Search Results (2,973)

Background/Objectives: Choosing the best prosthetic foot for a patient is complicated by the many available options and limited evidence to distinguish them. This work aimed to clarify performance differences in the level-ground walking of K3-functional-level persons with amputations across a variety of prosthetic feet within the energy storage and return class. Methods: This clinical trial assessed 10 subjects fitted with the Ossur ProFlex foot (LP and XC) compared to their original foot after a 30-day adaptation period and careful prosthetic alignment matching. Multivariate data (walking performance, noise/play, balance and satisfaction) were collected in the gait laboratory. Results: Results were mixed across the cohort. MCID and statistical analysis were used to assess the magnitude and importance of the changes observed. Overall, the changes were small and not statistically significant. Conclusions: Our findings support that performance across a variety of measures for K3-level amputees walking over level ground is relatively insensitive to prosthetic foot componentry within the energy storage and return class. While functional performance is not the only metric that contributes to foot choice, it is an important one. This study helps to circumscribe its role in the larger decision-making framework for this class of componentry in persons with transtibial amputation. Full article

Reduced arm swing frequently occurs in older adults and is associated with declined gait performance. Experimental studies have demonstrated that restricting arm swing decreases stride length and walking speed, whereas deliberately increasing arm swing can improve these gait parameters. This study evaluated whether a wearable haptic feedback system could effectively increase arm-swing amplitude and assess its effects on spatiotemporal gait outcomes during overground walking. Using a within-subject repeated-measures design, twelve community-dwelling older adults (6 males/6 females; $75.8\pm 6.5$ years) completed three no-feedback conditions (Baseline, Exaggerated, Fast) and six feedback conditions varying Direction (Forward, Backward, Combined) and target Magnitude (+100%, +200% of the Baseline). The arm-swing angle was estimated in real time from upper-arm inertial measurement unit (IMU) sensors; targets were defined for peak Forward flexion and/or peak Backward extension, and vibrotactile cues were delivered when the corresponding peak failed to reach the target. The arm range of motion (ROM) increased significantly across conditions, with the largest increase during Feedback (+229%), exceeding Exaggerated (+120%) and Fast (+64%) (all $p<0.001$). Walking speed and stride length also increased during Feedback relative to the Baseline ($p<0.001$). Within feedback conditions, the arm ROM showed independent main effects of the Direction and Magnitude, whereas gait outcomes were primarily influenced by Direction. Arm-swing symmetry was largely preserved, with the smallest variability during Feedback. These findings support the feasibility of vibrotactile feedback to enhance arm swing and improve gait outcomes in older adults. Full article

Background: Toe motor control contributes to postural stability and walking, yet clinical assessments have focused on toe-grip strength. The kinematics of selective toe extension under conditions requiring non-target toes to remain in contact with the ground remain poorly quantified. The aim of the present study was to characterize the kinematics and reliability of selective toe extension tasks using three-dimensional motion capture and to compare young and older adults. Methods: A total of 40 participants (20 young adults and 20 older adults) performed three tasks twice: all-toe extension, selective hallux extension, and selective four-toe extension (toes 2–5), with non-target toes required to remain in contact with the ground during selective tasks. Extension angles of the hallux, second, and fifth toes were quantified, and toe-grip strength was measured. Reliability was assessed using the intraclass correlation coefficient (ICC(1,2)). Toe angles were analyzed using two-way analysis of variance (group × condition, including resting and task conditions). Results: Toe angles demonstrated moderate to excellent reliability (ICC(1,2) = 0.81–0.95; 95% CI: 0.637–0.974). Compared with all-toe extension, both selective tasks showed reduced extension ranges, indicating an incomplete extension phenomenon in both groups. Significant group × condition interactions were observed for the hallux and second toes. During selective tasks, older adults exhibited greater unintended extension of non-target toes. Toe-grip strength was significantly lower in older adults (p < 0.001, Cohen’s d = 2.51). Conclusions: Selective toe extension tasks provide reliable kinematic indices of inter-toe motor control by quantifying incomplete extension and associated movements. Older adults showed greater associated movements under ground-contact constraints, suggesting age-related declines in motor coordination and possible reductions in toe flexor strength. Full article

