Search Results (428)

Background: The acromiohumeral distance (AHD) is a widely used imaging parameter for evaluating the subacromial region and shoulder function. Traditionally, it has been interpreted as a static anatomical measurement reflecting the available subacromial space and associated with rotator cuff pathology, superior humeral migration, and subacromial impingement. However, inconsistent relationships between AHD, symptoms, and function suggest that purely structural interpretations may be insufficient. Objectives: To propose a systems-based functional morphology framework that reinterprets AHD as an emergent functional state variable reflecting the instantaneous state of the glenohumeral system. Methods: A conceptual synthesis integrated evidence from shoulder biomechanics, functional morphology, movement science, connective tissue research, systems theory, and personalized neuromusculoskeletal modelling. Structural, connective tissue, neuromuscular, and mechanical determinants of AHD were integrated within a multilevel systems perspective. Results: The proposed framework conceptualizes AHD as emerging from the dynamic interaction of four organizational domains: structural constraints, connective tissue properties, neuromuscular regulation, and mechanical context. Rather than representing a fixed anatomical space, AHD is interpreted as a potential systems-level functional biomarker whose value varies according to the functional state of the glenohumeral system. This perspective explains the variability observed across imaging studies and the frequent discordance between structural findings, symptoms, and functional outcomes. Conclusions: Reframing AHD as an emergent functional state variable provides a theoretical basis for integrating anatomy, biomechanics, movement behavior, and neuromuscular control within personalized shoulder assessment. This systems-based perspective may help bridge the traditional gap between structural imaging and clinical presentation while supporting future developments in precision rehabilitation and subject-specific computational modelling. Full article

Background: Fatigue during intense activity challenges the neuromuscular system and can reveal deficits not evident during lower-demand functional tasks. In individuals with anterior cruciate ligament reconstruction (ACLR), differences in graft source may be associated with graft-specific neuromuscular adaptations. Although fatigue-related neuromuscular deficits after ACLR have been reported, few studies have examined whether these responses differ according to graft type during running. This study investigated the effects of running-induced fatigue on lower-limb muscle activity during the stance phase in ACLR patients with different graft types, compared with healthy controls. Methods: Fifty-three active males were allocated into four groups: single-bundle hamstring tendon (SB-HT), double-bundle hamstring tendon (DB-HT), allograft, and healthy controls. Participants completed a treadmill-based fatigue protocol that was terminated when they reached a Borg score > 17, which served as the primary criterion for confirming a high level of perceived fatigue. Heart rate ≥ 85% of estimated maximum heart rate was recorded as a complementary physiological indicator of high-intensity exertion. Electromyography (EMG) amplitudes of eight lower-limb muscles were recorded during the early and late stance phases of running, before and after fatigue. A two-way mixed-model ANOVA evaluated the effects of graft type and fatigue condition. Results: Fatigue reduced semitendinosus (p = 0.042, ηp² = 0.091) and gluteus medius (p < 0.001, ηp² = 0.442) activation during early stance regardless of group. Late-stance group effects were significant for the tibialis anterior, gastrocnemius, rectus femoris, biceps femoris, semitendinosus, and gluteus medius (p ≤ 0.05). Across stance phases, the SB-HT group showed greater hamstring and gluteus medius activation than healthy controls (p = 0.003–0.041), while the allograft group showed greater tibialis anterior, gastrocnemius, and rectus femoris activation during late stance (p = 0.005–0.043). The only significant group × fatigue interaction was observed for vastus medialis (p = 0.002, ηp² = 0.279), reflecting a fatigue-related reduction in the DB-HT group. Conclusions: Graft type was associated with distinct lower-limb EMG activation patterns during running after ACLR. Fatigue revealed a DB-HT-specific reduction in vastus medialis activation, while the allograft and SB-HT groups showed different compensatory activation profiles. These findings suggest that graft-specific neuromuscular adaptations during fatigue should be considered when developing rehabilitation protocols to improve functional stability and future joint health. Full article

