Search Results (181)

Population aging is an inevitable trend in contemporary society, and the application of technologies such as human–machine interaction, assistive healthcare, and robotics in daily service sectors continues to increase. The lower limb exoskeleton rehabilitation robot has great potential in areas such as enhancing human physical functions, rehabilitation training, and assisting the elderly and disabled. This paper integrates the structural characteristics of the human lower limb, motion mechanics, and gait features to design a biomimetic exoskeleton structure and proposes a human–machine integrated lower limb exoskeleton rehabilitation robot. Human gait data are collected using the Optitrack optical 3D motion capture system. SolidWorks 3D modeling software Version 2021 is used to create a virtual prototype of the exoskeleton, and kinematic analysis is performed using the standard Denavit–Hartenberg (D-H) parameter method. Kinematic simulations are carried out using the Matlab Robotic Toolbox Version R2018a with the derived D-H parameters. A physical prototype was fabricated and tested to verify the validity of the structural design and gait parameters. A controller based on BP fuzzy neural network PID control is designed to ensure the stability of human walking. By comparing two sets of simulation results, it is shown that the BP fuzzy neural network PID control outperforms the other two control methods in terms of overshoot and settling time. The specific conclusions are as follows: after multiple walking gait tests, the robot’s walking process proved to be relatively safe and stable; when using BP fuzzy neural network PID control, there is no significant oscillation, with an overshoot of 5.5% and a settling time of 0.49 s, but the speed was slow, with a walking speed of approximately 0.18 m/s, a stride length of about 32 cm, and a gait cycle duration of approximately 1.8 s. The model proposed in this paper can effectively assist patients in recovering their ability to walk. However, the lower limb exoskeleton rehabilitation robot still faces challenges, such as a slow speed, large size, and heavy weight, which need to be optimized and improved in future research. Full article

Traumatic Brain Injuries (TBIs) pose a significant global health burden, with high mortality and long-term disability rates. This retrospective cohort study investigates the implementation and impact of the Brain Trauma Foundation (BTF) guidelines on TBI management in a Saudi Arabian tertiary care center. Data from the pre-implementation (2012) and post-implementation (2022) of BTF guidelines periods were compared. The patient demographics, injury severity, guideline adherence, and outcomes were analyzed. The results revealed a 33% increase in severe TBI cases from 2012 to 2022, possibly due to the development of a well-established trauma system designed to manage such cases. More importantly, implementing the BTF guidelines led to a marked improvement in patient outcomes. Compliance with guidelines, including the avoidance of hypoxia and hypotension, hyperosmolar therapy, and DVT prophylaxis significantly increased post-implementation. Mortality rates decreased from 45.4% to 14.2%, accompanied by a reduction in the intensive care unit (ICU) length of stay and an increase in the hospital length of stay. A comparison with international trauma centers highlights the importance of protocol-based management in improving the TBI outcomes and reducing the mortality—factors such as specialist-led care, institutional policies, and increased resources influenced guideline adherence and patient care. This study underscores the critical role of evidence-based guidelines in optimizing TBI management and emphasizes the need for their widespread implementation in clinical practice. In conclusion, this study demonstrates the substantial impact of BTF guidelines on enhancing TBI patient outcomes in a Saudi Arabian tertiary care center. The implementation of these guidelines resulted in a significant reduction in mortality and in an improved adherence to the best practices in TBI management, highlighting the importance of evidence-based protocols in optimizing patient care and outcomes. Full article

Aging is a process characterized by tissue degeneration, increased susceptibility to chronic degenerative diseases, infections, and the appearance of neoplasms, which leads to disability and a reduction in the length and quality of life. This phenomenon is the result of the convergence of multiple processes, including mitochondrial dysfunction, fibrosis, inflammation, dysregulation of cell death processes, and immunosenescence. These processes have as their point of convergence an increase in the production of ROS. Avocado oil (Persea americana Mill.) contains a diverse array of bioactive compounds, including oleic acid, phytosterols, chlorophylls, xanthones, xanthines, and carotenoids. These bioactive compounds have the capacity to modulate the excessive production of ROS, thereby reducing the progression of age-related diseases and extending lifespan in experimental models of aging. In addition, several studies have demonstrated the efficacy of avocado oil in mitigating age-related diseases, including hypertension; insulin resistance; diabetes; non-alcoholic liver disease; and degenerative processes such as hearing loss, cognitive decline, neurodegeneration, and impaired wound healing. In light of these findings, it is hypothesized that avocado oil is a promising agent capable of promoting healthspan in later stages of life owing to its direct antioxidant actions and the activation of pathways that enhance endogenous antioxidant levels. Full article

