Search Results (273)

Spinal cord injury (SCI) is an acute, devastating neurologic condition that results in permanent progressive motor deficits, sensory disturbances, and autonomic dysfunctions, which limit function, participation, and quality of life. Although substantial progress has been made during the last several decades for both early trauma care and rehabilitation protocols following SCI, long-term neurological recovery remains unpredictable and often incomplete. This manuscript summarizes mechanistic and clinical evidence regarding robotic-assisted rehabilitation (RAR) and spinal neuromodulation (SN), which have been published since 2010 until the present time in a structured narrative review of the literature on these two emerging areas for neurorehabilitation after SCI. RAR provides high-intensity, task-specific training that consistently results in improvements in functional outcomes such as balance, coordination, and independence; however, its impact is limited when it comes to walking speed or voluntary motor control. SN (particularly epidural stimulation) can activate the residual neural pathways to standing up and stepping even after a complete injury but effects are typically stimulus dependent, with heterogeneous clinical results that often lack strong long-term evidence due in part to variability in patient selection, stimulation parameters and rehabilitation protocols. However, there is emerging mechanistic data supporting combining modulation of excitability through SN approaches along with structured sensorimotor training as an approach for enhancing recovery. Collectively, these findings support a shift toward more physiology-driven neurorehabilitation strategies and the need for future research to improve clinical translation and outcome predictability by patient stratification using standardized intervention protocols that include longitudinal evaluation. Full article

Background: Posterior spinal fusion is the mainstay of treatment for Cobb angle over 50 degrees with satisfactory long-term results. In the surgical management of scoliosis, surgeons usually focus on the amount of coronal curvature correction because it can determine the surgical outcome. Nevertheless, there are many factors that contribute to patients’ satisfaction after surgery, and achieving shoulder balance is one of the most vital factors of a successful surgery. Our objective is to study the differences in managing idiopathic scoliosis with pedicle screws versus hybrid fixation with regard to shoulder imbalance postoperatively. Methods: Continuous variables were described using mean and standard deviation, whereas categorical variables were described using frequencies. The association between predictor independent variables with the analyzed outcomes were expressed as (beta coefficients) with their associated 95% confidence intervals. The Alpha significance level was considered at 0.050 level. Results: The mean angle of the clavicle measured a significant drop post-surgery compared to their pre-surgical measured mean clavicular angle, p-value < 0.001, and so did the coracoid height difference: p-value < 0.001. Furthermore, the participants had measured a significantly lower mean angle of the clavicle compared to their baseline; p-value = 0.029, regardless of their surgery type. The participants mean measured coracoid height difference score had correlated positively with their mean angle of the clavicle: beta coefficient = 1.654, p-value < 0.001; when the coracoid height difference increased, so did the mean angle of the clavicle. Conclusions: Posterior spinal fusion is effective in correcting coronal curvature and improving radiographic shoulder asymmetry in AIS. Significant improvements were observed in Cobb angle, clavicle angle, and coracoid height difference, with pedicle screw constructs providing superior curve correction. These findings reinforce the value of individualized surgical planning that considers coronal, sagittal, and cosmetic alignment goals. Full article

Understanding how users perceive assistive robotic systems is critical for their successful adoption, particularly in rehabilitation settings where both patients and clinicians influence decision-making. While prior work has focused on technical performance and overall usability, affective responses such as trust, control, and perceived independence are often captured using coarse, single-score measures that overlook important nuances. This study analyzes focus group discussions with individuals with spinal cord injury to examine how users evaluate different aspects of assistive robot design. A hybrid aspect-based sentiment analysis approach is applied, combining lexicon-based and transformer-based methods to capture both interpretable and context-sensitive sentiment. The analysis separates sentiment across key dimensions, including independence, functionality, safety, control, cost, and data sharing. Participants expressed consistently positive views toward independence and functional support, while responses related to safety, control, and data sharing were more conditional. In particular, trust emerged as something that depends on transparency, user control, and the ability to override system behavior, rather than a fixed attitude toward the technology. These findings suggest that successful assistive robotic systems must balance autonomy with user authority and provide clear, adaptable mechanisms for control and data governance. Full article

