Search Results (385)

Quantifying mechanical loading during daily physical activities is essential for designing and evaluating bone health interventions. Accelerometers are a promising tool for estimating these loads under free-living conditions, yet existing prediction models depend on prior knowledge of the activity being performed. This study developed and validated machine learning models to automatically distinguish between walking, running, and jumping using accelerometer data. Forty-eight healthy adults completed a protocol of walking, running, and jumping tasks while wearing ActiGraph GT9X Link accelerometers at the ankle, lower back, and hip. Three algorithms (Random Forest, Support Vector Machine, and K-Nearest Neighbors) were trained and evaluated through multiple performance metrics. All models achieved excellent classification accuracy across sensor placements, with percent agreement between 93.8% and 97.7%, receiver operating characteristic area under the curve values consistently above 0.97, and Kappa coefficients exceeding 0.89. These results demonstrate that accelerometer-based activity classification can reliably differentiate walking, running, and jumping, establishing a practical framework for applying activity-specific mechanical loading prediction equations under free-living conditions. Full article

Neurological injuries and disorders affecting hand motor control can severely impair the ability to perform activities of daily living and substantially reduce quality of life. Technologies such as virtual reality (VR) are increasingly used to address fundamental challenges in therapy, including motivation and engagement; further, programmable features of digital interfaces offer additional opportunities to personalize and optimize motor training. In this proof-of-concept study, we developed and evaluated a novel VR-based training framework to support improved dexterity and hand function using physiological (sensory-driven) and cognitive (memory) cues designed to promote greater task-relevant neural engagement. The proposed approach leverages the integration of augmented sensory feedback (ASF) with memory-anchored cues for motor learning of target hand gestures. Using a within-subjects design, thirteen neurotypical adults completed four training conditions: (1) control (baseline gesture-matching in VR), (2) visual ASF (enhanced visualization and feedback of gesture accuracy), (3) memory-anchored cues (associating gestures with semantically meaningful entities, loosely analogous to American Sign Language), and (4) hybrid multimodal (visual ASF + memory-anchored cues). Training with the hybrid condition produced the fastest skill acquisition (9.3 trials to reach an 80% accuracy threshold) and the steepest initial learning slope (1.86 ± 0.12%/trial), with all conditions differing significantly in initial slope (all p < 0.002). Post-training assessment showed that the hybrid condition achieved the highest gesture accuracy (95.2%), greatest normalized post-training accuracy gain (14.3% above baseline), fastest execution time to target gesture (1.14 s), and lowest variability in gestural kinematics (SD = 3.9%). Both ASF and memory-anchored cue conditions each also independently outperformed the control condition on gesture accuracy (both p ≤ 0.002), with omnibus ANOVAs indicating significant condition effects across metrics. Together, these findings suggest that pairing ASF cues with memory-based cognitive scaffolding can yield additive benefits for motor skill acquisition and stability. Pending validation in clinical populations, such approaches may inform the design of VR-based motor training frameworks for rehabilitation. Full article

Caring for children with physical disabilities can be a daunting responsibility, often placing significant financial, psychological, social and health-related strains on the primary caregivers. This qualitative study explored the experiences of caregivers caring for children with physical disabilities in the Hardap region of Namibia. Using purposive sampling, twenty caregivers were selected as participants in the study. Data was collected using semi-structured interview schedules. Following the interviews, the data were manually analysed and categorised into distinctive themes and sub-themes and summarised in the final report as verbatim quotations. Study findings reveal that caregivers are motivated and determined to provide optimum care for children with physical disabilities under their care by acquiring assistive devices for them and assisting the children with activities of daily living. However, poverty and the general shortage of assistive devices, mostly wheelchairs, provide adverse conditions that are inimical to the development of children’s functional independence in daily living tasks. The burden of carrying the children was noted to be potentially deleterious to the caregivers’ physical health. The study concluded that providing assistive equipment for the children will ease the caregivers’ burden of care while equalising socioeconomic opportunities for both children with physical disabilities and their caregivers. The study only covered a small sample size in a small geographical area of Namibia. Therefore, interpretation and generalisation of the findings need to account for the specific context in the Hardap region of Namibia. Therefore, there remains scope for conducting further research with a larger sample size and one that is more geographically representative of Namibia. Full article

