness tests. A significant group × time interaction was observed for PSQI total score (p = 0.035). The PS group showed a significant reduction in PSQI score (−1.71 points, p < 0.01), indicating improved sleep quality, with favorable changes in subjective sleep quality, sleep latency, use of sleeping medication, and daytime dysfunction. However, the PS group demonstrated significant improvements in gait speed, grip strength, and 2 min walking performance. A significant group × time interaction was observed for the 30 s chair stand test (p = 0.011), with the GS group showing greater improvements in lower-extremity muscular endurance. Baseline sleep quality was associated with the pattern of adaptation to multicomponent exercise. Older adults with poor sleep quality experienced meaningful improvements in sleep, whereas those with good sleep quality showed greater gains in muscular endurance. These findings support the inclusion of sleep assessment when designing individualized exercise interventions for older adults. Full article

Background: Traditional gait assessments in adult degenerative scoliosis (ADS) often rely on prohibitively expensive, laboratory-bound optoelectronic systems that lack clinical accessibility. This research aims to independently evaluate both lower limbs using a wearable Inertial Measurement Unit (IMU) system, in contrast to studies that employ a unilateral reference, thereby elucidating the unique bilateral asymmetries and dynamic stability patterns exhibited in ADS. Methods: Gait patterns of 20 ADS patients and 15 healthy controls were analyzed using the Rokoko Smartsuit Pro. Segmental kinematic data were integrated with anthropometric mass distribution models to calculate the total body center of mass (CoM). Spatiotemporal parameters, joint range of motion (RoM), and CoM excursions in three planes were statistically compared between the groups. Results: ADS patients exhibited a cautious gait strategy characterized by significantly reduced step speed, shortened step lengths, and increased step width ($p<0.05$). Temporal analysis showed prolonged stride, stance, and double support time ($p<0.001$), while cadence remained comparable to healthy controls. A triple-joint deficit, including hip, knee, and ankle, was identified in the sagittal plane, especially with peak flexion reductions reaching up to 55% in the left knee and 38% in the right knee, highlighting profound functional asymmetry ($p<0.001$). Additionally, the CoM analysis reflected these stability restrictions, showing increased horizontal excursion and reduced vertical oscillation. Conclusions: Our findings suggest that ADS is associated with distinct, bilateral alterations in the lower limb kinematic chain and notable adaptations in dynamic balance parameters, characterized by a cautious gait strategy and profound sagittal triple-joint asymmetries. These findings highlight the feasibility of full-body wearable IMU technology in capturing objective, bilateral gait alterations, providing a foundational baseline that could complement standard static radiography in future clinical evaluations. Full article

Background: Postoperative rehabilitation following Total Knee or Hip arthroplasty (TKA, THA respectively) for end-stage osteoarthritis is frequently characterized by oxidative stress and chronic-inflammation-induced muscle atrophy. This study investigated the efficacy of a milk protein concentrate supplement (MCPS) on oxidative stress, inflammation markers, and functional regains in patients undergoing TKA or THA. Methods: 88 participants (aged 55–80 years) were allocated to either an Intervention Group (IG, n = 44), receiving the MPCS, or a Control Group (CG, n = 44), following conventional nutrition for 15 weeks. Appendicular skeletal muscle mass (ASMM) was measured using bioelectrical impedance analysis and functionality through handgrip strength, gait speed, and static balance. 8-Isoprostane levels were quantified in plasma samples using the Enzyme-Linked Immunosorbent Assay(ELISA) method. C Reactive Protein (CRP) levels in serum specimens were measured. Data analysis was conducted, with adjustments made for age, gender, and comorbidities. Results: The IG demonstrated a significant increase in ASMM (Adj. mean change, Δ = +2.34 kg, 95% CI: 1.99 to 2.69, p < 0.001) and ASMM Index (Δ = +0.82 kg/m², 95% CI: 0.64 to 1.00, p < 0.001) compared to the CG. Functional measurements also showed significant improvements in the IG, including Handgrip Strength (Δ = +4.40 kg, p < 0.001), Gait Speed (Δ = +0.23 m/s, p < 0.001), and the 2-Minute Walk Test (Δ = +12.02 m, p = 0.026). Regarding biochemical markers, the IG showed a significant reduction in plasma F2-isoprostane levels (Δ = −29.19, p < 0.001), CRP levels (Δ = −0.69 mg/L, p = 0.004), and PTH levels (Δ = −27.41 pg/mL, p < 0.001). A negative association between lipid peroxidation (8-isoprostanes) and ASMM was confirmed. Conclusions: Structural nutritional intervention can effectively mitigate catabolic stress triggered by surgical treatment. Implementing such strategies into orthopedic care offers a practical approach to treat challenges often associated with postoperative muscle loss. Full article

