Search Results (896)

Background: In occupational science and therapy, occupations are understood as meaningful activities. Satisfaction with the amount and variety of occupations is called occupational balance. The “Occupational Balance in Informal Caregivers” (OBI-Care) questionnaire assesses satisfaction with occupations across three subscales: occupational areas, characteristics, and resilience. In doing so, it also addresses occupational contingency, i.e., the ability to adapt occupations in response to unforeseen events. While previous studies have confirmed its validity in other populations, psychometric properties have not been explored in informal caregivers of stroke survivors. This study aimed to evaluate the construct validity, internal consistency, and suitability of the German OBI-Care for assessing occupational balance for this target group. Methods: A validation study was conducted using data collected via an online survey. Measurement properties of the three subscales were examined using Rasch Rating Scale analysis, exploring construct validity, internal consistency, and interpretability. Construct validity was assessed via dimensionality analyses, item fit, model fit, and threshold ordering. Internal consistency was evaluated using inter-item correlations, item–total correlations, person separation index, and Cronbach’s alpha. Interpretability was examined through floor and ceiling effects. Results: A total of 156 informal caregivers of stroke survivors participated, with 84% (n = 131) women and a median age of 58 (IQR: 49–66) years. All subscales showed unidimensionality with acceptable item and model fit and ordered thresholds. Internal consistency was excellent across all subscales. No floor and ceiling effects were observed. Conclusions: This study demonstrates good construct validity, internal consistency, and interpretability of the German OBI-Care. It is suitable for assessing occupational balance and may help identify and support occupational contingency in informal caregivers of stroke survivors. Full article

Background/Objectives: Neural compensation, in which healthy brain regions take over functions lost due to lesions, is a potential biomarker for functional recovery after stroke. However, previous neuroimaging studies often speculated on neural compensation simply based on greater measures in patients (compared to healthy controls) without demonstrating a more direct link between these measures and the functional recovery. Because taking over the function of a lesion region means taking on a similar role as that lesion region in its functional network, the present study attempted to explore neural compensation based on the similarity of functional connectivity (FC) patterns between a healthy regions and lesion regions. Methods: Seventeen stroke patients (13M4F, 63.2 ± 9.1 y.o.) underwent three resting-state functional MRI (rs-fMRI) sessions during rehabilitation. FC patterns of their lesion regions were derived by lesion network analysis; and these patterns were correlated with healthy FC patterns derived from each brain voxel of 51 healthy subjects (32M19F, 61.0 ± 14.3 y.o.) for the assessment of pattern similarity. Results: We identified five healthy regions showing decreasing FC similarity (29–54%, all corrected p < 0.05, effect size η²: 0.10–0.20) to the lesion network over time. These decreasing similarities were associated with increasing behavioral scores on activities of daily living (ADL, p < 0.001, η² = 0.90), suggesting greater neural compensation at early-stage post-stroke and reduced compensation toward the end of effective rehabilitation. Conclusions: Besides direct FC measures, the present results propose an alternative biomarker of neural compensation in functional recovery from stroke. For sensorimotor recoveries like ADL, this biomarker could be more sensitive than direct measures of lesion connectivity in the motor network. Full article

The global insect farming sector is rapidly expanding, driven by rising demand for sustainable protein sources and its potential to contribute to food security solutions. This study focuses on the quantification of chitin by comparing two gravimetric methods (ADF-ADL and crude fiber estimation) with a purification method considered as a reference method. It also aims to use the near-infrared spectroscopy (NIRS) to rapidly assess the quality of insect meals, in particular the macronutrients (moisture, protein, fat) and chitin content in a large data set of insect samples. Both alternative methods overestimated chitin content compared to the enzymatic purification method, which is the most reliable but more complex and expensive. Given their advantages (fairly simple, no significant investment, higher sample throughput, relatively short time execution), they can serve for rapid screening when precise chitin determination is not required. Calibration models showed good performance, particularly for protein and fat determination, and satisfactory results for chitin prediction. The NIRS models show promises for rapid and reliable prediction of insect products, although the chitin assessment remains to be further validated. Its implementation could streamline chemical quality control in insect-based food and feed production, offering speed and flexibility for industrial applications. Full article