Upper extremity (UE) pain and pathology are prevalent among manual wheelchair users (MWUs) due to repetitive loading demands, highlighting the need for tools to identify high-risk tasks and inform injury prevention. This study investigated the feasibility of classifying activity intensity for wheelchair-related tasks using wearable sensors and supervised machine learning. Twenty-four MWUs with chronic spinal cord injury completed a standardized mobility course and simulated activities of daily living while UE electromyography (EMG) and inertial measurement unit (IMU) data were collected. Signals segmented into 3, 5, and 10 s windows, and time- and frequency-domain features were extracted and labeled as low, moderate, or high intensity. Multiple classification algorithms were evaluated using subject-dependent and subject-independent cross-validation, and dimensionality reduction was explored to assess class separability. Subject-dependent analyses demonstrated performance above chance but below 75% accuracy, with decision tree models demonstrating superior performance, particularly when trained on data segmented into 5 s windows. IMU features outperformed EMG features, but combining signal types enhanced performance. Subject-independent analyses revealed similar overall accuracy across signal types, but decreased high-intensity classification for EMG data, indicating subject dependency. Findings support the potential of wearable sensor-based machine learning with population-specific findings for activity intensity classification in MWUs, while highlighting challenges related to inter-subject variability for injury risk prediction. Full article

Background: In addition to motor symptoms, persons with Parkinson’s disease (PD) experience several non-motor symptoms with challenges in working memory being particularly common. These cognitive challenges may worsen under stress. The purpose of this pilot study was to examine how physical stress affects working memory in persons with PD. Methods: Eight individuals with PD and 11 healthy older adults (HOAs) completed digit span forward and backward tasks following a socially evaluated cold pressor stressor and a control condition. Results: Under non-stressful conditions, persons with PD had a smaller digit span backward capacity and were slower during the digit span forward task compared to HOAs. However, during the stress condition, individuals with PD performed comparably to HOAs on the backward digit span task. Stress negatively affected response times on the backward task for both groups but did not alter capacity or response time on the forward task. Conclusions: These findings provide an initial step in understanding the effects of physical stress on working memory in PD. Since working memory supports many daily activities, understanding how stress influences this cognitive process may inform interventions that enhance stress regulation and improve cognitive and functional outcomes for individuals living with PD. Full article

Background: Spinal cord injury (SCI) is a leading cause of chronic disability. Loss of upper extremity (U.E.) function is central to limitations, in mobility, postural control, transfers, and self-care. The aim of this exploratory pilot study was to investigate whether self-reported UE function is associated with independence in activities of daily living (ADLs) in people with motor-incomplete tetraplegia. Methods: Eleven (n = 11) individuals with motor-incomplete tetraplegia (AIS C–D; neurological levels C4–T1; injury duration ≥ 1 year), recruited through convenience sampling from five specialist rehabilitation centres, participated in an exploratory cross-sectional pilot study designed to generate hypotheses rather than test them. U.E. function was assessed using the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, selected for its ability to capture pain and task-related functional difficulty in the elbow, wrist, and hand; its application in this neurological population is considered exploratory. Independence in ADLs was evaluated using the Spinal Cord Independence Measure III (SCIM III). Given the small sample, all analyses were primarily descriptive and along with bivariate associations (Spearman correlations). Regression findings are reported strictly for exploratory purposes. Results: The median age was 50 years (interquartile range [IQR] 43–55). A strong negative correlation was observed between PRTEE total score and SCIM III (r_s = −0.76). In an exploratory univariate analysis, each 1-point increase in PRTEE total score was associated with a 1.3-point lower SCIM III score (β = −1.3, 95% CI −2.34 to −0.26, p = 0.02). Age also showed a positive association (β = 1.31, 95% CI 0.04 to 2.58, p = 0.05) with SCIM III; however, this finding is highly likely to reflect a statistical artefact of the small and unrepresentative sample. Multivariable regression was not conducted as a primary analysis due to insufficient statistical power. All findings should be treated as strictly exploratory and hypothesis-generating. Conclusions: Self-reported U.E. function appears to be associated with ADL independence in motor-incomplete tetraplegia. U.E. capacity may contribute to functional tasks requiring postural stability and mobility-related activities, but no predictive inferences can be made from this underpowered, convenience sample. Future studies with larger cohorts and performance-based measures are needed to confirm these preliminary observations and clarify the role of U.E. function in rehabilitation planning. Full article

