Search Results (533)

Cerebral palsy (CP) is a developmental disability caused by injury to the fetal or infant brain, affecting between 1.6 to 3.7 per 1000 live births worldwide. Ambulatory patients with cerebral palsy experience various gait problems, for which they seek treatment from medical professionals. Varus foot deformities are among the most problematic for patients. Varus foot deformity is characterized by the inner border of the foot being tilted upward and the hindfoot inward, increasing weightbearing on the lateral aspect of the foot. This positioning increases weight-bearing pressure under the lateral (outside) of the foot and often under the fifth metatarsal head when walking. As such, varus foot deformity can contribute to in-toeing, make shoe and brace-wearing difficult and painful, compromise gait stability, and sometimes lead to metatarsal fractures. Current knowledge of CP etiology and classifications, as well as principles and advances in assessment and treatment decision making for varus foot deformities, are outlined in this narrative review. In younger children with flexible deformities, non-operative interventions such as bracing, botulinum toxin injection, and serial casting are effective. The literature and expert consensus suggest that, if possible, surgery should be delayed until after the age of 8 years. When surgery is indicated, soft tissue procedures are used for flexible deformities. In addition to the soft tissue procedures, bone surgery is needed for rigid deformities. Careful pre-operative foot assessment is needed, including assessment of deformity flexibility and range of motion, X-rays, and computerized gait analysis if possible. Strategies are presented for thorough assessment when gait analysis is not available or feasible. Research reports of surgical outcomes for soft tissue and bony correction are positive, but should be interpreted with caution. The quality of evidence on surgical outcomes is compromised by use of varying research design methods and selection of outcome measures, with few including measures of function or patient-reported outcomes. It is recommended that surgical outcome be assessed using standardized assessment tools, such as the Foot Posture Index, which have had their validity and reliability established. Recent advances in 3D kinematic foot model development and musculoskeletal modeling have the potential to greatly improve surgical outcomes for patients with CP. Full article

Background and Objectives: Early assessment interventions are recommended for older adults with sarcopenia. Gait speed in older adults considerably decreases activities of daily living (ADL). However, the association between ADL and gait speed in older adults with sarcopenia has not yet been fully elucidated. This study aimed to clarify the association between walking speed and ADL in older adults with sarcopenia. Materials and Methods: A total of 72 older adults with sarcopenia who required support or care under Japan’s long-term care insurance system were included. Correlation and multivariate analyses were performed to examine the association between walking speed and ADL performance. A receiver operating characteristic analysis was used to evaluate the discrimination power of gait speed for ADL independence. Results: Gait speed was significantly and positively correlated with the Barthel Index scores for the men and women. ADL were independently and significantly associated with walking speed in the multivariate analysis. The threshold for gait speed that distinguished ADL independence in older adults with sarcopenia was 0.76 m/s (area under the curve = 0.75, sensitivity 72.7%, specificity 74.0%). Conclusions: Decreased gait speed in older adults with sarcopenia was associated with decreased ADL. Gait speed had high discriminatory power in identifying ADL independence. This indicates that an assessment intervention for gait speed in older adults with sarcopenia may have high clinical utility. Full article

Maximum aerobic capacity (MAC) helps in physical work capacity evaluation. In practice, the construction jobs are designed using the standard treadmill or ergometer MAC value, which is inappropriate and leads to injuries. According to NIOSH, the average oxygen consumption during an 8 h day is recommended to be no more than 33% of the exercise-specific MAC. Therefore, there is a necessity for construction activity-specific MAC exercise protocols and estimation models. The aim of the study is to develop MAC estimation models for common construction activities such as walking, carrying, lifting, and combined (carrying, dragging, hammering, lifting, and wrenching) using the submaximal exercise test mode. Ten male participants performed all four activities at three different intensities for five minutes each. The oxygen uptake and heart rate were recorded for each trial. This study shows that the average MAC value for walking, carrying, lifting, and combined activities is 0.779 gpm (2.95 L/m), 0.674 gpm (2.55 L/m), 0.745 gpm (2.82 L/m), and 0.608 gpm (2.30 L/m), respectively. The MAC value of combined construction activities is significantly lower than walking (28%), carrying (11%), and lifting (22%). The study recommends using a construction activity-specific exercise protocol for evaluating jobs or workers to prevent a mismatch between job demands and worker capabilities. Full article

