Search Results (2,345)

Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs. Full article

Background/Objectives: Although considerable progress has been made in understanding lateral ankle sprains (LAS) and chronic ankle instability (CAI), recurrent injury rates remain high. This highlights the need to explore additional contributors such as comprehensive lower-limb gait analysis, including multisegmented foot models and proximal joint kinematics and strength. This study aimed to assess multisegmented foot and lower-limb kinematics throughout the gait cycle in individuals with CAI compared to healthy controls. Additionally, associations between hip abductor strength and frontal plane ankle kinematics were examined. Methods: Fifty males (25 with CAI and 25 healthy controls) participated in this cross-sectional study. Gait analysis was conducted using a BTS SMART 3D motion capture system to assess multisegmented foot and proximal joint kinematics. Isometric hip strength was measured using a Biodex dynamometer. Statistical Parametric Mapping (SPM) was used to assess group differences, and correlations were calculated between hip abductor strength and ankle kinematics. Results: The CAI group demonstrated significantly greater calcaneus abduction relative to the shank in the transverse plane between 88% and 93% of the gait cycle (MD = −3.50°, 95% CI [−5.60, −1.40], d = −0.95, p = 0.037). No other statistically significant between-group differences in hip, knee, or foot segment kinematics were detected. Furthermore, correlations between hip abductor strength and ankle frontal plane kinematics were not significant. Conclusions: Males with CAI demonstrated altered rearfoot kinematics in the transverse plane during the terminal swing phase. The multisegmented foot model was valuable in detecting subtle deviations and emphasized the importance of including the swing phase. Hip abductor strength was not associated with ankle kinematics, suggesting that its potential role in CAI may involve other mechanisms. These findings may support clinical gait assessment and rehabilitation planning by highlighting the importance of evaluating all foot segments and the entire lower limb, rather than focusing solely on the ankle joint. Segment-specific deviations, particularly those emerging during the swing phase, may help guide targeted interventions aimed at improving foot positioning in males with CAI. Full article

Background/Objectives: Pediatric acquired brain injury (ABI) often results in persistent challenges that extend beyond motor impairments, affecting quality of life (QoL), social participation, and engagement in physical activity. Given the complexity and chronicity of these outcomes, there is a pressing need for multidimensional interventions grounded in the International Classification of Functioning, Disability and Health (ICF). Sport-based exercise interventions, when developmentally adapted and tailored to individual interests, may promote intrinsic motivation, peer connection, and sustainable engagement—factors especially relevant in pediatric ABI populations, who often experience reduced physical activity and social isolation. However, standardized, replicable protocols specifically tailored to this population remain scarce. This study presents the protocol for a randomized controlled trial evaluating the effects of a 16-week sport-based intervention on QoL, social participation, physical activity engagement, and motor functioning tailored for adolescents with pediatric ABI. Methods: Participants will be randomly assigned to an intervention group or a control group receiving usual care. The intervention consists of one weekly 60-minute session, led by trained professionals in adapted physical activity and pediatric neurorehabilitation. It combines sport-based motor skill training, cooperative games, and group activities specifically tailored to each child’s developmental level, motor abilities, and preferences. Outcomes will be assessed at baseline and following the 16-week intervention period, focusing on QoL, participation, physical activity engagement, and motor functioning. Discussion: This study introduces a structured, child-centered model that bridges clinical rehabilitation and community-based sport. By integrating motor and psychosocial targets through a group sport-based intervention, it aims to enhance recovery across ICF domains. Findings may inform interdisciplinary practice and support the development of sustainable strategies to promote long-term engagement and well-being in adolescents with ABI. Full article

Antimicrobial resistance (AMR) poses an increasing threat to public health, with wildlife recognized as reservoirs and vectors of resistant bacteria. However, the role of wild species in the ecology of AMR remains insufficiently understood, highlighting the need to investigate resistant bacteria in these animals. This study focused on detecting and characterizing Escherichia coli obtained from 43 fecal samples of white storks (Ciconia ciconia), cattle egrets (Bubulcus ibis), and European hedgehogs (Erinaceus europaeus) admitted to a wildlife rehabilitation center in Portugal. Resistance profiles to twelve antibiotics and six virulence factors were characterized phenotypically. ESBL production was also tested. A total of 79 E. coli isolates were obtained from 39 out of 43 samples, and 75 were selected for further characterization. All isolates tested negative for ESBL production. Approximately 64% (n = 48/75) of isolates were resistant to at least one antibiotic, and 5.3% (n = 4/75) were multidrug-resistant. Most frequent resistances were to ampicillin (36%, n = 27/75), tetracycline (12%, n = 9/75), and chloramphenicol (8%), while all isolates were susceptible to meropenem, aztreonam, and third-generation cephalosporins. Most isolates (81.3%, n = 61/75) lacked virulence factors. These findings suggest that wildlife may act as a reservoir of resistant strains, emphasizing importance of AMR monitoring and the One Health approach. Full article