Background/Objectives: Vitamin D deficiency is linked to muscle loss and fat changes in older adults, but data regarding palliative patients are limited. Ultrasound offers a practical tool to assess these changes. This study explores the relationship between vitamin D levels and ultrasound-measured muscle, fat, and their ratio in older adult palliative patients. Methods: This prospective cross-sectional study was conducted in a tertiary palliative care unit (June–September 2024). A total of 187 patients were grouped by serum vitamin D levels (<50 vs. ≥50 nmol/L). Demographic and clinical variables included sex, BMI, Activities of Daily Living (ADLs), calf circumference (CC), and comorbidities. Ultrasonography assessed muscle thickness (MT), subcutaneous fat thickness (SFT), and cross-sectional area (CSA) of Rectus Femoris (RF) and Biceps Brachii (BB). MT/SFT ratio was calculated. Logistic regression identified independent predictors. Results: Mean age was 75.1 ± 14.4 years; 55.6% of participants were female. Vitamin D deficiency (67.9%) was significantly associated with female sex (p = 0.037), ADL dependency (p < 0.001), lower BMI (p = 0.020), and reduced CC (p = 0.006). RF-MT, RF-SFT, RF-CSA, BB-MT, and BB-CSA were lower in the deficient group. RF-MT/SFT ratio was higher (p = 0.049). ADL dependency (p = 0.002) and RF-MT/SFT (p = 0.015) were independent predictors. Conclusions: Vitamin D deficiency was linked to a higher muscle-to-fat ratio, mainly due to fat loss rather than muscle gain. This may misrepresent muscle preservation and should be interpreted cautiously. Although vitamin D levels appear to be associated with physical function, additional prospective cohort and interventional supplementation studies are warranted to determine whether routine screening and targeted vitamin D supplementation can effectively support physical function in this population. Full article

This paper proposes wideband circularly polarized (CP) 1-D connected array antennas with slant slot feeders and gradient artificial dielectric layers (ADLs). The slant slot feeder introduces an identical electric field (E-field) along the x- and y-directions. Three slabs consisting of multiple ADLs are stacked above the slot feeder. Due to the different boundary conditions of a 1-D connected array in the $zx$- and $zy$-planes, the guided wave in the slabs exhibits different multipath lengths along the x- and y-directions, leading to a 90° phase difference between the $E_x$ and $E_y$ components. Moreover, the cascaded slabs are designed with gradient effective permittivities for a gradual impedance transition from the guided mode to the radiating mode, allowing for wideband matching and CP performance. To validate the proposed design approach, an 8 × 1 array was fabricated and measured. The antenna shows a 1.96:1 (10.1–20 GHz) impedance bandwidth (VSWR < 2) and a 1.46:1 (12–17.5 GHz) 3 dB axial ratio bandwidth in measurement. The array exhibits an average right-hand CP boresight gain of 12.39 dBic. Moreover, we produced a frequency-invariant beam pattern with an average half-power beamwidth (HPBW) of 24.77° and a standard deviation below 3.63° over 12–18 GHz for the target pattern, with a HPBW of 26°, demonstrating wideband electronic warfare performance using the proposed array. Full article