Background/Objectives: This study aimed to describe changes in physical performance and nutritional status among frail adults at risk of falls receiving muscle-targeted oral nutritional supplementation (MT-ONS) as part of routine clinical care. Methods: A prospective, open-label, single-centre, uncontrolled, descriptive study was conducted in a real-world clinical setting. Patients ≥ 70 years attending an outpatient fall clinic were consecutively recruited and assessed at baseline and after at least 90 days of MT-ONS (100% whey protein enriched with leucine and vitamin D), provided as part of a comprehensive care plan including exercise recommendations, medication review, and home adaptation advice. Sociodemographic, physical performance [Short Physical Performance Battery (SPPB)], nutritional status [Mini Nutritional Assessment-Short Form, (MNA^®-SF)], walking ability [Functional Ambulation Categories (FACs)], number of falls, muscle strength (dynamometry), body composition (Tanita), health-related quality-of-life (SF-12), functional capacity (Barthel Index), and adherence data were collected. Statistics analyses were descriptive and exploratory. Results: Twenty-six participants were assessed (58% women, age: 82.1 ± 5.4 years). Mean SPPB score increased from 7.3 (±3.6) to 8.0 (±4.0) (p = 0.3). At baseline, 35% were malnourished, 42% at risk of malnutrition, and 23% well-nourished. After ≥90 days of MT-ONS, 4% were malnourished, 54% at risk, and 42% well-nourished. The number of falls decreased from 1.2 falls/month (±0.9) to 0.2 falls/month (±0.3, p < 0.0001). Favourable changes in physical performance were positively correlated with improvements in nutritional status (p = 0.03). Adherence was high (92%), largely attributed to pleasant taste (71%) and smell (58%) and positive health perceptions (58%). Conclusions: In routine clinical practice, frail adults at risk of falls who received MT-ONS, 100% whey protein enriched with leucine and vitamin D for ≥90 days, as part of a comprehensive care plan improved their physical performance and nutritional status and reduced the number of falls. These findings should be interpreted as preliminary. Full article

Background/Objectives: Physical activity benefits women with metastatic breast cancer. Past trials are typically well-resourced and supervised, but home-based interventions may be preferable and more accessible. This pilot trial evaluated the feasibility and preliminary efficacy of a remotely delivered behaviour change intervention aiming to increase physical activity for women with metastatic breast cancer. Methods: A 12-week, two-arm trial involved 20 women with metastatic breast cancer randomised 1:1 to a generic recommendation group or behaviour change group. Both groups received a physical activity recommendation, Fitbit^® watch, diary, and nine phone/video call sessions. The behaviour change group received individualised advice around physical activity benefits, motivation, barriers, and social support; the generic recommendation group completed a recurring symptom questionnaire. Feasibility outcomes were recruitment, retention and adherence rates. Acceptability was evaluated with a structured interview at trial completion. Preliminary efficacy outcomes included 5-day Actigraph wear, 6 min walk distance, 30 s sit-to-stands, and questionnaires for self-reported physical activity, quality-of-life, fatigue, behavioural factors, and patient-specific function. Results: Recruitment, retention, and adherence rates were 63% (n = 20/32), 80% (n = 16/20), and 76% (137/180 sessions), respectively. Participants across both groups reported that participation was acceptable, and their behaviour change was perceived as sustainable. Preliminary change scores for efficacy measures favoured the behaviour change group, except some quality-of-life and behavioural factor subscales. Conclusions: Participants were receptive to the trial, and feasibility and efficacy measures were positive. This indicates that a behaviour change intervention for unsupervised physical activity is acceptable and can be beneficial to women with metastatic breast cancer, warranting further exploration. Full article