Background/Objectives: Anosognosia for hemiplegia (AHP) is a multifaceted syndrome in which stroke survivors fail to recognize motor impairments. Although AHP has significant clinical implications, rehabilitation strategies have remained fragmented and underexplored. This systematic review aimed to critically evaluate rehabilitation interventions for AHP published between 2006 and 2025, categorize intervention types, and assess clinical outcomes to inform future research and practice. Methods: A structured search was conducted in the PubMed and PsycINFO databases on 31 March 2025, using predefined keywords related to stroke, anosognosia, and rehabilitation. The eligible studies included randomized controlled trials, case–control studies, and case studies. Following title, abstract, and full-text screening, nine studies focusing on rehabilitation interventions for AHP were selected and analyzed. Results: The interventions reviewed included sensorimotor recalibration techniques, neuromodulatory approaches, error-based cognitive training, and self-observation in video replay strategies. Interventions emphasizing motor intention monitoring, error correction, and self-observation were more consistently associated with durable improvements in motor awareness than neglect-based spatial interventions were. However, many studies were limited by small sample sizes and a lack of standardized outcome measures. Assessment methodologies vary widely, highlighting the need for multidimensional theory-driven evaluation tools. Conclusions: Effective rehabilitation for AHP requires strategies targeting disrupted self-monitoring and agency mechanisms, rather than spatial realignment alone. The video self-observation and error-based learning paradigms show particular promise. Future research should focus on controlled trials, longitudinal tracking, and the integration of individualized, mechanism-specific rehabilitation models to optimize outcomes for stroke survivors with AHP. Full article

Wildlife rescue centres face considerable challenges in promoting animal welfare and enhancing the care and housing conditions of animals under professional supervision. These challenges are further compounded by the diversity of species admitted, each with distinct specific needs. In Colombia and other Latin American countries, primates are among the most frequently rescued and behaviourally complex mammalian taxa, requiring particular attention. In response, this study aimed to assess the content validity of proposed animal welfare indicators for Cebus albifrons through a Delphi consultation process and to develop two species-specific assessment protocols: a daily-use tool for keepers and a comprehensive protocol for professional audits. A panel of 23 experts in primate care and rehabilitation participated in two consultation rounds to evaluate and prioritise the indicators based on their content validity, perceived reliability, and practicality. Indicators were classified as either animal-based (direct measures) or resource- and management-based (indirect measures). After each round, experts received summarised feedback to refine their responses and facilitate consensus building. Of the 39 initially proposed indicators, 28 were validated for inclusion in the extended protocol and 10 selected for the daily-use checklist. Among these, 20 indicators in the extended protocol and 6 in the daily protocol were resource- or management-based—such as adequate food provision, physical enrichment, and habitat dimensions—highlighting their practical applicability and relevance in identifying welfare issues and risk factors. Although these indirect indicators were more numerous, the top-ranked indicators in both protocols were animal-based, including signs of pain, affiliative behaviours, and abnormal repetitive behaviours. These are essential for accurately reflecting the animals’ welfare state and are therefore critical components of welfare assessment in captive non-human primates. This study demonstrates that welfare assessment tools can be effectively tailored to the specific needs of wildlife rescue centres, providing a robust foundation for enhancing welfare practices. These protocols not only offer practical approaches for assessing welfare but also underscore the importance of embedding animal welfare as a priority alongside conservation efforts. Future research should aim to refine these tools further, assess their implementation, and evaluate inter- and intra-observer reliability to ensure consistency across different settings. Full article

