Search Results (1,903)

Spinal Cord Injury (SCI) rehabilitation is undergoing a transformative shift with the emergence of new treatment strategies. Historically, treatment options were limited, and few offered meaningful recovery. Recent work in human models has shown that neuromodulation specifically with spinal cord epidural stimulation (SCES) paired with task-specific training (TsT) can partially restore motor function such as the ability to stand, step, and perform volitional movements. Despite these advances, the recovery has been shown to plateau even with the combination of therapies. The recovery process typically leads to partial rather than complete restoration of function. This limitation arises because current approaches primarily reactivate existing circuits rather than repair the disrupted pathways. Scar tissue and loss of descending and ascending connections remain major barriers to full recovery, restricting the transmission of neural signals. We argue that the next phase of research should be a synergistic strategy building upon the successes of neuromodulation and TsT while incorporating a regenerative therapy such as stem-cell-based interventions. Whereas neuromodulation and task-specific training increases excitability and reorganizes existing networks, stem cells have the potential to repair structural damage and re-establish communication across injured regions or facilitating the establishment of dormant pathways. The future of SCI recovery relies on multi-modal synergistic interventions that are likely to maximize long-term functional outcomes. In the current perspective, we summarized the basic findings on applications of SCES on restoration of sensory-motor functions. We then projected on current interventions on utilizing stem cell therapy intervention. We highlighted the outcomes of randomized clinical trials, and the major barriers for considering the synergistic approach between SCES and stem cell intervention. We are hopeful that this perspective may lead to roundtable scientific discussion to bridge the gap on how to conduct numerous clinical trials in the field. 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 and Objectives: Long COVID-19 (LC) is a multifaceted condition characterized by persistent fatigue and impaired health-related quality of life (HRQoL). Exercise intolerance and post-exertional symptom exacerbation (PESE) pose challenges for rehabilitation. This study aimed to evaluate the effects of a 12-week core-focused plank exercise program on fatigue and HRQoL in women with LC, using validated patient-reported measures. Materials and Methods: A pilot quasi-experimental design was implemented, with non-randomized group allocation. Thirty-nine women with LC were recruited from the Madrid Long COVID Association. Participants were assigned to either an intervention group (n = 20), which completed a supervised plank-based motor control program, or a control group (n = 19), which maintained usual activity. Fatigue was assessed using the Modified Fatigue Impact Scale (MFIS), and HRQoL was measured using the EQ-5D-5L and EQ Visual Analog Scale (EQ-VAS). Body composition was evaluated via bioelectrical impedance analysis. Results: The intervention group showed significant reductions after intervention in the MFIS total scores compared to the control group, particularly in the physical (21.26 ± 6.76 vs. 25.21 ± 6.06; p < 0.001) and psychosocial domains (4.51 ± 0.41 vs. 5.21 ± 0.38; p < 0.001), without triggering PESE. EQ-VAS scores improved significantly (63.94 ± 15.33 vs. 46.31 ± 14.74; p = 0.034). No significant changes were found in body composition parameters, suggesting that benefits were driven by neuromuscular adaptations rather than morphological changes. Conclusions: A core-focused, non-aerobic exercise program effectively reduced fatigue and improved perceived health status in women with LC. These findings support the use of motor control-based interventions as a safe and feasible strategy for LC rehabilitation, particularly in populations vulnerable to PESE, suggesting clinical applicability for the rehabilitation of women with LC. Further randomized trials are warranted to confirm these results and explore long-term outcomes. Full article