Background/Objectives: Performing Hajj, the annual Islamic pilgrimage to Mecca and one of the world’s largest mass gatherings, involves considerable physical exertion in high temperatures and presents unique challenges for people with type 1 diabetes (PWT1D). We examined the feasibility, safety, and user experience of automated insulin delivery (AID) systems during Hajj. Methods: This mixed-methods study evaluated six PWT1D who used an AID pump (2 MiniMed 780G, 2 Medtrum, 1 OmniPod 5, and 1 Open-source AID) while performing Hajj in 2024–2025. Pump and CGM-derived metrics were compared across pre-Hajj, during Hajj, and post-Hajj periods. A structured survey captured participants’ experiences, challenges, and recommendations for AID use during Hajj. Results: The average percent time in range (TIR) remained stable from pre- to during Hajj (54.98 to 54.18, p > 0.05) and significantly increased post-Hajj (62.62, p < 0.05). The percent time above range (TAR > 180) and Glycemia Risk Index significantly decreased from pre- to post-Hajj (28.34 to 26.28 and 50.3 to 19.3, respectively, both p < 0.05). The percent time below range (TBR) remained low (<1%) across the three periods with no incidence of acute diabetes-related complications. Participants emphasized increased confidence and peace of mind with AID use and reported challenges related to heat exposure, prolonged walking, and lack of awareness regarding diabetes technology among HCPs. Conclusions: The use of AID during Hajj appeared to be safe and effective for PWT1D in our study, maintaining stable glycemic control under physically demanding conditions. As the first study to evaluate AID use during Hajj, our findings call for larger studies to explore the integration of diabetes technology into Hajj care protocols and highlight the need for structured pre-Hajj education for PWT1D and HCPs. Full article

Optimizing the furniture layout of middle school laboratories is crucial for improving the emergency safety, operational efficiency, and resilience of teaching buildings. This study used AnyLogic software to model and simulate pedestrian evacuation behavior in a typical middle school laboratory layout. In a standardized laboratory (90.75 m²), we constructed a behavior-oriented multi-agent evacuation model. The model incorporated key student parameters, including shoulder width (312–416 mm), walking speed (1.5–2.5 m/s), and reaction time (10–15 s). To ensure comparability between different layouts, the number of evacuees was fixed at 48. Evacuation performance was evaluated based on total evacuation time, spatial density, and detour distance. The results showed that the hybrid layout achieved the shortest evacuation time (28.0 s), which was 10.3% shorter than the island layout (31.2 s) and 34.7% shorter than the parallel layout (42.9 s). The hybrid layout also had a shorter average detour distance (9.78 m) and the lowest path variability (coefficient of variation CV = 0.33), indicating a more balanced evacuation load and a smaller bottleneck effect. Overall, these findings provide evidence-based recommendations for improving laboratory safety, space utilization, and behavioral adaptability, and provide a quantitative reference for updating educational building codes, school laboratory construction standards, and guidelines for laboratory furniture and safety facility configuration. Full article

Background/Objectives: Specific pharmacological osteoporosis therapy (SPOT) is regarded as a key intervention to reduce fracture risk and improve musculoskeletal function. Real-life data, particularly regarding functional muscular outcomes and pain trajectories, remain limited. This study aimed to longitudinally analyze bone mineral density, laboratory parameters, handgrip strength, functional performance, and pain symptoms under guideline-based SPOT. Methods: In this monocentric prospective real-life observational study, 178 patients (80.9% women; median age 82 years) with confirmed osteoporosis were followed for a median of four years. All patients received guideline-recommended antiresorptive or osteoanabolic therapy. Analyses included T-scores, 25(OH)D, calcium, handgrip strength, Chair Rise Test (CRT), tandem stance (TS), pain parameters, alkaline phosphatase (AP), HbA1c, fractures, comorbidities, and body mass index (BMI). Time-dependent changes were evaluated using linear mixed-effects models. Results: Bone mineral density improved highly significantly (ΔT-score ≈ +0.45 SD; p < 0.001), with no differences between therapy groups (antiresorptive vs. osteoanabolic) or BMI categories. Serum 25(OH)D levels increased markedly (Δ ≈ +20 nmol/L; p < 0.001), while calcium levels showed a small but highly significant decrease (Δ ≈ −0.047 mmol/L; p < 0.001), particularly under antiresorptive treatment. Dominant (Δ ≈ −1.95 kg; p < 0.001) and non-dominant handgrip strength (Δ ≈ −0.83 kg; p = 0.046) decreased significantly. In contrast, functional performance improved significantly: CRT time decreased by ~1 s (p = 0.004), and TS time increased by ~1 s (p = 0.007). Back pain decreased highly significantly (Δ ≈ −1.5 NRS; p < 0.001), while pain-free walking time (Δ ≈ +38 min; p = 0.031) and pain-free standing time (Δ ≈ +31 min; p = 0.038) both increased significantly. AP levels decreased significantly (p = 0.003), particularly among normal-weight patients. HbA1c changes were not significant. Overall, 73% of patients had at least one major osteoporotic fracture. Conclusions: In this real-life cohort, guideline-based specific pharmacological osteoporosis therapy was associated with significant improvements in bone mineral density, vitamin D status, functional performance, and pain-related outcomes. Despite a moderate decline in handgrip strength, balance- and mobility-related functional parameters improved, suggesting preserved or even enhanced functional capacity in daily life. These findings provide real-world evidence on the associations between SPOT, laboratory parameters, functional performance, and pain outcomes in a very elderly and multimorbid population. Full article