Coital urinary incontinence is a frequently underdiagnosed manifestation of female pelvic floor dysfunction, characterized by involuntary urine leakage during sexual activity, particularly during vaginal penetration or orgasm. Although interest in this condition has increased in recent years, it remains insufficiently investigated in clinical practice and is often underreported by patients because of stigma, emotional distress, and the negative impact on intimate relationships and quality of life. Current evidence supports the existence of distinct pathophysiological mechanisms depending on the timing of urinary leakage. Leakage occurring during vaginal penetration is more commonly associated with stress urinary incontinence, urethral hypermobility, and pelvic support defects, whereas orgasm-associated urinary incontinence appears to be more closely related to detrusor overactivity and complex pelvic neurophysiological mechanisms. Hormonal changes associated with the peri- and postmenopausal period may further contribute to symptom progression through alterations in urethral and vaginal trophicity, local vascularization, and pelvic neuromuscular function. Clinical evaluation remains challenging because many affected women do not voluntarily report symptoms due to embarrassment or social stigma, therefore it requires targeted questioning regarding urinary leakage during sexual activity, associated lower urinary tract symptoms, and the impact on female sexual health. Therapeutic management should be individualized and tailored to the predominant underlying mechanisms, including pelvic floor rehabilitation, behavioral interventions, pharmacological treatment, local hormonal therapy, and surgical management of stress urinary incontinence or pelvic support defects. Minimally invasive and regenerative therapies, such as vaginal laser therapy, platelet-rich plasma, cellular therapies, and neuromodulation, represent promising therapeutic approaches. Greater awareness and proactive screening during urogynecological evaluation are essential for improving diagnosis, individualized treatment, sexual health, and overall quality of life in affected women. Full article

Background: Stroke remains a leading cause of long-term disability worldwide. Post-stroke spasticity (PSS) is increasingly recognized as a complex complication resulting from the interaction between neural hyperexcitability and non-neural muscular adaptations, including fibrosis, altered muscle architecture, and increased stiffness. Consequently, effective management requires a comprehensive approach targeting both components. Musculoskeletal ultrasound (MSK US) has emerged as a practical tool for muscle characterization, treatment targeting, and longitudinal monitoring within neurorehabilitation programs. Aim: To propose a clinical practice framework integrating serial MSK US into multimodal PSS management and to illustrate its application through a proof-of-concept clinical case. Methods: The proposed framework combines standardized clinical assessment, serial MSK US evaluation, BoNT-A injections, physical modalities (neuromuscular electrical stimulation and extracorporeal shock wave therapy), and task-oriented rehabilitation. Ultrasound findings, including muscle echogenicity, architecture, and Modified Heckmatt Scale (MHS) characteristics, were integrated with clinical outcomes and rehabilitation goals to support individualized decision-making. Results: Serial MSK US provided complementary information regarding muscle quality and potential non-neural contributors to spasticity syndrome, supporting treatment planning and follow-up. Although only modest morphological changes were observed over time, the illustrative case showed favorable changes in clinical assessments including spasticity, motor performance, gait, and functional independence following the multimodal intervention. Conclusions: This proof-of-concept framework highlights the potential role of serial MSK US as a practical decision-support and monitoring tool within multimodal PSS management. Integrating clinical assessment with ultrasound-informed evaluation of both neural and non-neural components may facilitate more individualized rehabilitation strategies and optimize functional outcomes. Further studies are warranted to validate and standardize this approach. Full article

Walking recovery is a central goal of geriatric rehabilitation, but it is shaped by multiple interacting factors rather than by muscle impairment alone. This mini-review examines whether sarcopenia-related weakness, low muscle quality, and reduced physical reserve identify a clinically important vulnerability phenotype relevant to delayed gait recovery in older adults after hospitalization, hip fracture, surgery, or cardiac procedures. We summarize current consensus definitions of sarcopenia, explain why muscle strength and physical performance are often more clinically informative than muscle mass alone, and review the mechanistic pathways that may connect sarcopenia with impaired walking, including anabolic resistance, inflammation, disuse, neuromuscular remodeling, trunk weakness, and cognitive–emotional modifiers. Across community, orthogeriatric, post-acute, and cardiac rehabilitation settings, sarcopenia markers are generally associated with slower gait or poorer attained mobility; however, findings for change in mobility are inconsistent, and most available studies are observational, heterogeneous, or indirect. Sarcopenia should therefore be interpreted as one potential marker of reduced reserve and mobility risk rather than as a determinant of walking recovery or evidence that sarcopenia-aware rehabilitation improves outcomes. Future work should use more consistent diagnostic frameworks and test whether a sarcopenia-aware rehabilitation integrating early strength assessment, individualized nutrition care, and multicomponent gait rehabilitation improve walking outcomes in medically complex older adults beyond current standards of care. Full article