Background/Objectives: Heterozygous variants in the heterogeneous nuclear ribonucleoprotein C gene (HNRNPC) have recently been reported to cause intellectual developmental disorder-74 (MRD74), a neurodevelopmental disorder with no recurrent diagnostic handles. Affected individuals show variable, non-specific, and subtle dysmorphic features. The degree of developmental delay (DD)/intellectual disability (ID) is also wide, ranging from mild to severe. The mutational spectrum is relatively broad with exon deletions and splice site and frameshift variants distributed along the entire length of the gene leading to HNRNPC loss of function. Only two missense changes located within the RNA-binding motif (RBM) and adjacent linker region of the more abundant isoform (Arg64Trp and Arg99Gln) have been described. Notably, the Arg99Gln amino acid substitution was reported in a subject presenting with a more complex and unique clinical phenotype characterized by distinctive facial features, DD/ID, cochlear aplasia, and bilateral colobomatous microphthalmia, suggesting the possible occurrence of phenotypic heterogeneity. Results: Here, we report the second individual carrying the Arg99Gln change in HNRNPC and having clinical features with a significant overlap with the peculiar phenotype of the previously described subject, supporting the occurrence of a genotype–phenotype correlation. Conclusions: Due to the concomitant occurrence of ocular and cochlear involvement as recognizable diagnostic handles, we propose that the HNRNPC^Arg99Gln-related phenotype should be considered as a potential differential diagnosis in subjects with ID and major signs of CHARGE syndrome not fulfilling the minimum criteria for a clinical diagnosis. Full article

Background/Objectives: International guidelines recommend the use of orthoses in subjects with cerebral palsy (CP), even though there is limited evidence of their effectiveness. Little is known about their effectiveness in children and adolescents with other types of neuromotor disability. Methods: The review protocol was recorded on the PROSPERO register (CRD42024509165) and conformed to the PRISMA guidelines. The inclusion criteria were any type of ankle–foot orthoses (AFOs); pediatric subjects with any non-acquired neuromotor disease; any type of outcome measure regarding gait performance; controlled studies; and those in the English language. Screening, selection, risk of bias assessment, and data extraction were performed by a group of independent researchers. Results: Fifty-seven reports were included, with most regarding CP; three involved subjects with Charcot–Marie–Tooth disease or Duchenne dystrophy. Nine were RCTs. A meta-analysis was performed for studies including subjects with CP. The meta-analysis demonstrated the effectiveness of AFOs in increasing stride length (MD −10.21 [−13.92, −6.51]), ankle dorsiflexion at IC (MD 9.66 [7.05, 12.27]), and peak ankle DF in stance (MD 5.72 [2.34, 9.09]) while reducing cadence (MD 0.13 [0.06, 0.17]) and the energy cost of walking (MD −0.02 [−0.03, −0.00]). The peak ankle power generated at push-off was significantly increased with flexible AFOs compared to rigid AFOs (MD 0.38 [0.30, 0.46]), but it decreased with both compared to walking barefoot or with shoes (MD −0.35 [−0.49, −0.22]). Evidence regarding DMD and CMT was limited but suggested opting for individualized flexible AFOs, which preserved peak ankle power generation. Conclusions: AFOs improve gait performance in CP. Flexible AFOs are preferable because they preserve the peak ankle power generated at push-off compared to rigid AFOs. Full article

Background: Arthroscopic rotator cuff repair (RCR) is a common procedure, yet long-term patient-centered outcome studies remain limited. This study aims to evaluate the outcomes of arthroscopic RCR using a single-row metallic anchor technique over a 12-year follow-up, focusing on patient-reported outcomes and potential risk factors. Methods: A monocentric cohort study was conducted on patients who underwent complete arthroscopic RCR with a single-row metallic anchor technique from January 2007 to July 2011. A total of 628 patients completed three standardized questionnaires: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Simple Shoulder Test (SST). They were also asked for their overall satisfaction on the procedure with a single direct question. Outcomes were analyzed by gender, age at surgery, lesion pattern, and follow-up duration. Results: The mean follow-up period was 12.9 ± 1.3 years. Overall satisfaction was 96.5%. The mean scores for QuickDASH, ASES, and SST were 7.2 ± 15.7, 83.8 ± 23.9, and 89.9 ± 22.3, respectively. Female patients reported significantly lower QuickDASH (p < 0.001), ASES (p < 0.001), and SST (p = 0.004) than male patients, but overall satisfaction did not differ by gender. Age, number of tendons repaired, anterior tear, and follow-up length were not significantly associated with differences in outcome measures. Conclusions: Single-row arthroscopic RCR provides excellent long-term patient-reported outcomes and high patient satisfaction. Female gender may be associated with slightly lower functional scores, yet satisfaction remains unaffected. This study supports the single-row technique as a reliable, efficient, and cost-effective option for long-term success in RCR, challenging the need for more complex multi-anchor approaches. Full article