Background: Long-distance hiking usually requires carrying a backpack, adding external load to the lower limbs and modifying plantar loading patterns. Excessive loads may contribute to overuse injuries, but quantitative evidence to support current recommendations on backpack weight is still scarce. This study aimed to examine how different backpack loads influence plantar pressure in long-distance hikers. Methods: A cross-sectional observational study was conducted in adults who had walked at least 20 km during the previous 24 h. Sociodemographic and clinical variables were recorded, and barefoot plantar pressure was assessed using the Podoprint^® system under four conditions: without a backpack, with the habitual backpack, and with backpacks loaded to 10% and 20% of body weight. Static and dynamic plantar pressure parameters were analyzed using repeated-measures comparisons. Results: A progressive increase in plantar force was observed in both feet as backpack load increased. Compared with the unloaded condition, static forefoot pressure rose by 5.41% with a 10% load and by 8.73% with a 20% load (p = 0.005); rearfoot pressure increased by 5.01% and 10.17% (p = 0.015); and total foot pressure by 5.04% and 9.61% (p = 0.002). Loads above 10% of body weight significantly modified static plantar pressures and were associated with measurable changes during dynamic assessment. Conclusions: In long-distance hikers, carrying a backpack that exceeds approximately 10% of body weight leads to a clear, load-dependent increase in plantar pressure. These findings provide biomechanical support for recommendations that advise limiting backpack load to around 10% of body weight to reduce plantar stress during hiking. Full article

Background/Objectives: Psychological stress is a common problem but hard to universally treat. Personalized (N-of-1) trials assess a participant’s response to multiple specific interventions. Though personalized (N-of-1) trials have been used in select interventions, no prior research has examined whether N-of-1 designs provide superior stress reduction relative to standard of care. Methods: Participants were randomized to personalized N-of-1 (N = 106) or standard-of-care (N = 106) arms for three stress-management interventions (mindfulness meditation; yoga; brisk walking). All participants completed ecological momentary assessments (EMA) of stress three times daily for 18 weeks (2-week baseline, 12-week intervention, 2-week assessment, and 2-week follow-up). After the intervention, participants in the N-of-1 arms received a personalized report identifying which intervention worked best for them. All participants chose one intervention to manage their stress during follow-up. The primary outcome was change in perceived stress between baseline and follow-up. Results: Participants in the personalized (N-of-1) arms did not report significantly reduced EMA stress levels relative to standard-of-care (p = 0.496), though the effect was stronger among N-of-1 participants who chose the stress-management intervention recommended by their report [B(SE) = −0.67(0.34); p = 0.049]. Conclusions: Results show the potential of personalized (N-of-1) trials to provide individuals with information unique to them to help identify interventions for stress management. However, many participants in the personalized trial arms did not choose the intervention recommended by their trial. Additional research is required to refine how personalized (N-of-1) trials are conducted and how trial results are reported to participants to ensure the maximal benefit of these trial designs. Full article