Older adults with mild cognitive impairment (MCI) often show gait impairment during dual-task walking and obstacle negotiation. This assessor-blinded randomized controlled trial investigated whether dual-task gait training with visual adaptation, added to a general exercise program, improves gait and related functional outcomes in older adults with MCI. Forty participants aged 65 years or older who met the MCI criteria were randomly allocated to a dual-task gait training with visual adaptation group or a control group (n = 20 each). Spatiotemporal and adaptive gait parameters were assessed before and after 4 weeks of intervention during level walking and during predictable and unpredictable obstacle negotiation under light and noise conditions. Balance, executive function, and concern about falling were also evaluated. Compared with the control group, the intervention group showed greater improvements in level walking and predictable obstacle negotiation, including longer step and stride length, shorter step and stride time, higher cadence, and faster gait speed. Under unpredictable obstacle conditions, gains were more selective and were observed mainly in step and stride length and adaptive gait indices. The intervention group also showed greater improvement in balance and executive function and a larger reduction in concern about falling. These findings suggest that adding dual-task gait training with visual adaptation to a general exercise program may have clinical value for improving adaptive gait and related functional outcomes in older adults with MCI. However, because the intervention group received additional gait-specific training and a higher total training dose than the control group, future dose-matched studies are needed to clarify the specific contribution of visual adaptation. Full article

Background and Objectives: Knee osteoarthritis (KOA) is a degenerative joint disease that affects quality of life through pain, impaired functional performance, and altered gait patterns. Hydrotherapy is a well-tolerated form of physical rehabilitation, especially suitable for patients with severe pain, as water’s properties support movement while reducing joint load. Its effects have been widely studied, primarily focusing on patient-reported outcomes, with limited synthesis of functional performance and gait-related outcomes. Materials and Methods: A systematic search was conducted in PubMed, Web of Science, Cochrane, PEDro, SpringerLink, ScienceDirect, and Google Scholar, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search strategy included a combination of Medical Subject Headings (MeSH) terms and keywords. For example, the PubMed search strategy was as follows: (“knee osteoarthritis” OR “knee OA”) AND (“hydrotherapy” OR “aquatic therapy” OR “water-based exercise”) AND (“gait” OR “walking” OR “functional performance”). Randomized controlled trials (RCTs) from the last 10 years involving patients with KOA undergoing aquatic therapy were included. Primary outcomes included functional performance assessed by measures such as the 6 min walking test (6MWT), the Timed Up and Go (TUG) test, the five sit-to-stand (5 STS) and stair climb (SC) tests, and by using gait-related parameters (e.g., speed, cadence, and step length) assessed clinically or using technology. Patient-reported outcomes, including the Visual Analog Scale (VAS), Western Ontario and McMaster University’s Osteoarthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS), were analyzed as a secondary objective. Results: A total of 479 studies were identified, of which 13 met the eligibility criteria. The results revealed improvements in functional performance, with increases in 6MWT in five studies, the TUG test in four trials, and better performance in the 5-STS and SC tests in five studies. Benefits in gait parameters were noted in four studies. Additionally, one of the articles reported improvements in static and dynamic balance, another showed enhanced proprioception, and a third described more efficient muscle activation during gait following hydrotherapy. Consistent benefits in pain reduction, joint stiffness, and activities of daily living, as reflected by VAS, WOMAC, and KOOS, were also noted immediately and maintained at follow-up. The variability in outcome measures and intervention characteristics limited the possibility of data integration and the calculation of effect sizes. Conclusions: Hydrotherapy as a rehabilitation intervention may be associated with improvements in functional capacity, mobility, and self-reported physical ability in patients with KOA, with some evidence supporting a beneficial effect on gait; however, the certainty of evidence remains low to moderate due to heterogeneity among studies and limited sample sizes. These findings should be interpreted in light of the methodological limitations identified across the included trials. Full article