Background/Objectives: Strokes remain a major global health concern, contributing significantly to disability and healthcare costs. Currently, there are no established indicators to accurately assess the degree of muscle tissue impairment in stroke-affected individuals. However, ultrasound imaging with an echotexture analysis shows potential as a quantitative tool to assess muscle tissue quality. This study aimed to identify specific echotexture features in the gastrocnemius medialis that effectively characterize muscle impairment in post-stroke individuals. Methods: An observational study was conducted with 22 post-stroke individuals. A total of 21 echotexture features were extracted and analyzed, including first-order metrics, a grey-level co-occurrence matrix, and a grey-level run length matrix. The modified Heckmatt scale was also applied to correlate with the most informative echotexture features. Results: Among the features analyzed, echovariation (EV), echointensity, and kurtosis emerged as the most informative indicators of muscle tissue quality. The EV was highlighted as the primary feature due to its strong and significant correlation with the modified Heckmatt scale (r = −0.81, p < 0.001) and its clinical and technical robustness. Lower EV values were associated with poorer muscle tissue quality, while higher values indicated better quality. Conclusions: The EV may be used as a quantitative indicator for characterizing the gastrocnemius medialis muscle tissue quality in post-stroke individuals, offering a more nuanced assessment than traditional qualitative scales. Future studies should investigate the correlation between the EV and other clinical outcomes and explore its potential to monitor the treatment efficacy, enhancing its applicability in clinical practice. Full article

The convenience of commuting for individuals using mobility aids (IMAs) depends on various features of urban road infrastructure. The present research selected different pathways based on the relevance and convenience of IMAs in three regions of Saudi Arabia, including Riyadh, Qassim, and Hail. A survey questionnaire was developed to evaluate the satisfaction of IMAs with four critical criteria of road infrastructure, including travel distance, slope, availability of footpaths, and number of junctions, using a 5-point Likert scale from very low to very high. A sufficient sample size of this exceptional proportion of the population from different genders, age groups, education levels, employment status, number of disability years, and types of mobility aid participated in the survey. The main reasons for dissatisfaction of more than 50% of the participants were inadequate infrastructure design of entrances to public facilities, pedestrian crossings, and junctions. Social stigma and inadequate assistive technology were also highlighted by around 20% of the participants. The fuzzy synthetic evaluation identified length, slope, and footpaths along the pathway as the most critical features based on the subjective opinion of the participants, of which around 65% have been using artificial limbs or manual wheelchairs. PROMETHEE II aggregated the importance of weights estimated by the participants’ opinion and performance scores of infrastructure features to effectively rank ten pathways in three major cities of the selected regions, using partial and complete outranking. The framework developed in the present study helps concerned organizations to comply with the Vision 2030 goal of a vibrant society in Saudi Arabia by identifying critical pathways and improving infrastructure design to ensure safety, convenience, and satisfaction for IMAs. Full article

Background: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. Methods: The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at −110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Results: Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. Discussion and Conclusions: The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes. Full article