Stroke remains a leading cause of death and disability worldwide, imposing significant burdens on patients, families, and healthcare systems. Despite advances in acute management and rehabilitation, effective interventions to promote neural recovery remain limited. Hyperbaric oxygen therapy (HBOT) has emerged as a potential adjunctive treatment, but its effects on cortical functional activity—particularly the neurophysiological mechanisms underlying clinical improvements—remain insufficiently understood. This study aimed to investigate the effects of hyperbaric oxygen therapy (HBOT) on cerebral activation in stroke patients using functional near-infrared spectroscopy (fNIRS) and to evaluate its therapeutic efficacy. A total of 23 patients with intracerebral hemorrhage and 20 with cerebral infarction were enrolled. fNIRS data were collected before HBOT and within 10–30 min after treatment completion. During data acquisition, participants performed an alternating left- and right-hand grip task while wearing the fNIRS device throughout the procedure. Changes in near-infrared light intensity were monitored to objectively reflect cortical activity. The results showed that after HBOT, activation patterns in relevant brain regions during the grip task were significantly altered: activation channels during the bilateral grip task changed in cerebral infarction patients, with some brain regions overlapping with those observed in intracerebral hemorrhage patients. In intracerebral hemorrhage patients, the number of significantly activated channels decreased during the left-hand grip task but increased notably during the right-hand grip task, which may be related to cerebral functional compensation and right-hand dominance. Clinical assessments revealed significant post-treatment improvements in Brunnstrom stage, Fugl-Meyer scores, and activities of daily living. These findings suggest that HBOT may contribute to multifaceted recovery of brain function in stroke patients, not only by enhancing cerebral blood flow and oxygenation but also by facilitating neural repair and regeneration, as well as optimizing cerebral activation and functional connectivity. Thus, this study provides an objective basis for understanding the mechanisms and efficacy of HBOT in stroke rehabilitation. Full article

The objective was to evaluate the impact of a 3-month comprehensive rehabilitation program on functional outcomes and caregiver burden in a 73-year-old male with end-stage Parkinson’s disease (PD) following pallidotomy. Baseline evaluation included cardiorespiratory, digestive, and neuromusculoskeletal assessments, complemented by a multidomain geriatric assessment: activities of daily living (Barthel Index), cognition (MoCA), nutrition (MNA), mental health (GDS, UCLA Loneliness Scale), sarcopenia (AWGS criteria), frailty (Clinical Frailty Scale), fatigue (FSS), mobility (De Morton Mobility Index), fall risk (Morse Fall Scale), and caregiver burden (Zarit Burden Interview). The patient then underwent a structured 3-month rehabilitation program consisting of strengthening and flexibility training, cardiopulmonary endurance exercise, functional task practice, and psychological and nutritional counseling, with monthly evaluations. At baseline, the patient presented with generalized rigidity, fatigue, low cardiorespiratory endurance, total ADL dependence, malnutrition, sarcopenia, frailty, loneliness, and high caregiver burden, but intact cognition and mood. After rehabilitation, he achieved short distance walking, improved appetite and weight gain, and reduced scores in Zarit Burden, Fatigue Severity Scale, and MNA. Functional independence (Barthel Index) and respiratory capacity (single-breath count) improved, while frailty and sarcopenia remained stable without progression. In advanced PD, comprehensive rehabilitation can yield meaningful gains in mobility, nutrition, and functional independence while alleviating caregiver burden. Frailty and sarcopenia remain strongly associated with disease progression and highlight the need for sustained multidisciplinary care for both patients and caregivers. Full article

Stroke-induced hand motor dysfunction severely limits activities of daily living (ADL). While conventional systems face challenges in portability and sustained actuation accuracy, this work addresses these limitations through an integrated adaptive control framework and a lightweight 10-degrees-of-freedom (DoFs) tendon-driven exoskeleton. The system employs a rigid–flexible coupling design with a wearable mass under 300 g, ensuring compatibility across various finger lengths. The system is implemented via a motor imagery-based brain–computer interface (MI-BCI); by processing 64-channel electroencephalogram (EEG) signals, the system adaptively maps motor intent into three discrete grasp intensity levels (20%, 50%, and 80% maximum voluntary contraction). To reduce cognitive load and enhance system stability during rehabilitation, we propose a novel “Force–Topology Coupling” control paradigm. This paradigm functions as a synergistic filter, leveraging the correlation between intended effort level (IEL) and grasp taxonomy to map intensity levels to ADL-specific grasps (lateral, precision, and power). Validation with healthy subjects demonstrated 0° to 90° joint mobility and the successful execution of 9 ADL tasks. The results verify the efficacy of utilizing adaptive MI-BCI modulation to trigger biomechanically precise assistance, establishing a foundational computational paradigm with significant potential for clinical stroke rehabilitation. Full article