Background: Neuromuscular electrical stimulation (NMES) is an effective exogenous neuromuscular activation method widely used in sports training and rehabilitation. However, existing research primarily focuses on land-based sports or single-joint movements, with limited in-depth exploration of its intervention effects and underlying neuromuscular control mechanisms for complex, multi-joint coordinated aquatic activities like breaststroke swimming. This study aimed to investigate the effects of NMES combined with traditional resistance training on neuromuscular function during sport-specific technical movements in breaststroke athletes. Methods: A randomized controlled trial was conducted with 30 national-level or above breaststroke athletes assigned to either an experimental group (NMES combined with traditional squat resistance training) or a control group (traditional squat resistance training only) for an 8-week intervention. A specialized fully waterproof wireless electromyography (EMG) sensor system (Mini Wave Infinity Waterproof) was used to synchronously collect surface EMG signals from 10 lower limb and trunk muscles during actual swimming, combined with high-speed video for movement phase segmentation. Changes in lower limb explosive power were assessed using a force plate. Non-negative matrix factorization (NMF) muscle synergy analysis was employed to compare changes in muscle activation levels (iEMG, RMS) and synergy patterns (spatial structure, temporal activation coefficients) across different phases of the breaststroke kick before and after the intervention. Results: Compared to the control group, the experimental group demonstrated significantly greater improvements in single-leg jump height (Δ = 0.06 m vs. 0.03 m) and double-leg jump height (Δ = 0.07 m vs. 0.03 m). Time-domain EMG analysis revealed that the experimental group showed more significant increases in iEMG values for the adductor longus, adductor magnus, and gastrocnemius lateralis during the leg-retraction and leg-flipping phases (p < 0.05). During the pedal-clamp phase, the experimental group exhibited significantly reduced activation of the tibialis anterior alongside enhanced activation of the gastrocnemius. Muscle synergy analysis indicated that post-intervention, the experimental group showed a significant increase in the weighting of the vastus medialis and biceps femoris within synergy module 4 (SYN4, related to propulsion and posture) (p < 0.05), a significant increase in rectus abdominis weighting within synergy module 3 (SYN3, p = 0.033), and a significant shortening of the activation duration of synergy module 2 (SYN2, p = 0.007). Conclusions: NMES combined with traditional resistance training significantly enhances land-based explosive power in breaststroke athletes and specifically optimizes neuromuscular control strategies during the underwater breaststroke kick. This optimization is characterized by improved activation efficiency of key muscle groups, more economical coordination of antagonist muscles, and adaptive remodeling of inter-muscle synergy patterns in specific movement phases. This study provides novel evidence supporting the application of NMES in swimming-specific strength training, spanning from macroscopic performance to microscopic neural control. Full article

Objective: To identify key predictors of clinical outcomes in burn survivors and clarify the role of mixed-depth burns and confounding by indication in observational rehabilitation research. Design: Retrospective cohort study using data from a burn rehabilitation registry (January 2024 to July 2025). Setting: Burn rehabilitation center. Participants: 120 adult patients (age ≥ 18 years) with burns affecting ≥1% total body surface area (TBSA) and complete baseline data. Interventions: Not applicable. Main Outcome Measures: Primary outcome was functional improvement (ΔFIM). Secondary outcomes included pain reduction (ΔPain), scar severity (Vancouver Scar Scale; VSS), Activities of Daily Living (ADL) improvement, and Range of Motion (ROM) recovery. Multivariable linear and logistic regression models were used to identify predictors. Results: Patients achieved significant improvements in function (mean ΔFIM = 11.3 ± 8.9 points) and pain (mean ΔPain = 1.28 ± 0.81). Having a mixed-depth burn was the strongest predictor of worse scar outcomes (β = 2.52, 95% CI: 0.93 to 4.12, p = 0.002) and failure to achieve full ROM (OR = 0.089, 95% CI: 0.008 to 0.930, p = 0.043). An apparent association between inpatient ward care and better scar outcomes (β = −1.30, p = 0.020) was determined to be an artifact of confounding by indication, as the outpatient group had a higher proportion of high-risk mixed-depth burns (6.2% vs. 3.5%). Longer therapy duration was the only significant predictor of achieving ADL goals (OR = 1.014, 95% CI: 1.002 to 1.026, p = 0.025). Conclusions: Injury characteristics, particularly the presence of a mixed-depth burn, emerged as the dominant predictors of long-term scar and functional outcomes. This study identifies mixed-depth burns as a potentially high-risk clinical phenotype requiring targeted therapeutic strategies and demonstrates the critical importance of accounting for confounding by indication when evaluating rehabilitation outcomes in observational burn research. Full article