Background and aim: Traditional marker-based optical motion capture systems are costly, time-consuming to operate, and constrained by laboratory environments, limiting their broader adoption in clinical practice and naturalistic settings. Markerless motion capture based on a sums-of-Gaussians (SoG) body model is a potential alternative; however, its metrological properties for kinematic assessment during walking and slow running remain insufficiently validated. Using a conventional marker-based Vicon system as the reference, this study evaluated the reliability and concurrent validity of an SoG-based markerless system (MocapGS) for bilateral lower-limb joint range of motion (ROM) during gait. Methods: Thirty-six healthy adults completed self-selected-pace speed walking and slow running tasks while both systems synchronously acquired bilateral lower-limb kinematics. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), SEM percentage (SEM%), minimal detectable change (MDC), MDC percentage (MDC%), and root mean square error (RMSE) were used to assess reliability. Concurrent validity was evaluated using the Pearson correlation coefficient, paired-sample t-tests, and the concordance correlation coefficient (CCC) to compare the ROM. Results: Vicon showed moderate-to-high reliability for ROM in most joints across both tasks. By contrast, the MocapGS achieved acceptable ICC values mainly for the sagittal-plane ROM at the hip and knee. The CCC analysis showed no significant agreement between the two systems. Bland–Altman plots showed systematic biases with spatially heterogeneous random errors. During walking, MocapGS systematically overestimated ROM relative to Vicon at several joint axes; the widest limits of agreement (LOA) occurred at the left knee X-axis and right hip Z-axis. During running, overestimation was consistent across all bilateral joints at the X-axis and the right hip at the Y-axis, while the widest LOA were found at the bilateral hip X-axes. These specific discrepancies highlighted the joint–axis combinations with the greatest measurement variance. In walking, the test–retest reliability of the knee flexion–extension ROM measured by the MocapGS approached that of Vicon; however, the SEM% and MDC% were generally larger for MocapGS than for Vicon. The RMSE exceeded 5 degrees for ROM in most joint planes, especially in the frontal and transverse planes and at distal joints; errors increased further during slow running. Conclusions: MocapGS may be used for coarse monitoring of large-magnitude changes in sagittal-plane kinematics during gait; however, it is currently unlikely to replace Vicon for clinical decision-making or detecting subtle gait changes, and its outputs should be interpreted with caution, particularly for ankle kinematics and non-sagittal-plane motion. Full article

This study develops and evaluates machine learning models for classifying Korean Baseball Organization (KBO) playoff advancement using pitching metrics from 2015 to 2024 (N = 100 team-seasons), focusing specifically on pitching’s contribution to playoff qualification to address the ERA-FIP paradox at the team level. Five algorithms were compared: Random Forest, Support Vector Machines, Logistic Regression, Neural Networks, and Decision Trees. Independent variables included ten pitching statistics: Earned Run Average (ERA), Walks and Hits per Inning Pitched (WHIP), Fielding Independent Pitching (FIP), Strikeouts per 9 Innings (K/9), Walks per 9 Innings (BB/9), Strikeout-to-Walk Ratio (K/BB), Home Runs per 9 Innings (HR/9), batting average against (BAA), and opponent On-Base Percentage (OBP) and On-Base Plus Slugging (OPS). Logistic Regression achieved the highest classification performance with an Area Under the Receiver Operating Characteristic Curve (AUC) of 0.804 and classification accuracy of 73.0%, followed by Neural Network (AUC = 0.799, CA = 72.0). Feature importance analysis showed ERA and WHIP, both defense-dependent metrics, as the dominant predictors of postseason qualification, collectively accounting for 33.7% of information gain, while FIP ranks fifth, indicating that defense-dependent metrics are more informative for team success than defense-independent measures. The findings highlight the strategic importance of pitching–defense synergy, demonstrate the applicability of machine learning-based playoff classification beyond Major League Baseball, and provide empirical evidence that defense-dependent metrics (ERA, WHIP) exhibit superior discriminatory power compared to defense-independent metrics (FIP) for team playoff qualification. Findings reflect pitching’s contribution to playoff success; comprehensive models integrating hitting, defense, and managerial factors would provide more complete classification frameworks. Full article

Background: Cerebral palsy (CP) is the most common cause of disability in developmental age, affecting motor and postural skills. With growth, lower-limb orthopedic surgery often becomes necessary. Post-surgical walking rehabilitation programs generally involve conventional therapy with only limited evidence on the use of robot-assisted gait training (RAGT). The aim of the present pilot study is to assess the feasibility and the preliminary functional outcomes of an intensive 3-week rehabilitation of 15 sessions with Lokomat combined with 15 sessions of conventional physiotherapy. Methods: In total, 27 patients with diplegic cerebral palsy who underwent orthopedic surgery were recruited. Outcomes collected: the 6 min walking test (primary outcome), the Gross Motor Function Measure-88, the Gillette Functional Assessment Questionnaire, 3D gait analysis, and spasticity and force metrics of the lower limbs. Paired statistical tests were used to assess pre–post changes. Results: A pre–post statistically significant improvement was observed in gait endurance in the 6MWT (Δ = 28.56 ± 34.28 m; p < 0.001) and in gross motor functional skills. Gait parameters showed some functional and structural improvements, and joint stiffness was reduced in some measures. Conclusions: This combined rehabilitative approach seems to be promising in postoperative patients with CP. Future studies, involving a control group and larger sample size, are needed to generalize our results. Full article