Background and Objectives: Amyloidosis is a disorder characterized by the abnormal folding of proteins, forming insoluble fibrils that accumulate in tissues and organs. This accumulation disrupts normal tissue architecture and organ function, often with serious consequences, including death if left untreated. Light-chain amyloidosis (AL) and hereditary transthyretin-type amyloidosis (hATTR) are two of the most common types. In amyloidosis, peripheral nervous system involvement is a significant diagnostic feature, particularly when it manifests as polyneuropathy, carpal tunnel syndrome (CTS), and dysautonomia. These neurological symptoms often point to the involvement of amyloid deposits in the peripheral and autonomic nervous systems, which can help identify and differentiate between the various types of amyloidosis. Materials and Methods: This retrospective study focused on the evolution of electrophysiological parameters in two groups: AL (n = 22) and hATTR-Glu54Gln patients (n = 14), with mixed axonal polyneuropathy. Patients were followed for two consecutive years to assess disease progression. The PND scale (polyneuropathy disability) was also used to assess motor impairment for each patient. Results: In our study AL amyloidosis patients presented with mixed, axonal polyneuropathy associated with CTS in 63.6% of cases and cardiomyopathy (45.5%). Serial EMGs (electromyography) showed decreased motor amplitudes of the common peroneal and tibial nerves and sensory amplitude of the superficial peroneal nerve, with mostly preserved conduction velocities. The patients maintained stage I PND throughout the monitoring period. The entire hATTR group displayed mixed, axonal polyneuropathy and cardiomyopathy; 85.7% of them had CTS, and 42.9% had orthostatic hypotension. EMG data showed decreased motor amplitudes of the tibial and common peroneal nerves, decreased sensory amplitudes of the superficial peroneal nerve, and mildly reduced conduction velocities, with significant progression at 12 and 24 months. The patients displayed additional reduced muscle strength, some reaching stage 3A and 3B-PND at the end of the study. Conclusions: The amyloidotic polyneuropathy found in the groups was similar in its axonal, sensory-motor, and length-dependent characteristics, but the study showed significant differences in its progression, with more abrupt changes in the hATTR-Glu54Gln group. The amyloidosis AL patients remained in stage 1 PND, while the hATTR-Glu54Gln patients progressed to stage 3 PND at 24 months. Full article

This study aimed to ascertain whether there were any differences in anthropometrics, heart rate, and swimming performance parameters in athletes with intellectual disabilities (ID) before and after a three-month training break. A total of 21 athletes participated in the study, comprising 16 males and 5 females, with a mean age of 28.3 ± 8.7 years. All participants had ID, and six of them had Down syndrome. The study participants were classified as S14 athletes from a local swimming club. All participants had a minimum of four years of swimming experience and attended two to three one-hour sessions per week for eight consecutive months. All athletes completed two trials of 25 m freestyle swimming, one at the end of a training session and the other at the beginning of a new session. The measurements included weight, body mass index (BMI), handgrip strength (HGS), heart rate (pre- and post-trial), performance (T25), stroke count (SC), stroke length (SL), stroke rate, and the SWOLF efficiency index. The results demonstrated statistically significant elevations in weight (80.2 ± 16.1 to 81.7 ± 15.9), BMI (26.8 ± 5.5 to 27.2 ± 5.5), T25 (33.1 ± 17.1 to 35.6 ± 18), SC (19.3 ± 6.1 to 20.7 ± 7.2), and SWOLF (52.4 ± 22.0 to 56.3 ± 25.2) and a reduction in SL (1.39 ± 0.48 to 1.27 ± 0.42). However, no significant differences were observed in the remaining parameters. Significant correlations were found for body weight, BMI, HGS, and SWOLF with T25 throughout the study. It was concluded that individuals with ID experienced a decline in 25 m swimming performance due to technical rather than physiological factors after three months of detraining. Full article

Para swimmers categorized as S10 and S12 are of particular interest due to their disability grading being closest to that of able-bodied swimmers, making them an ideal group for investigating disparities in limb coordination patterns. This study aimed to investigate whether S10 and S12 para swimmers, whose disability grading for movement and visual ability, respectively, were the closest to that of able-bodied swimmers, would differ in terms of the biomechanics of limb coordination. This study recruited twenty para swimmers (ten with minor limb absence (S10) in the hand and ten with minor visual impairment (S12)). Using panoramic video, the phase duration, stroke length, stroke rate, index of coordination, synchronization, and inter-limb coordination were digitized and compared in the context of a front-crawl sprinting test. The results showed a significantly different duration of the recovery phase for S10 para swimmers at the affected side, where a more random coordination pattern between arm and leg at the pull and push phases was statistically seen. The variation of the inter-limb coordination gradually increased for S10 para swimmers from hand entry to the end of push, but gradually reduced for S12 para swimmers. These results suggest that the same pace was achieved by different hand–leg coordination patterns according to their physical constraints. Consequently, the unique coordination patterns of different para swimmers from this study offer an opportunity to explore the adaptive strategies and biomechanical adjustments that enable optimal performance for para swimmers. Full article