Complete or partial loss of smell (anosmia), sometimes in association with distorted olfactory perceptions (parosmia), is a common neurological symptom affecting nearly 60% of patients suffering from post-acute neurological sequelae of COronaVIrus Disease of 2019 (COVID-19) syndrome, called long COVID. Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) may gain access from the nasal cavity to the brain (neurotropism), and the olfactory route has been proposed as a peripheral site of virus entry. COVID-19 is a risk factor for developing Alzheimer’s Disease (AD), an age-dependent and progressive neurodegenerative disorder characterized in affected patients by early olfaction dysfunction that precedes signs of cognitive decline associated with neurodegeneration in vulnerable brain regions of their limbic system. Here, we summarize the recent literature data supporting the causal correlation between the persistent olfactory deterioration following SARS-CoV-2 infection and the long-delayed manifestation of AD-like memory impairment. SARS-CoV-2 infection of the olfactory neuroepithelium is likely to trigger a pattern of detrimental events that, directly and/or indirectly, affect the anatomically interconnected hippocampal and cortical areas, thus resulting in tardive clinical dementia. We also delineate future advancement on pharmacological and rehabilitative treatments to improve the olfactory dysfunction in patients recovering even from the acute/mild phase of COVID-19. Collectively, the present review aims at highlighting the physiopathological nexus between COVID-19 anosmia and post-pandemic mental health to favor the development of best-targeted and more effective therapeutic strategies in the fight against the long-term neurological complications associated with SARS-CoV-2 infection. Full article

Background. Cervical spondylosis is a degenerative disorder of the spine, frequently associated with chronic neck pain, reduced mobility, and functional impairment. Patients develop alterations in muscle tone, stiffness, and elasticity, which further contribute to disability. This study aimed to investigate the effects of a 14-day standardized rehabilitation program on the biomechanical and contractile properties of cervical and scapular muscles in patients with cervical spondylosis. Methods. This study used a single-group pre–post observational design on 23 patients (16 women, 7 men; mean age 61.1 ± 14.2 years) diagnosed with cervical spondylosis. All participants completed a standardized rehabilitation treatment that included cervical mobilization, stretching, isometric exercises, scapular stabilization, electrotherapy, ultrasound, thermotherapy, and balneotherapy. Muscle properties were evaluated bilaterally using the MyotonPRO^® device, measuring frequency, stiffness, decrement, relaxation time, and creep. Assessments were performed in a sitting position for the deltoid, upper trapezius and pectoralis major, both at baseline (T0) and after treatment (T1). Handgrip strength was assessed bilaterally with a handheld dynamometer. Results. The deltoid muscle showed a significant reduction in frequency (14.86 → 13.50 Hz, p = 0.034) and stiffness (306.4 → 256.1 N/m, p = 0.014) on the right side, suggesting normalization of tone and passive resistance. The upper trapezius had a significant bilateral decrease in decrement (p < 0.05), reflecting improved elasticity. The pectoralis major displayed the most consistent adaptations, with increased frequency (right side, p = 0.008), improved relaxation bilaterally (p < 0.05), and significant reductions in decrement and creep (p < 0.01). Handheld dynamometry confirmed increased handgrip strength, with a 5.4% improvement on the left side and 7.6% on the right side. Conclusions. In our study measurable changes in muscle parameters were observed following a rehabilitation program in patients with cervical spondylosis. The integration of myotonometry and dynamometry allowed objective assessment of muscle adaptations supporting the clinical value of individualized rehabilitation strategies. Full article