In socio-economically disadvantaged communities, the challenges faced by children with special needs are often overshadowed by more visible issues such as poverty, family instability, and substance abuse. Children, especially those with special needs, are particularly vulnerable in these settings as they are disproportionately impacted by intersecting adversities, including neglect, exploitation, and limited access to education and healthcare. These adversities create a vicious cycle, where disability exacerbates financial hardship, and in turn, economic deprivation negatively impacts early childhood development, further entrenching disability. Conventional models, which require physical presence and focus primarily on diagnosis and treatment within clinical settings, often fail to address the broader social, environmental, and contextual complexities of disability. We propose an Information Technology-based Exit Pathway as an innovative, scalable solution to disrupt this cycle. Anchored in the five pillars of the Community-Based Rehabilitation (CBR) matrix of Health, Education, Livelihood, Social, and Empowerment, the model envisions a multi-level digital platform that facilitates coordinated support across individual, familial, educational, community, regional, and national levels. By improving access to services, fostering inclusive networks, and enabling early intervention, the proposed approach aims to promote equity, social inclusion, and sustainable development for children with special needs in marginalized communities. Full article

Low back pain (LBP) remains one of the most prevalent and disabling musculoskeletal conditions globally, with profound social, economic, and healthcare implications. The rising incidence and chronic nature of LBP highlight the need for more objective, personalized, and effective approaches to assessment and rehabilitation. In this context, bioengineering has emerged as a transformative field, offering novel tools and methodologies that enhance the understanding and management of LBP. This narrative review examines current bioengineering applications in both diagnostic and therapeutic domains. For assessment, technologies such as wearable inertial sensors, three-dimensional motion capture systems, surface electromyography, and biomechanical modeling provide real-time, quantitative insights into posture, movement patterns, and muscle activity. On the therapeutic front, innovations including robotic exoskeletons, neuromuscular electrical stimulation, virtual reality-based rehabilitation, and tele-rehabilitation platforms are increasingly being integrated into multimodal treatment protocols. These technologies support precision medicine by tailoring interventions to each patient’s biomechanical and functional profile. Furthermore, the incorporation of artificial intelligence into clinical workflows enables automated data analysis, predictive modeling, and decision support systems, while future directions such as digital twin technology hold promise for personalized simulation and outcome forecasting. While these advancements are promising, further validation in large-scale, real-world settings is required to ensure safety, efficacy, and equitable accessibility. Ultimately, bioengineering provides a multidimensional, data-driven framework that has the potential to significantly improve the assessment, rehabilitation, and overall management of LBP. Full article

Background and Objectives: Facial paralysis involves the complete or partial loss of facial movement due to damage to the facial nerve, leading to impaired voluntary muscle function and facial asymmetry. Given its significant physical and psychosocial impact, there is an urgent need to strengthen the evidence supporting non-pharmacological treatments. This umbrella review aims to compile the most reliable and current data to establish a consensus on the effectiveness of such interventions for patients with facial paralysis. Materials and Methods: This study is an umbrella review. A systematic search was conducted in PubMed, Embase, Scopus, and CINAHL (28 July 2024). The variables assessed included overall healing/recovery rate, facial disability, and facial function. Methodological quality was evaluated using the AMSTAR and ROBIS tools. Screening was performed independently by two reviewers, with a third reviewer resolving any discrepancies. Results: Five systematic reviews were included, all evaluating the impact of non-pharmacological interventions in facial paralysis. The findings suggest that acupuncture and electrical stimulation may improve recovery rates and facial function, although high heterogeneity and methodological limitations were noted in some studies. No definitive conclusions could be drawn regarding facial disability. Conclusions: The combination of electrotherapy with other complementary techniques, such as facial exercises or laser therapy, appears to be a safe and potentially effective approach for facial paralysis rehabilitation. Nonetheless, further research employing standardized protocols and higher methodological quality is necessary to establish more robust conclusions for physiotherapeutic practice. Full article