Background/Objectives: Strength training is a widely recommended form of physical activity due to its extensive health benefits and positive effects on musculoskeletal function, although improper technique and balance deficits may increase injury risk. While sex differences in spinal curvature and postural control have been identified in the general population, it remains unclear whether these differences persist among recreationally strength-trained individuals. This cross-sectional study investigated sex-specific differences in sagittal spinal alignment and static balance and examined potential associations between spinal curvature and postural control in trained young adults. The authors hypothesized that sex-related differences would persist despite regular training and that relationships between spinal alignment and balance would demonstrate sex-specific patterns. Methods: This cross-sectional study included 124 young adults (59.7% men and 40.3% women). Anthropometric measurements included height, weight, waist circumference, and hip circumference. Sagittal spinal curvature was assessed using an electronic inclinometer, and balance parameters were evaluated using a stabilometric platform under eyes-open and eyes-closed conditions. Results: Statistically significant sex-related differences were observed in sacral angle (p < 0.001) and lumbar lordosis (p = 0.02). Balance assessment revealed significant differences between sexes in several parameters under eyes-open conditions (p < 0.05), as well as in mean COP velocity in the anteroposterior direction under eyes-closed conditions (p = 0.003). In women, sacral inclination was positively but weakly correlated with selected balance parameters (r = 0.299–0.306, all p < 0.05), indicating an association between spinal alignment and postural control. Conclusions: The findings indicate sex-specific differences in sagittal spinal curvature and balance, with sacral alignment associated with balance performance in women. Differences in selected balance parameters were also observed independently of spinal curvature. These results highlight the importance of considering sex and spinal biomechanics when assessing postural control in strength-trained individuals and support further research in larger, more diverse populations with varying training experience and age ranges. Full article

The central nervous system (CNS), comprising the brain and spinal cord, represents the core regulatory hub of the body. Damage to the CNS often leads to irreversible structural and functional impairments of neural tissues, posing a major global public health challenge. Immune memory encompasses two states: immune training and immune tolerance, which are characterized by enhanced or attenuated immune responses, respectively, following initial exposure to external stimuli in immune cells such as monocytes and macrophages. Microglia, the resident immune cells of the CNS, can be rapidly activated by external stimuli. Accumulating evidence indicates that microglial immune memory plays a critical role in sustaining states and neuroinflammatory responses in CNS disorders. Specifically, the immune training state promotes amyloid-β (Aβ) accumulation in the brains of Alzheimer’s disease (AD) model mice, thereby exacerbating neuronal damage, whereas the immune tolerance state suppresses pro-inflammatory cytokine expression and alleviates neuroinflammation. This review focuses on two immune memory states in microglia—training and tolerance—and what triggers them. We summarize their roles and mechanisms in CNS diseases. Specifically, we break down how epigenetic and metabolic reprogramming control microglial immune memory, with an emphasis on how these two processes interact during memory formation and maintenance. Our goal is to fill key knowledge gaps about their combined effects and to suggest new therapeutic targets. Evidence shows that immune memory acts as a “double-edged sword” in the CNS: it can either fuel harmful inflammation and worsen damage, or, when moderately activated, protect nerves. Therefore, precisely balancing these two states could help reduce harmful inflammation while preserving the protective functions of microglia, offering a new, reversible immunotherapy for CNS diseases. Full article

This study aimed to explore athletes’ experiences of transitioning out of sport following spinal cord injury (SCI). Using a multiple-case study design, three former nondisabled competitive athletes participated in one-on-one semi-structured interviews. The participants’ interview responses were informed by quantitative measure data collected prior to the interviews using the Athletic Identity Measurement Scale, the Social Support Questionnaire-6, and the Satisfaction with Life Scale. The thematic analysis of the interviews revealed that participants experienced a range of cognitive, emotional, social, and behavioral influences during the transition process. These influences contributed to outcome-related appraisals of post-SCI transition. Balanced self-identity, adaptive sport participation, and peer-mentor relationships were common factors influencing athletes’ transition with spinal cord injury. The results partially support the conceptual model of adaptation to career transition and extend it to account for athletes’ experiences following SCI. The results also benefit rehabilitation professionals and athletes with spinal cord injury by providing insight into psychosocial factors and resources that may influence the transition experience. Full article