Chronic obstructive pulmonary disease (COPD) is a major health burden worldwide and in Taiwan, ranking as the third leading cause of death globally, and its prevalence in Taiwan continues to rise. Readmission within 14 days is a key indicator of disease instability and care efficiency, driven jointly by patient-level physiological vulnerability (such as reduced lung function and multiple comorbidities) and healthcare system-level deficiencies in transitional care. To mitigate the growing burden and improve quality of care, it is urgently necessary to develop an AI-based prediction model for 14-day readmission. Such a model could enable early identification of high-risk patients and trigger multidisciplinary interventions, such as pulmonary rehabilitation and remote monitoring, to effectively reduce avoidable early readmissions. However, medical data are commonly characterized by severe class imbalance, which limits the ability of conventional machine learning methods to identify minority-class cases. In this study, we used real-world clinical data from multiple hospitals in Kaohsiung City to construct a prediction framework that integrates data generation and ensemble learning to forecast readmission risk among patients with chronic obstructive pulmonary disease (COPD). CTGAN and kernel density estimation (KDE) were employed to augment the minority class, and the impact of these two generation approaches on model performance was compared across different augmentation ratios. We adopted a stacking architecture composed of six base models as the core framework and conducted systematic comparisons against the baseline models XGBoost, AdaBoost, Random Forest, and LightGBM across multiple recall thresholds, different feature configurations, and alternative data generation strategies. Overall, the results show that, under high-recall targets, KDE combined with stacking achieves the most stable and superior overall performance relative to the baseline models. We further performed ablation experiments by sequentially removing each base model to evaluate and analyze its contribution. The results indicate that removing KNN yields the greatest negative impact on the stacking classifier, particularly under high-recall settings where the declines in precision and F1-score are most pronounced, suggesting that KNN is most sensitive to the distributional changes introduced by KDE-generated data. This configuration simultaneously improves precision, F1-score, and specificity, and is therefore adopted as the final recommended model setting in this study. Full article

Background: The global increase in orthopedic implant use—both for trauma fixation and arthroplasty—has profoundly transformed musculoskeletal surgery. As a consequence, fractures occurring in the presence of implants have become more frequent and clinically relevant. Yet, these injuries are currently described using highly heterogeneous terminology, including periprosthetic (fracture occurring in the presence of a prosthetic joint replacement) peri-implant (fracture occurring around an osteosynthesis or fixation device), implant-related, and hardware-related fractures (umbrella terms encompassing both prosthetic and fixation devices, used descriptively rather than classificatorily). This coexistence of multiple, context-specific terminologies hinders clinical communication, complicates registry documentation, and limits research comparability across orthopedic subspecialties. Because fractures occurring in the presence of orthopedic implants significantly alter load transfer, muscle force distribution, and musculoskeletal biomechanics, a clear and unified terminology is also relevant for muscle-focused research addressing implant–tissue interaction and functional recovery. Objective: This systematic review aimed to critically analyze the terminology used to describe fractures influenced by orthopedic implants, quantify the heterogeneity of current usage across anatomical regions and publication periods, and explore the rationale for adopting a unified umbrella term—“artificial fracture.” Methods: A systematic search was performed in PubMed, Scopus, and Web of Science from January 2000 to December 2024, following PRISMA guidelines. Eligible studies included clinical investigations, reviews, registry analyses, and consensus statements explicitly employing or discussing terminology related to implant-associated fractures. Data were extracted on publication characteristics, anatomical site, terminology employed, and classification systems used. Quantitative bibliometric and qualitative thematic analyses were conducted to assess frequency patterns and conceptual trends. Results: Of 1142 records identified, 184 studies met the inclusion criteria. The most frequent descriptor in the literature was periprosthetic fracture (68%), reflecting its predominance in arthroplasty-focused studies, whereas broader and more practical terms such as implant-related and peri-implant fracture were more commonly used in musculoskeletal and fixation-related research. Terminological preferences varied according to anatomical site and implant type, and no universally accepted, cross-anatomical terminology was identified despite multiple consensus efforts. Discussion and Conclusions: The findings highlight persistent heterogeneity in terminology describing fractures influenced by orthopedic implants. A transversal, descriptive framework may facilitate communication across subspecialties and support registry-level harmonization. Beyond orthopedic traumatology, this approach may also benefit muscle and musculoskeletal research by enabling more consistent interpretation of data related to muscle–bone–implant interactions, rehabilitation strategies, and biomechanical adaptation. Full article