Urban green spaces (UGSs) are crucial for public health by supporting leisure-time physical activities (LTPAs), but the mechanisms by which micro-scale UGS features shape different LTPA types remain unclear. In this study, the relationship between the micro-scale features of UGSs and LTPAs was investigated in 63 sample plots of nine comprehensive parks in downtown Shanghai. Using the behavior annotation method and multiple linear regression analysis, we identified significant correlations between the UGS features and LTPA types. The results showed that sitting and chatting (SC) activities had the highest participation rate at 46.84%, while sports and fitness (SF) activities had the lowest at 9.82%. Walking and sightseeing (WS) activities and culture and entertainment (CE) activities accounted for 19.99% and 23.35% of participants, respectively. Spatial accessibility (SA) and canopy coverage ratios (CCRs) were significantly negatively correlated with SC, while seat number (SN), ground-cover density (D_GNC), and three-dimensional green quantity (TGQ) were positively correlated. For WS, SN and tree density (D_TREE) were positively correlated, while TGQ was negatively correlated. CE activities were positively associated with SN, D_TREE, and Shannon’s diversity index of ground-cover (SHI_GNC) but negatively associated with Shannon’s diversity index of trees (SHI_TREE). The regression models explained 65.9%, 38.3%, and 44.3% of the variance in SC, WS, and CE, respectively, while the overall model was not significant for SF. These findings highlight the need to optimize rest facilities, vegetation diversity, and spatial layout in UGS design to accommodate diverse LTPA needs and foster health-oriented environments. The conclusions are mainly applicable to seasons with mild climates, and LTPA characteristics in different seasons require further verification. Full article

Background: Diabetes-related foot complications are among the most common complications in individuals with type 2 diabetes mellitus. The prevention of foot problems that are at risk of developing because of type 2 diabetes mellitus should be addressed within the framework of preventive approaches prior to treatment. The aim of this study was to evaluate protective sensation in people with type 2 diabetes mellitus who have not been diagnosed with early diabetes-related foot complications and to investigate the effects of protective sensation on peripheral muscle strength, balance, and functional capacity. Methods: This study included 42 volunteer patients (56.71 ± 7.59 years) who were followed up with a diagnosis of type 2 diabetes mellitus and met the inclusion criteria. Individuals were evaluated prospectively and via face-to-face interviews. Light-touch, vibration, and discrimination sense was evaluated to determine protective sensation. Peripheral muscle strength (quadriceps femoris, biceps brachii, and hand grip) was measured and a 6 min walking test for functional capacity and balance evaluation were performed. Spearman correlation analysis was conducted using SPSS Statistics 21.0 for data analysis. Results: At least one of the components of protective sensation was moderately correlated with peripheral muscle strength, functional capacity, and balance scores. Reduced protective sensation was also observed in individuals with type 2 diabetes mellitus without neuropathy. Conclusions: In type 2 diabetes mellitus patients, decreases in light-touch, vibration, and discrimination sense are moderately associated with parameters of peripheral muscle strength, functional capacity, and balance. In patients with type 2 diabetes mellitus, early foot sole sensory examination may prevent the development of neuropathy and support clinicians in early diagnosis. Full article

Background and Objectives: This study aimed to verify the validity of markerless gait analysis using both single-camera markerless system (S-ML) and multi-camera markerless system (M-ML) approaches by comparing them with a gold-standard marker-based system (MB). Materials and Methods: Sixteen healthy adults walked at their gait speed, and their gaits were simultaneously analyzed using three systems: S-ML, M-ML, and MB. Intraclass correlation coefficients were used to assess the reliability of the spatiotemporal parameters, and the root mean squared error (RMSE) was calculated to quantify the kinematic differences relative to the MB systems. Results: Both S-ML and M-ML demonstrated good-to-excellent reliability in spatiotemporal parameters, including step length, stance time, and gait speed, whereas stride length and swing time measured by S-ML revealed moderate reliability. In terms of joint kinematics, S-ML demonstrated a performance comparable to that of M-ML, particularly at the hip and knee in the sagittal plane. For certain parameters, such as knee abduction/adduction in the frontal plane, the S-ML demonstrated lower RMSE values than M-ML. In contrast, the ankle joint angles estimated using S-ML exhibited reduced agreement. Conclusions: In conclusion, markerless gait analysis can serve as an alternative to conventional gait analysis. However, certain parameters need to be improved. Full article