Background and Objectives: Acute ischemic stroke is a major cause of disability and mortality. Cerebrolysin, a neuropeptide with neuroprotective and neurotrophic properties, may enhance post-stroke recovery. This study evaluated the impact of adding Cerebrolysin to standard therapy on clinical outcomes in patients with acute ischemic stroke. Materials and Methods: This non-randomized prospective observational study included 143 adults with acute ischemic stroke at Kovai Medical Center and Hospital, Coimbatore (April 2016–May 2018). Participants were divided into two groups: the standard therapy group (n = 70) and the adjuvant therapy group (n = 73), which received Cerebrolysin (30 mL IV daily for 14 days) in addition to standard care. Stroke severity and functional outcomes were evaluated using the National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) at baseline and Day 14. A p < 0.05 was considered statistically significant. Results: Stroke severity improved in both groups, but the adjuvant group demonstrated significantly greater reductions in NIHSS scores from 9.90 ± 2.90 to 3.40 ± 1.40 compared to the standard group, which improved from 10.10 ± 2.80 to 4.80 ± 1.30 (t = 6.19, p < 0.001). Additionally, 43.84% of patients in the adjuvant group shifted to minor stroke severity versus 25.71% in the standard group. Both groups showed significant improvements across all domains of the BI, which assesses activities of daily living (ADL); however, the gains were consistently greater in the adjuvant group (p < 0.001). A higher proportion of patients in the Cerebrolysin group achieved slight dependency (38.36%) or full independence (16.44%), compared to 20% and 5.71% in the standard group, respectively. Conclusions: This prospective observational study suggests that adding Cerebrolysin to standard therapy was associated with greater neurological recovery and functional independence in acute ischemic stroke patients. However, the short follow-up, single-center setting, and lack of randomization limit generalizability. Larger multicenter randomized trials with longer follow-up are needed to confirm these findings. Full article

(1) Background: Integrating assessment with training helps to enhance precision prosthetic rehabilitation of trans-radial amputees. This study aimed to validate a self-developed closed-loop rehabilitation platform combining accurate measurement in comprehensive assessment and immediate interaction in virtual reality (VR) training in refining patient-centered myoelectric prosthesis rehabilitation. (2) Methods: The platform consisted of two modules, a multimodal assessment module and an sEMG-driven VR game training module. The former included clinical scales (OPUS, DASH), task performance metrics (modified Box and Block Test), kinematics analysis (inertial sensors), and surface electromyography (sEMG) recording, verified on six trans-radial amputees and four healthy subjects. The latter aimed for muscle coordination training driven by four-channel sEMG, tested on three amputees. Post 1-week training, task performance and sEMG metrics (wrist flexion/extension activation) were re-evaluated. (3) Results: The sEMG in the residual limb of the amputees upgraded by 4.8%, either the subjects’ number of gold coins or game scores after 1-week training. Subjects uniformly agreed or strongly agreed with all the items on the user questionnaire. In reassessment after training, the average completion time (CT) of all three amputees in both tasks decreased. CTs of the A1 and A3 in the placing tasks were reduced by 49.52% and 50.61%, respectively, and the CTs for the submitting task were reduced by 19.67% and 55.44%, respectively. Average CT of all three amputees in the ADL task after training was 9.97 s, significantly lower than the pre-training time of 15.17 s. (4) Conclusions: The closed-loop platform promotes patients’ prosthesis motor-control tasks through accurate measurement and immediate interaction according to the sensorimotor recalibration principle, demonstrating a potential tool for precision rehabilitation. Full article

Background: Physical inactivity is a major contributor to increased mortality among aging populations, especially in middle-aged and older adults. Methods: Data were derived from the China Health and Retirement Longitudinal Study (CHARLS, 2011–2020). Participants self-reported their physical activity frequency, categorized as low (≤1 day/week), medium (2–4 days/week), or high (≥5 days/week). All-cause mortality was tracked through verified records. Cox proportional hazards models were used to estimate hazard ratios (HRs), with adjustments for demographics, lifestyle factors, and baseline health conditions. Results: A total of 2092 participants (mean age = 63.7 ± 10.4 years) were included in the final analytic sample. Higher physical activity frequency was significantly associated with lower mortality in unadjusted models. Participants engaging in activity ≥5 days/week had a 67% reduced mortality risk compared to the low-frequency group (HR = 0.33, p < 0.001). However, after adjusting for health-related covariates, the protective effect was attenuated and no longer statistically significant. In the fully adjusted model, advanced age, current smoking, and ADL limitations emerged as the strongest independent risk factors for mortality, while being married and residing in a rural area were significantly protective effects. Conclusions: The association between frequent physical activity and reduced mortality risk among Chinese older adults is profoundly mediated by baseline health status and functional capacity. These findings highlight the importance of integrated, multifactorial public health interventions that address chronic disease management and functional rehabilitation alongside physical activity promotion. Full article