Background/Objectives: Wolfram syndrome type 1 (WS1) is a rare, progressive, multisystem neurodegenerative disorder characterized by diabetes mellitus, optic atrophy, diabetes insipidus, and sensorineural hearing loss. As survival has improved, an increasing number of affected women are reaching reproductive age. However, evidence on pregnancy and peripartum management in WS1 remains scarce, and practical guidance is limited. This case report describes the multidisciplinary management of pregnancy and delivery in a woman with genetically confirmed WS1 and highlights key considerations for peripartum care. Case Presentation: A woman with genetically confirmed WS1 and long-standing multisystem involvement, including diabetes mellitus, diabetes insipidus, neurogenic bladder requiring frequent self-catheterization, progressive neurologic manifestations, and severe sensory impairment, achieved pregnancy through assisted reproduction with oocyte donation and was closely monitored by a multidisciplinary team. Due to persistent breech presentation, a planned external cephalic version was performed at 37 + 5 weeks’ gestation with immediate availability for cesarean delivery. After unsuccessful attempts, cesarean delivery was performed under combined spinal–epidural anesthesia. Peripartum management focused on strict glycemic control, careful monitoring of fluid balance and urine output, neuraxial anesthesia with proactive hemodynamic management, precautions related to the cochlear implant, and tailored communication strategies. Postpartum recovery was favorable, although anemia on postoperative day 1 required transfusion of one unit of packed red blood cells and intravenous iron therapy. Discussion and Conclusions: Pregnancy in WS1 represents a high-risk clinical scenario because of the coexistence of endocrine, urologic, and neurologic comorbidities, while published evidence on peripartum management remains limited. This case supports an individualized, multidisciplinary approach to obstetric and anesthetic planning and the use of a practical framework to optimize peripartum management and enhance maternal–fetal safety in this rare condition. Full article

Background and Objectives: The association between spinal and pelvic alignment significantly impacts sagittal balance in adults. This study, that is retrospective, aims to investigate sagittal alignment anatomy of the pelvis and spine in juvenile idiopathic scoliosis (JIS) and adolescent idiopathic scoliosis (AIS) patients. Materials and Methods: We evaluated nine sagittal parameters from lateral radiographs of 100 JIS and AIS patients, including thoracic kyphosis (TKA), lumbar lordosis (LLA), pelvic tilt (PTA), pelvic incidence (PIA), spinosacral (SSA), sacral slope (SSLA), C7 tilt angles (C7-TA), sagittal vertical axis length (SVAL), and odontoid process hip axis angle (OPHAA) using the ImageJ program. Participants were classified based on their coronal curve group. Analysis of variance compared parameters between curve groups, and Pearson coefficients assessed the relationship between all parameters (p < 0.05). Results: Female participants had an average age of 13.4, and male participants had an average age of 13.0. Female participants had an average scoliosis degree of 19.3, while male participants had 15.2. PIA, PTA, SSLA, and SSA values were significantly higher in women participants than in men participants (p < 0.05). Additionally, PIA, PTA, SSLA, SSA, and OPHAA values were significantly lower in participants with a lower scoliosis degree (p < 0.05). We observed a moderately positive association between LLA and TKA, PIA, SSA, and C7-TA. There was also a moderate positive association between spinopelvic alignment parameters and the degree of scoliosis in participants. Conclusions: Easily measured values such as PIA, PTA, SSLA, SSA, and OPHAA may be related to severity of vertebral column deformities in patients, making them valuable for monitoring scoliosis patients. Full article

Postural balance is a foundational component of human motor behavior, yet it remains conceptually ambiguous and methodologically heterogeneous across the clinical, educational, and sport sciences. This narrative review aims to provide an integrative framework that clarifies key concepts (postural control vs. postural balance), synthesizes the main sensorimotor and biomechanical mechanisms underpinning balance, and organizes current assessment approaches and functional implications across populations. Narrative literature synthesis was conducted to integrate evidence covering multisensory integration and sensory reweighting, central neural control (spinal, brainstem, cerebellar, and cortical contributions), neuromuscular and biomechanical strategies (e.g., ankle/hip/stepping), and cognitive influences (e.g., dual-task effects). We further summarize commonly used instrumental outcomes derived from force-platform center-of-pressure metrics and widely adopted clinical and functional balance tests, highlighting their typical applications and limitations across the lifespan including pediatric, general adults, older adults, and athletic populations. This review proposes a closed-loop, systems-based model in which postural balance is conceptualized as an emergent functional outcome arising from distributed postural control processes shaped by task, environmental, and individual constraints. In conclusion, integrating mechanistic understanding with population-specific assessment enhances interpretability and supports more precise, context-sensitive balance evaluation and intervention in both health and performance settings. Full article