Interventions on Heritage Buildings (HBs) involve significant challenges due to their tangible (embodied in the material, architectural, physical and technical integrity of the cultural asset), and intangible values (linked to socio-historical–cultural and collective identity, memory, customs and symbols meanings), which must be preserved while also adapting to current sustainability and circular economy goals. However, current conservation and management practices often lack systematic tools to trace, assess, and organise material and component information, hindering the implementation of circular strategies. In line with the European Union’s objectives for climate neutrality and resource efficiency and sufficiency, Material and Product Passports (MPPs) have emerged as digital tools that enhance data traceability, interoperability and transparency throughout a building’s lifecycle. This paper examines the potential of MPPs to support circular management of HBs by analysing the structure of MPPs and outlining the information flows generated by rehabilitation, maintenance and adaptive reuse strategies. A mixed methods approach, combining literature review and data structure analysis, is adopted to identify how the different categories of data produced during maintenance, rehabilitation and adaptive reuse processes can be integrated into MPP modules. The research highlights the conceptual opportunities of MPPs to document and interlink historical, cultural, and technical data, thereby improving decision-making and transparency across intervention stages. The analysis suggests that adapting MPPs to the specificities of historic contexts, such as authenticity preservation, reversibility, and contextual sensitivity, can foster innovative, sustainable, and circular practices in the conservation and management of HBs. Full article

Background/Objectives: Chronic Obstructive Pulmonary Disease (COPD) is frequently associated with dyspnea, impaired health-related quality of life (HRQoL), and cognitive dysfunction. Although pulmonary rehabilitation (PR) is considered a core therapeutic strategy, its specific effects on cognitive function, dyspnea, and dysphonia remain unclear. This systematic review aimed to evaluate the impact of PR and respiratory or cognitive-focused rehabilitative interventions on dyspnea, quality of life, cognitive performance, and voice outcomes in adults with COPD. Methods: This review was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420251131325). A systematic search of PubMed, Scopus and Web of Science identified studies published between 2010 and 21 August 2025. Eligible designs included randomized and non-randomized controlled studies, cohort, and mixed-method studies involving adults with COPD undergoing rehabilitative interventions targeting dyspnea, cognition, dysphonia, or swallowing. Outcomes included cognitive measures, dyspnea scales, voice parameters, and HRQoL indices. Results: Twelve studies (n ≈ 810 participants) met inclusion criteria. Most PR and exercise-based programs showed improvements in global cognition and executive functions, particularly when combined with cognitive training or high-intensity exercise modalities. Dyspnea improved consistently following short- to medium-term PR or respiratory muscle training, whereas low-frequency long-term programs yielded limited benefit. HRQoL improved across structured PR programs, especially in multidimensional interventions. Only one study assessed dysphonia, reporting transient improvements in maximum phonation time following inspiratory muscle training. No included study evaluated dysphagia-related outcomes. Conclusions: PR and respiratory muscle training can enhance cognition, dyspnea, and HRQoL in COPD, although evidence for dysphonia remains scarce and dysphagia is entirely unaddressed. Future high-quality trials should adopt standardized outcome measures, include long-term follow-up, and integrate voice and swallowing assessments within PR pathways. Full article