Background: Measurements are necessary in rehabilitation for evaluating service effectiveness. The ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE) is used for evaluating ADL performance and the impact of neurobehavioral impairments on the performance. Recently, Rasch-based software was constructed for the A-ONE ADL and neurobehavioral scales. It converts ordinal rating scale scores into measures, estimates missing data values and calculates the statistical significance of changes. Objectives: To expand the A-ONE software by developing a cerebrovascular accident (CVA) neurobehavioral subscale. Additionally, to pilot-test whether the ADL and CVA scales of the software can detect statistically significant improvements. Method: Rasch analysis was used for evaluating the item fit, PCA, person separation and reliability to establish the internal validity of the CVA subscale (n = 222). The external validity (n = 22) was obtained by comparing A-ONE software measures to Winsteps measures. Subsequently 21 pre–post-intervention comparisons were made of stroke patients using both the ADL and CVA scales. Results: All set criteria for internal and external validity were met. By using the software clinically after incorporating the CVA subscale, statistically significant changes were detected in 90.5% of comparisons using the ADL scale and 36.4% using the CVA scale. The intervention program used was determined to consist of 66.4% occupation-based activities. Conclusions: This study is the first to deliver a clinically deployable Rasch-based CVA subscale integrated into routine occupational therapy software. The A-ONE software offers considerable time saving for therapists and the potential to detect significant differences in performance and impairment impact. It contributes to the removal of clinical obstacles toward the use of the instrument as an outcome measure and encourages the use of measures in rehabilitation. Full article

The assessment of upper limb (UL) movement patterns plays a critical role in the rehabilitation of individuals with motor impairments resulting from neuromotor disorders, which significantly affect essential activities of daily living (ADLs) such as drinking and eating. However, conventional clinical evaluation methods often lack objective and quantitative insights into the biomechanics of movement. To enable accurate identification of pathological patterns, it is first necessary to establish normative biomechanical and electrophysiological benchmarks in healthy individuals. In this study, a previously developed, low-cost, wearable, and portable prototype device was employed to objectively assess UL movement. The system, specifically designed for clinical applicability, integrates surface electromyography (EMG) sensors and an inertial measurement unit (IMU) to capture muscle activity and kinematic data, respectively. Thirty healthy participants were recruited to perform standardized drinking and eating tasks. The analysis focused on characterizing muscle activation patterns and joint range of motion during different task phases. Results revealed consistent variations in muscle contraction and joint kinematics, allowing the identification of distinct activation profiles for key shoulder muscles. The findings contribute to the establishment of a normative dataset that can serve as a reference for the assessment of clinical populations. Such data are essential for informing rehabilitation strategies and developing predictive models of UL function during ADLs in individuals with neuromotor disorders. Full article

Background/Objectives: Essential tremor (ET) is the most common movement disorder worldwide. It negatively affects patients’ activities of daily living (ADL) and quality of life. Unilateral transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy has been proven as a highly effective and safe treatment option for patients with refractory ET. The aims of this study are to explore the effectiveness and safety of tcMRgFUS thalamotomy in patients with ET in a real-world setting. Methods: Patients who underwent tcMRgFUS thalamotomy at the University Hospital of Palermo were prospectively enrolled. Scores obtained by Quality of Life in Essential Tremor Questionnaire (QUEST) and The Essential Tremor Rating Assessment Scale (TETRAS) were compared before and after tcMRgFUS thalamotomy. Predictors of tcMRgFUS thalamotomy effectiveness were explored by multivariable Cox regression analyses. All the adverse events (AEs) during and after the procedure were collected. Results: Fifty patients were included (80% male; median age at tcMRgFUS 67.4 years). After procedure, the QUEST score decreased by 46.2%, while TETRAS-ADL and TETRAS Performance (TETRAS-PE) decreased by 52.2% and 51.8%, respectively. Temperature peak and longitudinal lesion diameter positively correlated with the magnitude of QUEST and TETRAS-PE reduction. A higher baseline TETRAS-PE score predicted a good prognosis (HR = HR 6.6 [95% CI: 2.1–21.3]; p = 0.001). AEs were mild to moderate and transient, while permanent AE was observed only in one case. Conclusions: This real-world study confirms the higher effectiveness and the favorable safety profile of tcMRgFUS thalamotomy in patients with ET by reducing the tremor-related interference in quality of life, disability in ADL, and tremor severity. Full article