Background/Objectives: This study aimed to assess nerve conduction studies (NCS) parameters of the median nerve and abductor pollicis brevis (APB) muscle activity in patients with cervical spondylosis. Additionally, we evaluated longitudinal changes in these parameters at six months following a multimodal rehabilitation treatment. Methods: This quasiexperimental, nonrandomized study included 41 patients with cervical spondylosis and 25 healthy controls. Median nerve conduction studies and semiquantitative surface electromyography (sEMG) of the APB muscle were assessed using a two-channel Neuro-MEP-Micro system (version 2009, Neurosoft Ltd.). The evaluations were performed at baseline in both groups and repeated after six months in the patient group. Pain intensity was assessed using the Visual Analog Scale (VAS). Results: Compared with controls, patients showed reduced compound muscle action potential (CMAP) amplitude (Cohen’s d = 1.53–1.83), slower motor conduction velocity (r = 0.91–0.95), and impaired sEMG amplitude and recruitment pattern of the APB muscle (all adjusted p < 0.001). After application of multimodal rehabilitation treatment, VAS scores decreased significantly (adjusted p < 0.001), and favorable changes in NCS and sEMG parameters were observed, with moderate to large effect sizes (Cohen’s d = 0.56–0.82; r = 0.52–0.86; all adjusted p ≤ 0.006). CMAP amplitude correlated positively with sEMG amplitude and recruitment pattern (ρ = 0.483–0.632, all adjusted p ≤ 0.001). Conclusions: Multimodal rehabilitation treatment may be associated with clinical and electrophysiological improvements, suggesting the complementary value of NCS and sEMG for the evaluation and follow-up of patients with cervical spondylosis. However, because of the nonrandomized uncontrolled design and the absence of longitudinal follow-up in controls, causal treatment effects cannot be inferred. Full article

Background/Objectives: Aquatic therapy is widely used in pediatric rehabilitation because buoyancy and water resistance facilitate movement practice under reduced gravitational load. The Halliwick Method is a prominent approach; however, its effects on balance, motor function, and neuromuscular performance in children and young adults with disabilities have not been comprehensively synthesized. This systematic review summarized the effects of Halliwick aquatic therapy and aquatic exercise on balance, strength, and functional mobility in this population. Methods: This review followed Cochrane and PRISMA 2020 guidelines and was registered in PROSPERO (CRD42025635215). PubMed, MEDLINE Complete, PEDro, Web of Science, and Google Scholar were searched from inception to November 2025. Randomized controlled trials (≥2 weeks; ≥10 participants per trial) involving individuals aged 3–29 years with disabilities were included. Risk of bias was assessed using the Cochrane RoB2 tool. Results: Eight randomized controlled trials (involving 222 participants) met inclusion criteria. Despite heterogeneity in diagnoses and protocols (Halliwick-based hydrotherapy, swimming, strengthening, task-oriented balance training), most studies reported improvements in balance and postural control (BBS/PBS, WOTA2), gross motor function (GMFM), and functional mobility (6MWT, TUG, gait indices). Several trials demonstrated gains in strength, and one reported favorable changes in lower-limb electromyographic activation. Methodological limitations included small samples, limited blinding, variable dosing, and scarce follow-up. Due to heterogeneity in interventions and outcomes, findings were synthesized narratively. Conclusions: Halliwick aquatic therapy and aquatic exercise appear to improve balance, motor function, and neuromuscular performance in children and young adults with disabilities. However, evidence is limited by heterogeneity and methodological constraints. More robust, standardized RCTs with direct muscle and neuromuscular assessments are needed. Full article

Sport-related concussion (SRC) rehabilitation has advanced toward active, multidomain management, yet recovery may still be judged largely through symptom resolution and broad clinical indicators that may not fully capture persistent functional deficits. Emerging evidence suggests subtle disturbances in postural control, gait, and sensorimotor coordination may persist beyond apparent clinical recovery, raising the possibility that unresolved asymmetries represent an underrecognized dimension of dysfunction. This Viewpoint proposes symmetry restoration as a potential rehabilitative construct in SRC management and explores how biofeedback-guided approaches may provide a conceptual framework for identifying, monitoring, and retraining symmetry-related deficits. Drawing from concussion research, motor control theory, rehabilitation science, and biofeedback applications, this article discusses postural and movement asymmetries as possible markers of incomplete recovery, examines visual, wearable, neuromuscular, and auditory biofeedback strategies as potential mechanisms for symmetry-informed rehabilitation, and outlines clinical implications and future research priorities. Rather than proposing symmetry as a stand-alone determinant of recovery, this Viewpoint advances the conceptual proposition that symmetry-oriented approach may complement existing multidomain models by serving as an additional layer of functional assessment alongside symptom reporting, neurocognitive evaluation, vestibular and oculomotor examination, exertional testing, and routine clinical assessment. Within this framework, symmetry-related measures are envisioned not as independent clearance criteria, but as potentially informative indicators of residual sensorimotor function that may help guide rehabilitation progression and contribute to more functionally informed return-to-sport decision making through adjunctive measures such as center-of-pressure behavior, center-of-mass displacement, gait symmetry, stance and swing time asymmetry, limb-loading patterns, interlimb coordination, and muscle activation symmetry. Full article