Aim of the Study: To determine whether adding a lateral extra-articular tenodesis (LET) to primary anterior cruciate ligament reconstruction (ACLR) lowers graft-failure risk and improves functional recovery in competitive athletes with high-grade pivot-shift. Methods: Multicentre retrospective cohort with 1:1 propensity-score matching (age, sex, sport, graft, centre). Competitive athletes with pivot-shift grade ≥ 2 who underwent primary ACLR with hamstring or bone–patellar tendon–bone (BPTB) autografts (2018–2024) were eligible. The primary outcome was graft failure within 24 months (composite of revision ACLR, symptomatic rotatory laxity with pivot-shift ≥ 2 plus KT-1000 > 5 mm, or MRI-confirmed rupture). Time-to-event was summarised with Kaplan–Meier (KM) curves and log-rank tests. Secondary outcomes included residual rotatory laxity and functional performance (single-leg hop, side hop, Y-Balance) analysed as the proportion achieving Limb Symmetry Index ≥ 90% at 6 and 24 months and as continuous LSI means. Two-sided α = 0.05; secondary outcomes were prespecified without multiplicity adjustment. Results: Of 1368 ACL reconstructions screened, 97 eligible athletes were identified; 92 were analysed after matching (46 isolated ACLR; 46 ACLR + LET; mean follow-up 30.0 ± 4.2 months). KM survival at 24 months was 95.7% after ACLR + LET versus 82.6% after isolated ACLR (log-rank p = 0.046). The absolute risk reduction was 13.0% (Number Needed to Treat 8; 95% CI 4→∞). In graft-type subgroups, failures were 6/32 vs. 1/30 for hamstring and 2/14 vs. 1/16 for BPTB (ACLR vs. ACLR + LET, respectively); there was no evidence of interaction (Breslow–Day p = 0.56). At 6 months, a higher proportion of ACLR + LET athletes achieved LSI ≥ 90% across tests—single-leg hop 77.8% vs. 40.9% (p = 0.0005), side hop 62.2% vs. 34.9% (p = 0.012), Y-Balance 84.4% vs. 59.1% (p = 0.010), with a larger mean LSI (between-group differences +8.2 to +9.1, all p < 0.001). By 24 months, threshold attainment largely converged (all p ≥ 0.06), while mean LSI differences persisted but were smaller (+3.9 to +4.9, all p ≤ 0.001). Conclusion: In competitive athletes with high-grade pivot-shift undergoing accelerated, criteria-based rehabilitation, adding LET to primary ACLR was associated with lower graft-failure risk and earlier functional symmetry, with consistent effects across hamstring and BPTB autografts. Given the observational design, causal inference is limited; confirmation in randomized and longer-term studies is warranted. Full article

Background/Objectives: The coexistence of metabolic syndrome and COVID-19 presents a major challenge for healthcare systems, as individuals with metabolic syndrome are at significantly higher risk of severe disease and poor outcomes. The aim of this study was to assess how metabolic syndrome influences the outcomes of rehabilitation in patients recovering from COVID-19. Methods: This is a prospective observational study conducted at a rehabilitation hospital in Szczecin (Poland). One hundred and forty-six patients with COVID-19 were enrolled. Data on age, gender, BMI, comorbidities, and hospitalization were analyzed. The intervention included a comprehensive post-COVID-19 rehabilitation program. Data were collected using functional tests (6MWT and spirometry), and clinical records were analyzed. Results: Patients with metabolic syndrome had significantly higher BMI (p < 0.001), lower HDL cholesterol (p < 0.001), and higher triglyceride levels (p < 0.001) compared with the group without metabolic syndrome. After rehabilitation, both groups showed significant improvements in 6MWT distance (with MetS p < 0.001; without MetS p < 0.001) and FEV₁% predicted (MetS p = 0.025; without MetS p = 0.021). However, regression analysis shows that age was a significant negative predictor of 6MWT performance in both groups (p < 0.01), whereas hypertension and diabetes predicted worse post-rehabilitation outcomes in the group without MetS. Conclusions: Comprehensive rehabilitation after COVID-19 benefits all patients, regardless of the presence of metabolic syndrome. However, individual clinical factors such as age, hypertension, diabetes, and male gender are crucial to its effectiveness. This highlights the need for individualized rehabilitation programs, especially for patients with metabolic conditions, which can significantly increase the effectiveness of therapeutic interventions. Full article