Background: Post-Intensive Care Syndrome (PICS), which includes Intensive Care Unit-Acquired Weakness (ICU-AW), can lead to lasting functional impairments even after patients are discharged from the hospital. Early mobilization is a key strategy for preventing ICU-AW, a major contributor to PICS. The primary objective of this study is to assess the impact of early mobilization on ICU-AW in critically ill sepsis patients, while also evaluating the feasibility of a larger, multicenter study through comparison with previous data. Methods: This multicenter observational study, conducted in four hospitals in Nagano Prefecture, Japan, from April 2020 to March 2023, included sepsis patients admitted to the ICU or emergency departments. Patients were classified into ICU-AW and non-ICU-AW groups based on admission data. Background factors and discharge outcomes (complications, ADL, physical function) were assessed. Logistic regression analysis was performed to evaluate the relationship between early mobilization and ICU-AW incidence, with a subgroup analysis on the impact of a dedicated team or physiotherapist. Results: A total of 154 sepsis patients were enrolled, with 76 (49.4%) diagnosed with ICU-AW at discharge. The most common infection source in ICU-AW patients was the urinary tract (31%). Early mobilization (≥3 days) significantly reduced ICU-AW incidence, with adjusted odds ratios of 3.73 (95% CI = 1.79–7.77) for treatment details and 2.93 (95% CI = 1.22–7.08) for patient factors. However, the presence of a dedicated team or physiotherapist did not significantly affect ICU-AW incidence, with adjusted odds ratios of 0.50 (95% CI = 0.24–10.6) and 0.99 (95% CI = 0.40–2.47), respectively. Conclusions: Early mobilization effectively reduced ICU-AW incidence in sepsis patients, though a dedicated team or physiotherapist had no significant impact. Urinary tract infections were the most common infection source in ICU-AW patients. Early mobilization during dialysis for acute kidney injury shows promising potential and warrants further promotion. Full article

In an era when AI systems curate increasingly fine-grained aspects of everyday media use, understanding algorithmic fatigue and resistance is essential for safeguarding user agency. Within the horizon of a more algorithmic and hyper-personalized advertising environment, knowing how people resist algorithmic advertising is of immediate importance. This research formulates and examines a structural resistance model for algorithmic advertising, combining psychological and cognitive predictors such as perceived ad fatigue (PAF), digital well-being (DWB), advertising literacy (ADL), and perceived relevance (PR). Based on a cross-sectional survey of 637 participants, the research employs Partial Least Squares Structural Equation Modeling (PLS-SEM) and mediation and multi-group analysis to uncover overall processes and group-specific resistance profiles. Findings show that DWB, ADL, and PR are strong positive predictors of resistance to persuasion, while PAF has no direct effect. PAF has significant indirect influences through both PR and ADL, with full mediation providing support for the cognitive filter function of resistance. DWB demonstrates partial mediation, indicating that it has influence both directly and through enhanced literacy and relevance attribution. Multi-group analysis also indicates that there are notable differences in terms of age, gender, education, social media consumption, ad skipping, and occurrence of digital burnout. Interestingly, younger users and those who have higher digital fatigue are more sensitive to cognitive mediators, whereas gender and education level play a moderating role in the effect of well-being and literacy on resistance pathways. The research provides theory-informed, scalable theory to enhance the knowledge of online resistance. Practical implications are outlined for policymakers, marketers, educators, and developers of digital platforms based on the extent to which psychological resilience and media literacy underpin user agency. In charting resistance contours, this article seeks to maintain the voice of the user in a world growing increasingly algorithmic. Full article