Smart insoles equipped with pressure sensor matrices are increasingly used for gait analysis, yet high-density arrays compromise battery life and data throughput. This study aims to identify the optimal sparse sensor layout required to accurately estimate the Center of Pressure (CoP) by analyzing the trade-off between sensor number, spatial placement, and reconstruction error. Plantar pressure data were collected from twelve healthy participants walking at a self-selected speed using 16-sensor connected insoles. A combinatorial algorithm evaluated all $2^{16}-1$ possible sensor combinations to minimize the Root Mean Square Error (RMSE) in the antero-posterior, medio-lateral, and global Euclidean directions. Results reveal a non-linear convergence of accuracy that depends on the spatial axis. For longitudinal and global progression, a clear inflection point achieving sub-centimetric accuracy (RMSE < 5 mm) is reached at seven sensors. In contrast, medio-lateral tracking shows its largest discrete error reduction at five sensors, followed by gradual improvements at higher densities. Anatomical frequency analysis highlights distinct spatial requirements: the posterior heel is consistently selected for medio-lateral accuracy, while the lateral arch and metatarsal regions are critical for longitudinal progression. These findings suggest that while a minimum of seven strategically placed sensors enables robust CoP tracking across all spatial axes, optimal hardware design should remain task-specific. This work provides a data-driven framework for the development of energy-efficient wearable gait monitoring systems. Full article

Background: In dual-task (DT) conditions, individuals must walk while simultaneously engaging in cognitive or motor tasks, which impacts gait performance, especially in older adults and individuals with Parkinson’s disease (PD). Gait impairments in PD under DT conditions have implications for intersegmental coordination. Research question: Intersegmental coordination and gait biomechanics during the DTs were compared between people with PD and older adults. Methods: Thirty-two individuals (16 PD, H&Y 1–3; and 16 older adults) participated in this study and were asked to walk under the following self-selected conditions: single task, DT with a math component, and texting on a cell phone. Spatiotemporal, angular, and intersegmental coordination data were collected using a markerless motion analysis system (OpenCap). Results: Dual-task conditions significantly affected spatiotemporal and kinematic variables, as well as intersegmental coordination. A significant task effect was observed for thigh–shank coordination, whereas no significant group effect was found for the main coordination outcomes. Significance: Significant task effects were observed for intersegmental coordination (thigh–shank CRP), with no significant group differences. The concurrent demands of processing visual and motor information for texting and walking lead to significant reductions in gait speed and lower limb movement, as well as altered intersegmental coordination, with task demands rather than disease status being the primary driver of coordination changes. Full article