Robotic-assisted rehabilitation has become an essential field in supporting the functional recovery of patients with neurological, musculoskeletal or post-traumatic conditions. This paper provides a systematic and applicative analysis of the control algorithms used in robotic rehabilitation systems, with a focus on the functional classification: position control, force, impedance, adaptive, artificial intelligence-based and hybrid schemes. The characteristics of each type of control, clinical applications, advantages and technical limitations are discussed in detail, illustrated by block diagrams and comparative graphs. The paper also includes a synthesis of existing commercial systems, a multi-criteria evaluation of the performance of the algorithms and an analysis of emerging trends in the recent literature (2020–2024). Current challenges regarding sensor integration, system standardization, real-time clinical feasibility and the applicability of brain–machine interfaces or adaptive myoelectric prostheses are discussed. The results obtained can support the development of efficient, safe and personalized solutions in the field of robotic rehabilitation. Full article

Soft–rigid interfaces in exoskeletons are key to balancing flexibility and structural support, providing both comfort and function. In our experience, combining Bioflex material with a rigid filament improves mechanical properties while allowing the exoskeleton to adapt to complex hand movements. Flexible components provide adaptability, reducing pressure points and discomfort during prolonged use. At the same time, rigid components provide the stability and force transfer necessary to support weakened grip strength. A key challenge in this integration is achieving a smooth transition between materials to prevent stress concentrations that can lead to material failure. Techniques for providing adhesion and mechanical locking are essential to ensure the durability and longevity of soft and rigid interfaces. One issue we have observed is that rigid filaments can restrict movement if not strategically placed, potentially leading to unnatural hand movement. On the other hand, excessive softness can reduce the force output needed for effective rehabilitation or assistance. Optimizing the interface design requires iterative testing to find the perfect balance between flexibility and mechanical support. In some prototypes, material fatigue in soft sections led to early failure, requiring reinforced hybrid structures. Addressing these issues through better material bonding and geometric optimization can significantly improve the performance and comfort of hand exoskeletons. The aim of this study was to investigate the transition between rigid and soft materials for exoskeletons. Full article

Background/Objectives: Patients with inappropriate sinus tachycardia (IST) and postural orthostatic tachycardia syndrome (POTS) exhibit complex clinical profiles due to autonomic dysfunction. While sinus node sparing (SNS) hybrid ablation is emerging as a promising therapy, there are no established guidelines worldwide for post-procedure patient management and care is mainly based on telemonitoring. In contrast, our hybrid cardiac rehabilitation (HCR) program integrates inpatient care and home-based telerehabilitation. We aim to evaluate the implementation of the HCR program, patient acceptance and adherence, and the effectiveness of the Malmö POTS scoring system in monitoring disease progression and rehabilitation outcomes. Methods: Patients underwent a personalized HCR program after SNS. The program included early mobilization, psychological support, respiratory therapy, and structured exercise. Clinical outcomes were assessed using symptom burden (Malmö POTS score), ECG parameters, exercise duration, perceived exertion, and rehabilitation adherence. Results: All patients completed the inpatient phase, and 87% completed the home-based phase. In the early postoperative period, pericarditis, anemia, and benign rhythm disturbances were mild and self-limiting. The Malmö POTS score decreased from 65.3 to 25.7. Lower perceived exertion early in the program correlated with clinical improvement. At the 2-month follow-up, 81% of patients no longer met the clinical criteria for IST/POTS without the use of medications. The program was evaluated as safe, feasible, and well-tolerated, with high patient satisfaction. Conclusions: A well-organized hybrid cardiac rehabilitation program after SNS is feasible, safe, and well-tolerated in IST/POTS patients. The Malmö POTS score may support outcome monitoring. The integration of individualized training and telemedicine represents a promising development for patients post-SNS ablation. While this study demonstrates feasibility and potential benefits, further controlled studies are needed to evaluate its impact on long-term recovery and symptom control. Full article

The role of blood pressure variability (BPV) as an important marker of cardiovascular (CV) health, specifically its relationship with arterial stiffness and left ventricular remodeling in patients with hypertension, was investigated. This review aimed to elucidate the intricate relationship between BPV, arterial stiffness, and cardiac remodeling. BPV, as both a risk factor and a target of treatment, was also evaluated. The results point to the pivotal role of BPV in cardiovascular events, serving as an independent factor contributing to arterial stiffness and adverse left ventricular remodeling. The article concludes that BPV is a modifiable risk factor and that there is a need for an intervention in specific regions. BPV is a therapy target that is significant in the treatment of hypertension. The optimization of risk and prevention needs a multidisciplinary approach involving rehabilitation therapy, which will improve cardiovascular conditions and patient outcomes. Full article