Background and Objectives: Children with Developmental Coordination Disorder (DCD) show substantial motor and balance difficulties that affect daily activities. Although action observation (AO) and motor imagery (MI) are effective in other neurological conditions, their impact in DCD remains underinvestigated. This review explores the preliminary evidence of AO- and MI-based interventions for improving motor and functional outcomes in children with DCD. Methods: A systematic search of PubMed, Scopus, and Web of Science identified randomized controlled trials and controlled trials published in the last 15 years evaluating AO and MI interventions in children with DCD. Two independent reviewers conducted the screening of the studies, data extraction, and the risk-of-bias assessment using RoB2 and ROBINS-I. The review followed PRISMA reporting guidelines and was pre-registered on the PROSPERO database (CRD420251084196). Results: Of 320 records initially identified, seven studies, involving 199 children with DCD (aged 5–12 years), were included. Interventions varied from single-session to multi-session protocols (1–16 sessions) and included AO, MI, or a combination of both (AO + MI), with heterogeneous control conditions. Within these studies, the outcomes were primarily assessed using standardized motor coordination measures (MABC/MABC-2, DCDQ), planning tasks, and performance-based activities of daily living (ADLs) measures. Improvements were reported in motor imagery tasks, planning, and functional task performance. However, RCTs and CTs were identified to have a moderate and high risk of bias, respectively. Conclusions: The present review suggests that AO and MI, either alone or in combination, may enhance motor planning, coordination, and daily functional skills in children with DCD, supporting internal motor representations and predictive motor control, reflecting functional gain in motor skills and ADL performance. Interestingly, these mental training approaches can be applied in clinical and everyday settings and are suitable for supporting these processes, with VR-based combinations representing a promising, but exploratory, approach. Although critical heterogeneity and a moderate risk of bias remain, the findings need to be interpreted with caution and require further investigation. Full article

Background: Manual dexterity (MD) impairment is a frequent and disabling feature in patients with Parkinson’s disease (PD) and paranoid schizophrenia (PS), significantly affecting functional independence and activities of daily living. However, rehabilitation strategies specifically targeting fine motor control remain insufficiently integrated into routine physiotherapy (PT). Objective: This study investigated the effects of a structured, progressive PT program incorporating targeted MD training on upper limb function in patients with PD and PS. Methods: A prospective, exploratory, interventional study was conducted in 30 patients, allocated to either an experimental group (EG, n = 20) or a control group (CG, n = 10). Participants had PD (Hoehn and Yahr stages II–III) or chronic, clinically stable PS. MD was assessed using the Purdue Pegboard Test, Coin Rotation Task, and Kapandji opposition score. The EG completed a four-phase, 40-week dexterity-oriented rehabilitation program, while the CG received standard disease-specific PT. Between-group differences in change scores were analyzed using one-way ANOVA. Results: The EG showed significantly greater improvements than the CG in thumb opposition, psychomotor processing speed, and unilateral and bilateral fine motor performance (p < 0.001 for all), with large to very large effect sizes (η² = 0.45–0.76). No significant between-group differences were observed for complex sequential assembly tasks. Conclusions: Integrating targeted MD training into structured PT programs significantly improves fine motor performance in patients with PD and PS, supporting its inclusion in rehabilitation protocols for residential and outpatient care settings. Full article