Background: Sarcopenia is the age-related, progressive loss of strength, function, and skeletal muscle mass, which can be assessed with specific tests. The Growth differentiation factor 15 (GDF-15) has been proposed as a key biomarker of aging, and it has been associated with mitochondrial dysfunction, cachexia, and physical impairment. Methods: The cohort of this study comes from the SardiNIA study, an ongoing longitudinal survey focused on the identification of genetic and phenotypic variants associated with aging. We assessed hand grip strength, gait speed, and GDF-15 in all samples. Linear multivariate analysis was used to assess the correlation after adjusting for a range of potential confounders. Results: The sample consisted of 4842 subjects (57.5% female) with a median age of 48.6 years. Levels of GDF-15 were comparable between males and females and showed a strong positive association with aging (rho 0.617, p < 0.001). Linear multivariate regression analyses showed that GDF-15 was negatively associated with gait speed and grip strength in both hands (respectively, Beta −0.09, Beta −0.07, and Beta −0.08, p < 0.001 for all). Conclusions: GDF-15 was negatively associated with physical function. GDF-15 may be considered a proxy for reduced physical performance. Future research is needed to understand the pathogenetic role of GDF-15 in the reduction in skeletal muscle in aging people. Full article

Sarcopenia is a complex condition marked by reductions in muscle strength, mass, and overall physical performance, which has significant consequences for functional autonomy and metabolic health in elderly women. This study aimed to examine the correlations between lower limb strength, functional capabilities, and metabolic indicators in community-dwelling older women categorized according to the European Working Group on Sarcopenia in Older People 2 (EWGSOP2) criteria. A total of thirty-eight women aged ≥ 60 years underwent assessments, including anthropometric, hemodynamic, and metabolic evaluations, along with functional tests such as handgrip strength, chair-rise test, gait speed, Timed Up-and-Go, and maximal isometric hip extension strength (MIHE). The criteria for probable sarcopenia were established using the handgrip thresholds set by the EWGSOP2. Women identified as having probable sarcopenia displayed markedly lower MIHE, diminished gait speed, inferior performance in chair-rise and Timed Up-and-Go tests, decreased muscle mass, and a lower resting metabolic rate than their non-sarcopenic counterparts. MIHE exhibited robust correlations with muscle mass, resting metabolic rate, and functional performance metrics. These results suggest that assessments of lower limb and trunk strength yield pertinent insights beyond handgrip strength alone. Function-oriented evaluations may improve sarcopenia screening and facilitate the identification of older women at risk of functional and metabolic deficiencies in community-based environments. Full article

Background: Frailty is a multifactorial condition that significantly impacts older adults’ health and independence, which can be mitigated through training. This study examined the effects of a 12-week progressive strength training (PST) program on frailty status and short-term autonomic compensatory responses during postural transitions. Methods: Eight older adults (60–79 years) classified as pre-frail or frail according to the frailty index (FI) participated in a 12-week PST program. Time and frequency-domain heart rate variability (HRV) in the supine position, cardiac parasympathetic modulation (CPM) determined from the HR 30:15 ratio (longest RR interval around the 30th heartbeat divided by the shortest RR interval around the 15th heartbeat after standing), and cardiac baroreceptor gain (CBG) assessed as the ratio of heart rate change to systolic blood pressure drop (ΔHR/ΔSBP) at 30, 60, 180, and 420 s after standing were assessed at pre-test, 8 weeks and 12 weeks (autonomic function outcomes). Physical activity levels (PAL), handgrip strength (HGS), and gait speed (GS) were assessed, and orthostatic intolerance (OI) symptoms were self-reported at pre-test, 8 weeks, and 12 weeks. Results: After 12 weeks of PST, FI scores decreased from 0.18 to 0.04 (78% reduction). PAL, HGS, and GS improved by 152%, 13%, and 11%, respectively. Three of eight participants reported OI symptoms at pre-test, with no reported symptoms at week 12. Despite this, PST did not enhance short-term autonomic responses. Conclusions: PST counteracted frailty and improved physical and muscular function but did not enhance indices of short-term autonomic regulation in frail older people. Full article