Background and Objectives: Low back pain (LBP) is one of the most frequent complications during pregnancy, with a high and variable incidence. LBP has been associated with physical inactivity, but it has not been evaluated exclusively in physically active (PA) pregnant women. This study aimed T to estimate the incidence of LBP in PA pregnant women and describe its clinical, functional, emotional, and occupational impact. Materials and Methods: A prospective cohort of 147 women with PA pregnancies was recruited between gestational weeks 11 and 13⁺⁶. Most (92.5%) hold a university degree. All received standardized informational intervention based on international recommendations on PA during pregnancy and LBP prevention. Data were collected through an in-person interview in the first trimester and a postpartum follow-up phone interview. PA was assessed using the International Physical Activity Questionnaire (IPAQ, short version), and LBP intensity was evaluated using the Visual Analog Scale (VAS). Results: LBP occurred in 64.6% of participants, despite maintaining regular PA. Pain intensity was higher in standing position (VAS = 4.9) and lower in lateral decubitus (VAS = 2.7). More than half (55.8%) did not seek medical consultation. LBP was associated with functional limitations (work, sleep, walking), emotional distress (52.6%), and work leave (30.5%; mean 9.4 weeks). In the multivariable logistic regression analysis, standing occupational position showed a borderline association with LBP (OR = 2.14; 95% CI: 1.00–4.55; p = 0.047), while a history of LBP in a previous pregnancy showed a statistically significant association (OR = 2.89; 95% CI: 1.12–7.48; p = 0.029). Higher PA levels during pregnancy were associated with slightly lower odds of LBP (OR = 0.91 per 500 MET·min/week; 95% CI: 0.83–0.99; p = 0.032), although the magnitude of this association was small. Conclusions: LBP showed a high incidence even among PA and highly educated pregnant women. More than half of the women did not seek medical consultation, suggesting potential under-recognition of LBP. Standing occupational position and a previous pregnancy-related LBP were identified as independent risk factors associated with LBP in the multivariable model. Higher PA levels were inversely associated with LBP. Full article

Background and Clinical Significance: Hemiplegia following a cerebrovascular accident (CVA) disrupts gait symmetry and efficiency, compromising functional independence. The integration of surface electromyography (sEMG) and inertial measurement units (IMU) enables quantitative assessment of muscle activation and segmental dynamics, providing objective data for therapeutic planning. Case presentation: A 57-year-old male with chronic right hemiplegia, eight years post-ischemic stroke of the left middle cerebral artery. The patient ambulated independently without assistive devices, exhibiting right lower-limb circumduction. Clinical assessment revealed the following scores: Barthel Index 85/100, Tinetti Performance-Oriented Mobility Assessment (POMA) 16/28, Timed Up and Go (TUG) test 13 s, and Modified Ashworth Scale (MAS) scores of 1 (upper limb) and 1+ (lower limb). Methods: Multichannel sEMG (Miotool 800^®, 8 channels) was recorded form the lumbar erectors, gluteus medius and maximus, vastus medialis, vastus intermedius, vastus lateralis, biceps femoris, tibialis anterior, medial gastrocnemius, and lateral gastrocnemius. Ag/AgCI electrodes were positioned according to SENIAM recommendations: sampling rate: 1000 Hz; band-pass filter: 20–500 Hz; notch filter: 60 Hz; normalization to %MVC. Simultaneously, IMU signals (Xsens DOT^®, 60 Hz) were collected from both ankles during slow, medium and fast walking (20 s each) and compared with a healthy control subject. Results: The patient exhibited reduced sEMG amplitude and increased peak irregularity on the affected side, particularly in the gluteus medius, tibialis anterior, and gastrocnemius, along with agonist desynchronication. IMU data revealed decreased range of motion and angular pattern irregularity, with inconsistent acceleration peaks in the right ankle compared to the control, confirming neuromuscular and kinematic asymmetry. Conclusions: The combined sEMG-IMU analysis identified deficits in selective motor control and propulsion on the affected hemibody, providing essential information to guide physiotherapeutic interventions targeting pelvic stability, dorsiflexion, and propulsive phase training, enabling objective follow-up beyond specialized laboratory settings. Full article