Objectives: Frozen shoulder (FS) leads to pain, reduced shoulder function, and deficits in postural stability and sensorimotor control during upper-limb weight-bearing and activities of daily living tasks. This study investigated how an eight-week Dynamic Neuromuscular Stabilization (DNS) program affected Center of Pressure (COP) control and pain in midlife women with FS. Methods: Twenty-two midlife women with FS were randomly assigned to a DNS group (DNSG, n = 11) or a control group (CG, n = 11). The DNSG performed DNS exercises twice weekly for eight weeks, while the CG performed a dynamic stretching–based active control program. COP variables (distance, velocity, and root mean square (RMS) in the anterior–posterior (AP) and medial–lateral (ML) directions) were measured using a force platform under affected-side single-hand support with visual input and bilateral hand support with and without visual input. Pain was assessed using the Visual Analog Scale (VAS). All variables were analyzed using a two-way mixed ANOVA. Results: Under the affected-side single-hand support condition, a significant group × time interaction was observed for the prespecified primary outcome, ML-RMS (p < 0.05). Other COP variables under this condition were not significant after Holm–Bonferroni correction. Under bilateral hand-support conditions, ML-RMS remained significant after multiplicity adjustment in both visual conditions (p < 0.05). Pain (VAS) decreased over time in both groups, with no significant group × time interaction observed. Conclusions: The DNS intervention was associated with positive changes in COP-based postural control during upper-limb weight-bearing tasks in midlife women with FS. Pain decreased over time in both groups, with no significant group-by-time interaction. These findings suggest that DNS may be a potentially useful intervention for improving postural stability during upper-limb support tasks in patients with FS. Full article

Tracking knee joint movement during activities of daily living can have the potential to transform the rehabilitation and functional assessment of patients. The present study evaluated the validity of a low-cost, instrumented knee brace to determine whether it was appropriate for the monitoring and quantification of human knee function during five activity-of-daily-living (ADL) tasks including walking, inclined walking, stepping, sitting, and object manipulation. A sensor platform was designed to acquire sagittal plane knee data from 13 healthy participants across five different tasks and compared to gold-standard motion analysis. The brace showed good-to-excellent validity (RMSE: 4.97–8.65°), with differences in knee joint angles and angular velocities noted during various ADLs, specifically during early and late portions of a given movement. The results for instantaneous knee joint angles and angular velocities were very similar to those of the gold-standard system (mean bias: 0.59–9.52°·s⁻¹), which may be applicable to everyday movement tasks, but may preclude analyses at a clinical level. Although the low-cost sensor platform shows promise an effective monitoring tool, it is not ready yet for a clinical application. Full article

Analyzing the dynamics of muscle activation patterns and joint range of motion is essential to understanding human movement during complex tasks such as tooth brushing Activities of Daily Living (ADLs). In individuals with neuromotor impairments, accurate assessment of upper limb motor patterns plays a critical role in rehabilitation, supporting the identification of compensatory strategies and informing clinical interventions. This study presents the validation of a previously developed novel, low-cost, wearable, and portable multimodal prototype that integrates inertial measurement units (IMU) and surface electromyography (sEMG) sensors into a single device. The system enables bilateral monitoring of arm segment kinematics and muscle activation amplitudes from six major agonist muscles during ADLs. Eleven healthy participants performed a functional task, tooth brushing, while wearing the prototype. The recorded data were compared with two established gold-standard systems, Qualisys^® motion capture system and Biosignalsplux^®, for validation of kinematic and electrophysiological measurements, respectively. This study provides technical insights into the device’s architecture. The developed system demonstrates potential for clinical and research applications, particularly for monitoring upper limb function and evaluating rehabilitation outcomes in populations with neurological disorders. Full article

Individuals with developmental disabilities often experience physical and mental chronic conditions from early childhood, which can negatively affect their education, employment, and social participation without appropriate interventions. These impairments frequently limit the acquisition of essential daily living skills, including personal hygiene skills. This study examined a multicomponent intervention package—comprising video prompting, step-by-step instruction based on task analysis, systematic error correction, and reinforcement—to support the acquisition of handwashing skills for two adolescents with developmental disabilities (Autism Spectrum Disorder and Intellectual Disability) and toothbrushing skills for one adolescent. A nonconcurrent multiple-baseline design across participants and skills was employed, including baseline, intervention, maintenance, and generalization phases. The intervention was conducted over eight weeks. The results indicated low and stable baseline performance for both participants, followed by a systematic increase in performance after the introduction of the intervention, reaching accuracy levels between 80% and 91%. Participants demonstrated meaningful improvements in hygiene skill performance following intervention. These gains were maintained over time and generalized to new settings, although a few task steps continued to require prompting. Furthermore, teachers and parents rated the intervention as highly feasible, practical, and useful for supporting hygiene skills, while students reported enjoyment, perceived improvement, and willingness to participate again. Overall, the findings suggest that structured, evidence-based instructional approaches may support increased functional participation in essential daily living skills, particularly when complete independence may not be attainable for all individuals. Full article