Background/Objectives: Response heterogeneity limits the implementation of dry needling for spasticity in multiple sclerosis (MS). This secondary analysis aimed to identify early responders and explore predictors of response. Methods: We conducted a responder analysis of a pilot randomized, double-blind, sham-controlled trial (NCT05956119) including 18 ambulatory MS patients with spasticity, randomized to a single session of dry needling (n = 9) or sham (n = 9). Sensitive responder criteria were defined as improvement ≥ 2.0 s in Timed Up-and-Go, ≥5 points in MSQOL-54 physical component, or ≥10% in 25-Foot Walk Test at 4 weeks. Results: Using these criteria, 33.3% (3/9) of dry needling recipients were classified as responders versus 0% (0/9) in the sham group (p = 0.214). Responders were more frequently observed among participants with relapsing–remitting MS (100% vs. 40%, p = 0.090) and lower baseline disability (Expanded Disability Status Scale 3.4 vs. 4.4). A positive association was observed between baseline pyramidal subscore and physical quality-of-life change, although this did not reach statistical significance (r = 0.52, p = 0.150) in the active group. Conclusions: Approximately one-third of participants met predefined responder criteria following dry needling; however, these findings should be interpreted as preliminary signals derived from an exploratory, underpowered pilot analysis. These results are hypothesis-generating and require confirmation in adequately powered trials. Full article

Background: Transtibial prostheses are commonly classified as endoskeletal or exoskeletal and differ in weight, adaptability, and mechanical response, which may influence gait performance. This study examined whether prosthesis type affects overground walking movement structure and neuromuscular control and assessed the relationship between walking speed and neuromuscular control. Methods: Principal component analysis (PCA) was applied to kinematic marker data from 20 unilateral transtibial amputees using either endoskeletal (n = 10; 54.7 ± 6.1 years) or exoskeletal prostheses (n = 10; 57.9 ± 8.7 years) during self-selected overground walking. Principal movements (PMs) were extracted to represent functionally meaningful gait components. Movement structure was evaluated using the relative explained variance of PM positions (rVAR), whereas neuromuscular control was quantified using the root mean square of PM accelerations (RMS; acceleration magnitude) and the number of zero crossings (N; regularity/predictability). Group differences were examined using covariate-adjusted analyses, controlling for preferred walking speed. Results: No significant differences in walking movement structure were found between prosthetic types. Unadjusted analyses suggested greater swing-phase acceleration (PM₂) and lower neuromuscular variability across PM₁–PM₄ in the endoskeletal group; however, these effects were no longer significant after adjusting for BMI and walking speed. Walking speed showed strong associations with neuromuscular control (p ≤ 0.003), with faster speeds linked to greater swing-phase acceleration and reduced variability. Conclusions: Walking movement structure and neuromuscular control were comparable between prosthetic types, while walking speed emerged as a key factor in gait evaluation among transtibial amputees. Full article

Land readjustment (LR) constitutes the foundation of orderly and sustainable urbanization, serving as the primary implementation tool for development plans. LR implementations are generally addressed within the framework of development implementation models—namely area-based, value-based, and hybrid models—based on the principle of redistribution. The present study aims to implement an equivalence-based LR model in the Davultepe Neighborhood of Mezitli, Mersin. In addition, it compares an equivalence-based LR implementation with an area-based LR implementation. The area-based LR implementation was conducted according to Article 18 of Law No. 3194 within the scope of Turkish Zoning Legislation. The equivalence-based implementation was performed using the hybridized multi-criteria decision analysis methods—specifically, SWARA and WASPAS. Cadastral and zoning criteria were determined separately. For data related to spatial criteria, walking distances were calculated using network analysis in Geographic Information Systems software. The weighting of the criteria was performed using the SWARA method. Cadastral and zoning parcels were treated as alternatives, and the WASPAS weight for each parcel was determined. The results indicate that, although allocated zoning parcel areas were generally smaller than the original cadastral parcel areas, in some cases, they exceeded the cadastral parcel areas due to the allocation of zoning parcels designated for agricultural use. Full article