Background: Adolescent idiopathic scoliosis (AIS) is often associated with central nervous system disorders and deficits in sensorimotor function. While the Schroth method is a common clinical intervention, research evidence regarding its effectiveness in enhancing sensorimotor control remains limited. This study aimed to evaluate the impact of the Schroth method on sensorimotor control and quality of life (QoL) in AIS patients. Methods: Sixty female participants (mean age 13.4 years) with Cobb angles between 10° and 45° were divided into an intervention group (n = 30), receiving Schroth exercises and bracing for 10 weeks, and a control group (n = 30), receiving bracing alone. Outcome measures included static and dynamic balance, spine lateral flexion joint position sense (JPS), upper-limb functional proprioception, and the GR-BSSQ Brace questionnaire. Results: Statistical analysis using two-way mixed ANOVA revealed significant Group × Time interactions across several parameters. The Schroth group showed significant improvements in static and dynamic balance, with ellipse area reduction (p = 0.005) and reduced Fukuda test distance (p = 0.007), respectively. Significant enhancements were noted in spine lateral flexion JPS (Bilateral p = 0.008) and upper-limb proprioception (Bilateral p = 0.000). Furthermore, the intervention group reported a significant improvement in QoL scores compared to the control (p = 0.000). Conclusions: The findings demonstrate that the Schroth method was associated with enhanced sensorimotor control, supporting its use as a targeted approach to improve functional outcomes in individuals with AIS. These results highlight the clinical value of the method, beyond spinal curve correction. Full article

Background: Interbody spinal fusion is a common surgical treatment for degenerative, traumatic, and deformity-related spinal pathologies. Despite advances in cage geometry and fixation strategies that improve alignment and early stability, reliable fusion remains limited by the mechanical and biological constraints of conventional interbody implant materials. Traditional titanium and polymer-based cages often fail to optimally balance load sharing, osteointegration, and biological activity within the mechanically demanding interbody environment. This narrative review examines the development and translational potential of 3D-printed interbody fusion devices, with emphasis on how additive manufacturing enables the integration of mechanical performance with biologically active scaffold design. Methods: A thorough literature review was performed to evaluate the evolution, design principles, material properties, and translational outcomes of three-dimensional (3D)-printed interbody fusion devices. Results: Additive manufacturing enables precise control over implant architecture, allowing for the fabrication of porous, lattice-based cages with tunable stiffness, optimized load sharing, and enhanced bone–implant integration. Preclinical and early clinical studies suggest that 3D-printed porous titanium cages may reduce subsidence, promote osteointegration, and improve fusion-related outcomes compared with conventional designs. Emerging evidence indicates that scaffold porosity, surface microtopography, and bioactive coatings influence macrophage polarization, angiogenesis, and osteogenic signaling. Polymeric and composite constructs, particularly hybrid designs incorporating surface functionalization, represent promising adjuncts, though clinical evidence remains limited. Conclusions: Three-dimensional printing represents a paradigm shift in interbody fusion device design. Continued translational research and longer-term clinical follow-up are required to validate efficacy and guide widespread clinical adoption. Full article

Polyether ether ketone (PEEK) is a high-performance thermoplastic with potential applications in aerospace, automotive, and biomedical components, owing to its exceptional specific strength, thermal stability, and biocompatibility. However, its moderate hardness and limited wear resistance in dry sliding severely constrain its use in highly loaded tribological contacts. In this study, PEEK-based reinforced hybrid composites were produced utilizing a powder metallurgy technique, with reinforcement fractions of 10 wt.% graphite (Gr), boron (B), hydroxyapatite (HAp), and zirconium (Zr). The processing sequence included homogeneous wet-mixing, uniaxial cold compaction at pressures of 10–30 MPa, and sintering at 250–300 °C. The composition and microstructures were characterized by X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Mechanical and tribological performances were assessed by Vickers microhardness, uniaxial compression and dry sliding wear tests. The best-performing Gr-B hybrid composite increased hardness by 240% and compressive strength by 175% compared with unreinforced PEEK. Tribologically, boron-containing PEEK demonstrated up to a 34.7% reduction in the coefficient of friction and approximately a 90% drop in wear-induced mass loss compared with unreinforced PEEK. The resulting Gr-B-reinforced PEEK hybrids are excellent choices for demanding load-bearing and tribological components like aerospace bushings, automotive sliding elements, spinal cages, and orthopedic fixation devices in biomedical applications because of their balanced combination of high hardness, superior wear resistance, and high compressive strength. Full article