Background: Female rugby players are exposed to repeated contact, impact, acceleration, deceleration, and trunk-stabilization demands that may challenge lumbopelvic control and intra-abdominal pressure regulation. Rehabilitative ultrasound imaging can characterize transversus abdominis (TrA) thickness changes during standardized tasks, although these measures should not be interpreted as direct indicators of neuromuscular activation or sport-specific trunk function. This study aimed to characterize ultrasound-derived TrA thickness and thickness change in nulliparous female rugby players and to explore whether these measures, immediate visual feedback, sport-related variables, and body mass index were associated with urinary leakage. Methods: A cross-sectional observational study was conducted with 34 nulliparous female rugby players recruited from two competitive rugby clubs. Urinary leakage was assessed using the validated Spanish version of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI SF), with current urinary leakage defined as leakage reported within the four-week recall period. TrA thickness was measured bilaterally using rehabilitative ultrasound imaging at rest, during the abdominal drawing-in maneuver (ADIM), and during ADIM with real-time ultrasound-based visual feedback. Exploratory analyses were conducted to examine associations between current urinary leakage and ultrasound-derived TrA measures, sport-related variables, and body mass index. Results: Overall, 41.2% of participants reported having experienced urinary leakage at some point, while 20.6% reported current urinary leakage. Among participants reporting leakage type, stress urinary incontinence was the most frequent pattern, and perceived impact on daily life was low. TrA thickness increased bilaterally during ADIM compared with rest. Immediate visual feedback did not produce a statistically significant additional increase in TrA thickness. No significant associations were observed between current urinary leakage and TrA thickness measures, side-to-side differences, weekly training hours, years of rugby practice, or body mass index. Conclusions: In this exploratory sample, ultrasound-derived TrA thickness measures during controlled ADIM tasks were not significantly associated with current urinary leakage. Future studies should include larger samples, direct pelvic floor muscle assessment, respiratory monitoring, body composition measures, and dynamic rugby-specific tasks. Full article

Background: Disease-modifying therapies have profoundly changed the natural history of spinal muscular atrophy (SMA) type I, shifting rehabilitation priorities beyond survival and motor function toward participation, autonomy, and quality of life. However, rehabilitation models have not evolved at the same pace, and the role of early powered mobility in this new clinical scenario remains insufficiently conceptualized. Methods: This narrative review integrates current evidence on early powered mobility in children with severe motor disabilities with contemporary rehabilitation frameworks, including the International Classification of Functioning, Disability and Health (ICF), participation-based therapy, family-centered care, and the concept of on-time mobility. Evidence from the AMEsobreRuedas research program is incorporated to develop a conceptual framework for early powered mobility in children with SMA type I receiving disease-modifying therapies. Results: Current evidence suggests that early powered mobility should be understood as a developmental rehabilitation intervention rather than solely as an assistive technology for transportation. Independent mobility facilitates exploration, play, social interaction, autonomy, and participation, while positively influencing family experiences and expectations. Findings from the AMEsobreRuedas program further indicate that the benefits of powered mobility extend beyond driving skill acquisition, supporting participation, quality of life, and family well-being when implemented within meaningful daily contexts. Based on this evidence, a conceptual framework is proposed in which independent mobility acts as an early facilitator of developmental opportunities, with participation emerging through the interaction between the child, family, and environment. Conclusions: In the era of disease-modifying therapies, rehabilitation in SMA should move from a motor-centered approach toward a participation-oriented model. Early powered mobility represents a key intervention for promoting developmental opportunities and meaningful participation rather than simply compensating for motor impairment. The proposed conceptual framework may support clinical decision making and provide a foundation for future rehabilitation research in pediatric neuromuscular disorders. Full article