Background/Hypothesis: Motion sensitivity symptoms, such as dizziness or unsteadiness, are frequently reported as non-headache symptoms of migraine. Postural imbalance has been observed in subjects with vestibular migraine, chronic migraine, and aura. We aimed to assess the ability of largest Lyapunov’s exponent for a short time series (sLLE), which reflects the ability to cope with internal perturbations during gait, to detect differences in local dynamic stability between individuals with migraine without aura (MO) with an episodic pattern between attacks and healthy subjects (HS). Methods: Trunk accelerations of 47 MO and 38 HS were recorded during gait using an inertial measurement unit. The discriminative ability of sLLE was assessed through receiver-operating characteristics curves and cutoff analysis. Partial correlation analysis was conducted between the clinical and gait variables, excluding the effects of gait speed. Results: MO showed higher sLLE values, and reduced pelvic rotation, pelvic tilt, and stride length values. sLLEML and pelvic rotation showed good ability to discriminate between MO and HS and were correlated with the perceived pain, migraine disability assessment score, and each other. Conclusions: these findings may provide new insights into the postural balance control mechanism in subjects with MO and introduce the sLLEML as a potential measure of dynamic instability in MO. Full article

Patients with severe traumatic brain injury (STBI) often experience an abnormal hemostasis that contributes to mortality and unfavorable neurological outcomes. Objectives: We aimed to analyze epidemiologic, clinical, and laboratory factors associated with mortality in patients with STBI during the first 48 h after in-hospital admission. Methods: We performed an observational retrospective study of STBI patients with associated extracranial trauma [defined as Injury Severity Score (ISS) ≥ 16 with an Abbreviated Injury Scale (AIS) head and neck ≥ 3 and Glasgow Coma Scale (GCS) ≤ 8] admitted to a Level II trauma center over seven years (2015–2021). Patients were divided into two groups: survivors and dead. We assessed differences regarding demographics, trauma severity, hemodynamics, disability, need for surgery, length of stay, transfusions, need for massive transfusion protocol, and hemostatic laboratory parameters at different time points. Results: A total of 134 STBI patients were included. Patients who died were older, mostly men, and showed higher trauma severity and disability. Hemoglobin, platelets, and clotting parameters deteriorated after admission to the emergency department (ED) with significant differences between groups within the first 24 h after admission. Platelet count < 150 × 10³/μL at ED arrival, GCS, and age were independent risk factors for mortality. Conclusions: Older age, GCS, and platelet count at ED arrival were independent risk factors for mortality in STBI patients with associated extracranial trauma. Early thrombocytopenia < 150 × 10³/μL at ED arrival may be used as a simple prognostic tool to early predict mortality between non-isolated STBI. Full article

Background and Objectives: Successful treatment of severe trauma and fractures of the long bones with successful healing and bone union is still a significant challenge for surgeons. Unfortunately, up to 10% of long-bone fractures develop bone healing disorders. The aim of this study was to evaluate the results of treating bone defects with different etiologies in the upper and lower extremities using the induced membrane technique. Materials and Methods: We prospectively evaluated the radiological and clinical outcomes of 45 patients with severe bone defects treated with the induced membrane technique during the period from May 2021 to October 2023. The time to bone defect regeneration, size of the bone defect, and the cost of treatment were evaluated. Functional outcomes were assessed using the Disabilities of the Arm Shoulder and Hand (DASH) scale, SF-36, and the Lower Limb Functional Index (LLFI). Results: The mean follow-up time was 31 months (12–35). There were 20 patients with upper extremity bone defects and 25 with lower extremity bone defects. The mean defect length was 7.9 cm for the upper extremity (3.5–18) and 5.3 cm for the lower extremity (3–11). The mean times to achieve bone union and remodeling were 6.0 months (3–12) and 9 months (3–13) for the upper and lower limbs, respectively. Clinical evaluation at the end of treatment (achieving bone union) showed statistically significant improvements in the DASH, SF-36, and LLFI scales for pre- and postoperative outcomes. There was no statistical significance in the SF-36 clinical scale scores after surgical treatment compared to reconstructive treatment of upper and lower extremity bone defects. Results: The presented reconstructive approach to the treatment of bone defects and healing disorders and extensive analysis demonstrate the effectiveness of the induced membrane technique in a short follow-up period, with a relatively high level of patient comfort and good clinical results in the treatment of severe bone defects with particularly infectious etiologies. Full article