Background: Parkinson’s disease (PD) is characterized by motor disturbances that significantly impact balance, gait, and quality of life. Personalized Rhythmic Auditory Stimulation (pRAS) is an emerging rehabilitative approach that utilizes auditory entrainment to improve step and gait control. The aim of this systematic review is to critically summarize the data from the most recent evidence concerning the use of pRAS in gait rehabilitation for patients with Parkinson’s disease. Methods: A systematic review was conducted following PRISMA guidelines, including records that evaluated music-based or technological interventions based on personalized RAS. Primary outcomes included spatiotemporal gait parameters and distance covered. Results: Ten studies were included in the analysis. All the studies reported clinically relevant improvements: increases in gait speed, step length, and amplitude. Moreover, a reduction in freezing of gait episodes (up to 36%), greater walking distance, and good adherence were reported. Conclusions: Personalized, adaptive, or on-demand solutions proved more effective than traditional forms of cueing. Moreover, the available evidence suggests that pRAS constitutes an effective and safe rehabilitative option for gait disturbances in PD. However, further studies with larger sample sizes and prolonged follow-up periods are necessary to evaluate its long-term impact and transferability into clinical practice. Full article

This study investigates the link between changes in physical activity (PA) measured by wearable accelerometers and the worsening of knee osteoarthritis (KOA) symptoms over two years. Using data from 782 participants in the Osteoarthritis Initiative accelerometer sub-study, PA was tracked with hip-worn ActiGraphs. Participants were classified as “worsening” if their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score increased by >10 points and as “stable” otherwise. PA was categorized into daily counts and minutes spent in various intensity levels, and analyzed in 3 h intervals across the day. Of the participants, 123 (15.7%) experienced worsening symptoms. At baseline, both groups had similar characteristics aside from slower sit-to-stand times in the worsening group. Over two years, the worsening group had a greater decline in total daily activity counts (−18% vs. −10%) and more significant reductions during late afternoon and evening (15:00–21:00; −21% vs. −6%). This group also showed a notable decrease in gait speed, longer sit-to-stand times, and a trend towards greater medial joint space narrowing. These findings suggest that larger declines in PA, especially in activities in the late afternoon and evening, are associated with worsening KOA symptoms, although causality cannot be established. Full article

Background: Walking cadence is commonly adjusted in sport and rehabilitation, yet its effects on spatiotemporal gait parameters and regional plantar pressure distribution under controlled speed conditions remain incompletely characterized. Therefore, this study aimed to determine whether imposed cadence increases at a constant walking speed would (i) systematically reduce temporal gait parameters while preserving inter-limb symmetry and (ii) be associated with region-specific increases in forefoot plantar loading, representing the primary novel contribution of this work. Methods: Fifty-two adults walked at three imposed cadences (110, 120, 130 steps·min⁻¹) while maintaining a fixed treadmill speed of 1.39 m·s⁻¹ via auditory biofeedback. Spatiotemporal parameters were recorded with an OptoGait system, and plantar pressure distribution was measured using in-shoe pressure insoles. Normally distributed variables were analyzed using repeated-measures ANOVA, whereas plantar pressure metrics were assessed using the Friedman test, followed by Wilcoxon signed-rank post-hoc comparisons with false discovery rate (FDR) correction. Associations between temporal parameters and plantar loading metrics (peak pressure, pressure–time integral) were examined using Spearman’s rank correlation with FDR correction (α = 0.05). Results: Increasing cadence produced progressive reductions in gait cycle duration (~8–10%), contact time (~7–8%), and step time (all p < 0.01), while inter-limb symmetry indices remained below 2% across conditions. Peak plantar pressure increased significantly in several forefoot regions with increasing cadence (all p_FDR < 0.05), whereas changes in the first ray were less consistent across conditions. Regional forefoot pressure–time integral also increased modestly with higher cadence (p_FDR < 0.01). Spearman’s correlations revealed moderate negative associations between temporal gait parameters and global plantar loading metrics (ρ = −0.38 to −0.46, all p_FDR < 0.05). Conclusions: At a constant walking speed, increasing cadence systematically shortens temporal gait components and is associated with small but consistent region-specific increases in forefoot plantar loading. These findings highlight cadence as a key temporal constraint shaping plantar loading patterns during steady-state walking and support the existence of concurrent temporal–mechanical adaptations. Full article