Ensuring user safety while enabling independent mobility is crucial to autonomous healthcare and rehabilitation robots, such as active lower-limb orthoses and exoskeletons. A key requirement for these devices is to provide full assistance without supervision; however, existing designs do not simultaneously satisfy autonomous operation and inherent safety. To address this gap, a novel safety principle, Safety by Design, and a corresponding system architecture for a fully assistive active knee orthosis are introduced. The proposed architecture is based on a comprehensive risk analysis for the use of active orthoses and exoskeletons and integrates redundancies for all safety-critical components while minimizing additional weight. This redundancy enables the orthosis to remain operational at reduced power in the event of component failure, improving both user safety and system reliability. The design supports safe, unsupervised operation by ambulatory users, enhancing independent patient mobility and the performance of the gait activities of level walking, stair climbing and sitting down/standing up. The proposed architecture is scalable and adaptable to a wide range of robotic devices. By improving robustness, efficiency, and safety, this work contributes to the advancement of autonomous biomedical robotic systems and wearable assistive devices. Full article

Background: Developmental dysplasia of the hip (DDH) is the most common musculoskeletal condition in infants, and it is routinely managed with abduction orthoses. Despite high treatment success rates, concerns persist regarding potential delays in motor milestone acquisition. This meta-analysis evaluates the impact of orthotic treatment in children with DDH on early motor development. Methods: PubMed, Web of Science, and Embase were screened from inception to 17 February 2025. The review followed PRISMA guidelines. Risk of bias was assessed using the ROBINS-I tool V2 and visualized with the ROBVIS application. Mean differences in motor milestone achievement timepoints were compared in months between the intervention and control groups using a random effects meta-analysis model. A meta-regression was conducted to explore potential moderators of effect size. The protocol was prospectively registered in PROSPERO (ID: CRD42025648186). Results: Four studies, including 952 children, were analyzed—335 were treated for DDH with abduction orthoses, and 617 were healthy controls. Pavlik harness was used in three studies (n = 235), while the Koszla brace was used in one study (n = 100). Children in the orthosis group began walking approximately 0.55 months later than healthy controls (95% CI: 0.40 to 0.70). Sitting was also delayed by 1.11 months (95% CI: 0.76 to 1.47). No significant difference was found for crawling. Conclusions: The use of abduction orthoses may result in a slight, clinically marginal delay in achieving motor milestones, such as sitting and unaided walking. However, given that untreated DDH can lead to severe functional limitations, early intervention with orthoses remains a justified and safe standard of care. Full article

Background: Research on vibrations induced by running has gained significant attention due to its implications for athletes’ performance, injury prevention, and overall well-being. Distance running exposes the body to repetitive impulsive forces, causing significant vibrations to travel through physiological systems and biomechanical structures. These vibrations increase fatigue and the risk of injury. Although it has gained importance, research on induced vibration during running and wearable equipment for monitoring is scarce. This study aims to evaluate the performance of a measurement system for monitoring the acceleration levels of induced vibrations during long-distance running, exploring the capability of non-invasive wearable devices to characterise vibration transmissibility and exposure. Moreover, a preliminary quantitative assessment of induced vibration levels for an indoor testing scenario is given. Methods: Metrological characterisation of Xsens Motion Trackers Awinda (MTw), off-the-shelf inertial magnetic motion trackers, was performed by measuring the sensors’ frequency bandwidth in a controlled environment, providing logarithmic sweep sine excitations at different levels (2 g, 5 g, 7 g, where g is meant to be the gravitational acceleration). A testing protocol for indoor testing was derived from the literature, allowing characterisation of the sensors’ behaviour in terms of vibration transmissibility and exposure detection in the intended application. Time domain and frequency domain analyses were conducted by following the ISO 2631 standard guideline for vibration exposure assessment, and measurement uncertainty was defined, either for the dynamic correction of the sensors’ frequency behaviour or for the computed time and frequency domain metrics. In this framework, a treadmill-based test was conducted. The aim was to evaluate the Xsens sensors’ performance in measuring vibration dose exposure and transmissibility. Three MTws were placed on the subject’s right tibia, back, and forehead using elastic bands. A 25-year-old female amateur runner completed a series of tests consisting of walking for 1 min at 3.5 km/h (instrumentation setup), followed by running at two speeds (8 km/h and 11 km/h) for 2–4 min per trial, with 5 min rest periods between tests. Conclusions: The tested measurement system showed promising results due to its capability to assess vibration exposure during sports activities, but dynamic correction was found to be mandatory for accurate vibration level assessment. The main outcome of this study is a method for characterising the accelerometers embedded in the proposed devices, along with an analysis strategy for future testing campaigns. Thanks to the portability of IMUs (inertial measurement units), this approach enables the evaluation of induced vibrations during in-field running measurements. Full article