Background/Objectives: Selection of the upper instrumented vertebra (UIV) in Lenke type 1 adolescent idiopathic scoliosis (AIS) influences postoperative proximal balance; however, the long-term clinical relevance of radiographic differences remains uncertain. This study evaluated long-term radiological and clinical outcomes in a homogeneous Lenke type 1 AIS cohort undergoing posterior spinal fusion with UIV selection at T2 or T4. Methods: During the study period, 120 consecutive Lenke type 1 AIS patients underwent posterior spinal fusion. Twelve patients who developed major postoperative complications were excluded, resulting in a final cohort of 108 patients (T2: n = 61; T4: n = 47). Patients requiring posterior column osteotomies were excluded to maintain surgical homogeneity. Radiological parameters, including coronal and sagittal alignment, proximal balance measures, and curve flexibility, were assessed preoperatively, postoperatively, and at a minimum follow-up of five years. Clinical outcomes were evaluated using validated Turkish versions of the Pediatric Quality of Life Inventory (PedsQL) and the Scoliosis Research Society—22 revised questionnaire (SRS-22r). Longitudinal within-group changes were analyzed. Results: Substantial correction of the main thoracic curve was achieved postoperatively and maintained at long-term follow-up within each cohort (p < 0.001). Preoperative bending radiographs demonstrated preserved curve flexibility, indicating that postoperative alignment differences were not attributable to baseline rigidity. Proximal coronal and shoulder balance parameters improved over time within each cohort, with residual differences observed according to UIV selection. Psychosocial domains of the PedsQL and SRS-22r improved significantly over time within each cohort. In contrast, PedsQL physical functioning scores declined significantly at long-term follow-up (p < 0.001), consistent with fusion-related stiffness rather than global clinical deterioration. No clinically meaningful divergence in patient-reported outcome trajectories was observed according to the UIV strategy. Conclusions: In Lenke type 1 AIS, UIV selection influences long-term proximal balance-related radiological parameters but does not confer a clinically meaningful advantage in patient-reported outcomes. Both T2 and T4 strategies provide durable deformity correction and sustained multidimensional recovery when guided by individualized criteria. Prospective multicenter investigations are warranted to further clarify the clinical relevance of proximal balance metrics. Full article

Leisure time physical activity (LTPA) plays a vital role in preventing and managing chronic diseases in people with disabilities (PWD). Using virtual reality (VR) can help people feel more comfortable and confident about LTPA. The aim of this study is to identify research focusing on VR, LTPA, and people with motor disabilities. Methods: A scoping review was completed by searching MEDLINE, CINAHL, SportDiscuss, Academic Search Premier, and Web of Science in June 2024 (updated July 2025). Eighteen studies were included. Results: Most studies examined cycling (56%) and targeted post-stroke (28%) and spinal cord injury (22%) populations. VR interventions showed potential to improve various domains such as functional mobility, motor function, and psychosocial well-being. A total of 35 distinct outcome measures were identified, categorized into motor/balance, physiological, psychological, user experience, and performance themes. Conclusions: While most VR interventions used LTPA primarily as a therapeutic tool, some were designed to teach sport-specific skills to facilitate participation outside the clinical setting. Future research should examine how VR can aid rehabilitation and prepare PWD for sustained engagement in LTPA. Full article

Osteoarthritis is associated with chronic inflammation, which contributes to a hypercoagulable state. Oxidative stress may further disrupt homeostatic balance, thereby promoting thrombotic events. This study evaluated the association between biomarkers of oxidative stress, inflammation, haemostasis, and bone metabolism in patients with spinal osteoarthritis. A total of 48 patients were included. The levels of inflammatory, bone turnover, haematological, and coagulation biomarkers were determined using standard laboratory methods. Redox status was assessed via prooxidant–antioxidant balance (PAB) and superoxide dismutase (SOD) activity. Patients with elevated PAB showed significantly higher erythrocyte sedimentation rate (ESR) (p = 0.005), alkaline phosphatase (ALP) (p = 0.003) and fibrinogen levels (p = 0.006) and platelet count (p = 0.040), along with lower 25-OH vitamin D levels (p = 0.045) and shortened PT (p = 0.008) and aPTT (p = 0.017). In low oxidative stress states (PAB < 100 U/L), significant correlations were observed among redox, coagulation, and bone turnover markers, whereas in high oxidative stress (PAB ≥ 100 U/L), it was characterised by predominant associations between redox and bone turnover biomarkers. Patients with grade V disc degeneration had a significantly higher probability of elevated D-dimer levels compared to those with grade IV (OR = 5.440; p = 0.009). In addition, elevated D-dimer levels were associated with increased ESR (p = 0.015), IL-6 (p = 0.016) and ALP levels (p = 0.034). The associations between biomarkers of redox status, inflammation, coagulation and bone turnover are influenced by the extent of oxidative stress. Our results suggest that PAB and D-dimer may serve as potential biomarkers for disease severity and thrombotic risk. Further studies are needed to confirm these preliminary findings. Full article