Background: Non-specific low back pain (NSLBP) is associated with altered neuromuscular control of the lumbopelvic–hip complex (LPHC). However, the functional behavior of the transversus abdominis (TrA) and gluteus medius (GM) during upright postural tasks, with and without the abdominal drawing-in maneuver (ADIM), remains unclear. This study aimed to compare TrA and GM activation between individuals with NSLBP and asymptomatic controls during standing and single-leg stance using rehabilitation ultrasound imaging (RUSI). Methods: Thirty-two participants (16 with NSLBP and 16 asymptomatic controls) underwent RUSI assessment under four task conditions: standing and single-leg stance, with and without ADIM. Muscle function was quantified using thickness change derived from ultrasound measurements. A two-way mixed-model analysis of variance with Bonferroni-adjusted post hoc comparisons was performed. Results: Significant group × condition interactions were identified for TrA activation (p < 0.05). Individuals with NSLBP demonstrated reduced TrA activation during standing with ADIM and reduced GM activation during single-leg stance compared with asymptomatic controls. The effect sizes were moderate to large for TrA activation and small to moderate for GM activation. Conclusions: These findings suggest task-specific differences in neuromuscular activation patterns in individuals with NSLBP. Ultrasound-derived thickness change measures obtained during functional, weight-bearing tasks may provide clinically relevant information to support motor control rehabilitation strategies. Full article

Hand exoskeletons are increasingly used to support post-stroke reach-to-grasp, yet most intention-detection strategies trigger assistance from local hand events without considering the synergy between proximal arm transport and distal hand shaping. We evaluated whether proximal arm kinematics, alone or fused with EMG, can predict flexor and extensor digitorum activity for synergy-aligned hand assistance. We trained nine models per participant: linear regression (LINEAR), feedforward neural network (NONLINEAR), and LSTM, each under EMG-only, kinematics-only (KIN), and EMG+KIN inputs. Performance was assessed by RMSE on test trials and by a synergy-retention analysis, comparing synergy weights from original EMG versus a hybrid EMG in which extensor and flexor digitorum measure signals were replaced by model predictions. Results have shown that kinematic information can predict muscle activity even with a simple linear model (average RMSE around 30% of signal amplitude peak during go-to-grasp contractions), and synergy analysis indicated high cosine similarity between original and hybrid synergy weights (on average 0.87 for the LINEAR model). Furthermore, the LINEAR model with kinematics input has been tested in a real-time go-to-grasp motion, developing a high-level control strategy for a hand exoskeleton, to better simulate post-stroke rehabilitation scenarios. These results suggest the intrinsic synergistic motion of go-to-grasp actions, offering a practical path, in hand rehabilitation contexts, for timing hand assistance in synergy with arm transport and with minimal setup burden. Full article

Robot-assisted rehabilitation has demonstrated significant efficacy in improving motor function among patients with physical and neurological impairments. The development of effective rehabilitation robots requires careful integration of mechanical design and control systems to ensure safe, compliant, and intention-oriented human–robot interaction while delivering appropriate therapeutic assistance and feedback. Parallel robot manipulators have increasingly gained attention in rehabilitation applications due to their superior precision, structural stiffness, and high load capacity compared to their serial counterparts. This paper presents a scoping review of control strategies specifically implemented in parallel rehabilitation robots between 2015 and 2025. The control strategies include position control, force control, compliance control, adaptive control, intelligent control, and hybrid control. Our analysis showed a progressive shift from traditional position-based control toward more sophisticated adaptive and intelligent strategies that better accommodate patient-specific needs and therapeutic requirements. Full article

Analyzing the dynamics of muscle activation patterns and joint range of motion is essential to understanding human movement during complex tasks such as tooth brushing Activities of Daily Living (ADLs). In individuals with neuromotor impairments, accurate assessment of upper limb motor patterns plays a critical role in rehabilitation, supporting the identification of compensatory strategies and informing clinical interventions. This study presents the validation of a previously developed novel, low-cost, wearable, and portable multimodal prototype that integrates inertial measurement units (IMU) and surface electromyography (sEMG) sensors into a single device. The system enables bilateral monitoring of arm segment kinematics and muscle activation amplitudes from six major agonist muscles during ADLs. Eleven healthy participants performed a functional task, tooth brushing, while wearing the prototype. The recorded data were compared with two established gold-standard systems, Qualisys^® motion capture system and Biosignalsplux^®, for validation of kinematic and electrophysiological measurements, respectively. This study provides technical insights into the device’s architecture. The developed system demonstrates potential for clinical and research applications, particularly for monitoring upper limb function and evaluating rehabilitation outcomes in populations with neurological disorders. Full article