Background and Objectives: Knee Osteoarthritis affects about 10% of people over 50, causing pain and functional limitation. Hyaluronic acid (HA) is crucial in regulating the osteocartilaginous matrix. Patients are usually assessed using clinical scores to examine symptoms and quality of life, and in this context, gait analysis could provide an objective assessment of walking patterns to identify any deficits. This systematic review investigates the short and long-term effects of intra-articular HA injections on gait kinematics, pain and activities of daily living (ADL), investigating the correlation between outcomes. Materials and Methods: The review followed PRISMA guidelines. The PICO model included patients with radiographic knee osteoarthritis who received intra-articular HA injections, comparing them to healthy controls or those receiving corticosteroids or placebo. Outcomes included gait kinetics and functional scales at baseline and during follow-ups. Results: From 342 identified articles, 13 were included, comprising a total of 321 patients. The gait analysis utilized optoelectronic systems, inertial sensors, and electromyographic sensors pre- and post-HA treatment. Clinical parameters were assessed using the Visual Analogue Scale, WOMAC OA, Knee Society Score, Lequesne Score, and SF-36. The data showed significant improvement in speed (p = 0.001) and step cadence (p < 0.005) 30 days post-treatment and improvements in knee adduction moment (p < 0.001) and sagittal ground reaction force vectors (p < 0.01) up to six months post-treatment. Pain reduction and improvements in VAS (p < 0.001) and Lequesne score (p < 0.001) were observed in short-term follow-ups. Conclusions: Our study suggests an improvement in pain and knee function after hyaluronic acid injection. Moreover, gait analysis is an important tool for objectively assessing deficits and developing personalized rehabilitation programs. Furthermore, combining infiltrative treatment with rehabilitation could extend the effects of hyaluronic acid and improve results. Full article

Background/Objectives: The increasing emphasis on early mobilization in intensive care units (ICUs) has underscored the need for quick, simple, and reliable tools to assess patients’ mobilization levels. The ICU Mobility Scale (IMS) was developed to address this need and has been translated into a Japanese version. This study aimed to evaluate the construct and predictive validity of the Japanese version of the IMS in critically ill patients. Methods: This was a secondary analysis of the EMPICS study, which included patients who stayed in ICUs for at least 48 h. The Japanese version of the IMS and physical function were assessed at ICU discharge. At hospital discharge, outcomes such as walking ability, discharge destination, activities of daily living (ADL) dependency, ICU-acquired weakness, and physical impairment were evaluated. At 90-day follow-up, the presence of post-intensive care syndrome (PICS) was assessed using quality of life scores, and mortality data were collected. Construct and predictive validity were analyzed using Spearman’s rank correlation coefficients, the Mann–Whitney U test, and logistic regression analysis. Results: A total of 193 patients (mean age 68.2 years; 65.8% male) were included. The mean IMS score at ICU discharge was 5.6. The IMS score at ICU discharge showed significant correlations with the Barthel Index (ρ = 0.55, p = 0.001), Medical Research Council sum score (ρ = 0.45, p < 0.001), and grip strength (ρ = 0.44, p < 0.001), but not with body weight or sex. Logistic regression analyses demonstrated that a higher IMS score at ICU discharge was significantly associated with better physical outcomes at hospital discharge, a lower incidence of PICS, and reduced 90-day mortality. Conclusions: The Japanese version of the IMS demonstrated both construct and predictive validity in ICU patients. It is a useful tool for assessing daily mobilization levels in critical care settings. The findings may not be generalizable to all ICU patients due to the strict eligibility criteria. Full article