Background: After unilateral total knee arthroplasty (TKA), patients place more weight on the nonsurgical limb than the surgical limb. The objective of this study was to determine the possibility of providing live biofeedback during early recovery of patients undergoing unilateral TKA and to determine the necessary sample size for future trials. Methods: Twenty patients with unilateral TKA were randomized into two groups: a feedback group and a control group. Inclusion criteria included no contralateral knee pain and aid-free walking before surgery. There were 8 patients in the feedback group and 10 in the control group. Compliance with the recommended training was 91%. The feedback group trained with an insole device for 15 min a day for 4 weeks, along with normal physiotherapy. The control group received normal physiotherapy only. Gait parameters were recorded on level ground at two and six weeks. The primary outcome was the percent loading rate. The secondary outcomes included gait speed, cadence, percent peak force, and pain. Results: Patients within the feedback group showed a small, non-significant trend toward a higher precent load rate at 6 weeks compared to the control group in level walking (p = 0.92). Conclusions: Our findings indicate that live biofeedback on a gait parameter, like percent load rate, can be provided by the mentioned system and may support immediate changes in gait parameters. The compliance of 91% with training and no reported adverse events indicates that the system was easy to use. Following TKA, there may be a potential exploratory use of mobile, real-time biofeedback to help address gait abnormalities and accelerate rehabilitation. This clinical trial was registered at clinicaltrials.gov (Identifier: NCT03673293) on 14 September 2018. This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional review board of the University of Utah (IRB_00110935) on 10 September 2018. Full article

Background: Clinical assessment of gait typically consists of patients walking a few trials at various speeds while the clinician assesses performance. Unfortunately, there is no clear guidance on how gait changes across trials, leaving clinicians uncertain about the optimal number of trials needed to observe consistent (non-variable) performance. To address this issue, we examined gait performance from a large dataset of older adults who participated in a community-based comprehensive fall risk assessment. Methods: Community-dwelling, older adults (n = 340; 70.8 ± 7.4 years; 120 men, 220 women) performed gait trials under two conditions: preferred and maximum walking speed. Individuals were encouraged to complete five trials for both conditions. Consistency between gait trials within each condition was calculated using intraclass correlation (ICC) and standard error of measurement (SEM) analysis. Results: Our data showed the middle three trials had the most consistency compared to the average of 2–5 trials. Conclusions: When performing a clinical gait analysis, the first trial should be used to acclimate the participant to the protocol and not used for analysis. Data should be recorded from the next three trials, which is when gait appears to stabilize. Data from a fifth trial differs from the second trial, potentially indicating fatigue and/or motivation changes, so it is recommended that the gait analysis conclude after the fourth trial. Full article

Background: Vitamin C deficiency remains an under-recognized condition in children, especially in Southeast Asia. This study aimed to study the clinical characteristics, dietary risk factors, and outcomes of pediatric vitamin C deficiency in a tertiary hospital in Southern Thailand. Methods: This retrospective study reviewed the medical records of children aged 1 to 15 years diagnosed with vitamin C deficiency from 2004 to 2024. Diagnosis was based on serum ascorbic acid levels below 0.4 mg/dL, or clinical-radiographic findings. Data collected included demographics, developmental status, dietary history, clinical presentations, radiological and laboratory results, treatment, and outcomes. Results: Forty-six children were diagnosed; the median age was 4.8 years, and 60% were male; developmental delay was present in 54.4%. The majority had poor dietary intake, with 73% not consuming adequate fruits and vegetables; no significant differences were observed when classified by developmental status. Common clinical signs included: limb pain (76.1%), refusal to walk (52.2%), and bleeding gums (39.1%). Radiographs showed osteopenia in 73.8% and white line of Frankel in 47.6%. Serum ascorbic acid deficiency was significantly associated with low fruit and vegetable intake and excessive milk consumption over the recommendations (p < 0.05). Treatment with oral vitamin C resulted in clinical improvement; although, residual symptoms persisted in some cases. Conclusions: As pediatric vitamin C deficiency is still of concern, this study highlights the importance of early detection in at-risk children and the critical role of detailed dietary history to identify inadequate nutrition. Prompt recognition and intervention can prevent misdiagnosis and improve clinical outcomes. Hence, strengthening parental education on nutritional intake is essential to reduce future incidences. Full article