Proprioception is traditionally defined as the perception of joint position and movement, yet contemporary evidence supports a broader view: a multimodal sensorimotor system integrating peripheral afferent input with central motor commands. Despite its recognised importance in rehabilitation and sport, conceptual and methodological inconsistencies persist regarding its definition, assessment and training, and interventions labelled proprioceptive are frequently indistinguishable from general neuromuscular or balance-based exercise. This narrative review, reported in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA), critically analyses the current state of knowledge on proprioception and clarifies the concept of proprioceptive training. PubMed, Scopus, Web of Science and SPORTDiscus were searched from January 2000 to May 2025, combining “proprioception”, “kinaesthesia”, “joint position sense” and “force sense” with “definition”, “assessment”, “training” and “rehabilitation”. Sources addressing conceptual foundations, assessment instruments, interventions explicitly labelled proprioceptive, or critical reviews were eligible, with no restriction of body region; studies on balance alone without proprioceptive measurement and non-peer-reviewed material were excluded. Of 1412 records screened, 119 informed the synthesis. Proprioception comprises distinct submodalities—joint position sense, kinaesthesia and force sense—mediated by specific receptors and pathways. Current tools isolate these under artificial conditions with limited ecological validity, and most interventions labelled proprioceptive induce general motor adaptations rather than genuine sensory ones. Submodality-specific operational definitions and ecologically valid assessment tools are required. Full article

Background: Regular physical activity is recommended for obesity management, but adherence remains difficult for many patients. Neuromuscular electrical stimulation (EMS) has been proposed as an adjunctive intervention. Methods: In this prospective, single-center, randomized controlled trial, adults with severe or morbid obesity (BMI ≥ 35 kg/m²) enrolled in a three-week inpatient rehabilitation program were randomized 1:1 to rehabilitation program alone (control group) or rehabilitation supplemented with EMS (5 sessions/week, 20 min/session, 75 Hz). Outcomes assessed at admission and discharge included body composition, lipid and glucose metabolism, continuous glucose monitoring, physical capacity, quality of life, adherence, and safety. Results: Both groups showed significant improvements in BMI, waist circumference, body composition, lipid and carbohydrate profiles, and physical performance assessed by the 6 min walk test, without significant between-group differences. BMI decreased by −0.9 kg/m² in controls and −1.2 kg/m² in the EMS group (both p < 0.001). Waist circumference also decreased significantly in both groups. EMS showed a potential effect on continuous glucose monitoring parameters, but this was no longer significant after adjustment for diabetes status. Conclusions: Adding EMS to inpatient rehabilitation did not provide additional benefits for weight loss or body composition.) Full article

Water-resistance rowing machines are widely used in fitness and rehabilitation; however, the neuromuscular effects of different resistance levels remain unclear. This study investigated resistance-dependent muscle activation during water-resistance rowing using surface electromyography (sEMG). Participants performed rowing exercise under four water-resistance conditions (MIN, Level 2, Level 3, and MAX) while maintaining a fixed stroke rate of 40 cycles/min. sEMG signals from the biceps brachii, triceps brachii, deltoid, latissimus dorsi, rectus femoris, and tibialis anterior were collected using a Delsys wireless system (1000 Hz) and normalized to maximal voluntary isometric contraction (MVIC). Results revealed significant interaction effects between resistance level and muscle group. The biceps brachii exhibited the greatest activation across all resistance conditions, whereas overall muscle activation remained below 40% MVIC. Activation differences were limited among the first three resistance levels but increased substantially at the highest resistance level. These findings support the use of sEMG for quantifying resistance-dependent neuromuscular adaptations and optimizing exercise prescription monitoring. Full article

Background/Objectives: As cancer survival improves, rehabilitation has become an increasingly important component of comprehensive oncology care, addressing the growing burden of treatment-related impairments. Although electrotherapy modalities are widely used in Physical and Rehabilitation Medicine, their application in oncology remains controversial because of persistent concerns regarding safety and potential interactions with tumor biology. This narrative review critically evaluates the current evidence regarding the clinical applications, safety, contraindications, and therapeutic potential of electrotherapy modalities in oncology rehabilitation. Methods: A structured literature search was performed in PubMed, Scopus, and Web of Science for studies published between January 2000 and March 2026. Evidence from randomized controlled trials, observational studies, systematic reviews, meta-analyses, clinical practice guidelines, consensus statements, and narrative reviews was analyzed. Results: The strongest clinical evidence supports transcutaneous electrical nerve stimulation (TENS), photobiomodulation (PBM)/low-level laser therapy (LLLT), neuromuscular and functional electrical stimulation (NMES/FES), Deep Oscillation Therapy, and extracorporeal shock wave therapy (ESWT) for selected supportive indications in oncology rehabilitation. Therapeutic ultrasound, pulsed electromagnetic field therapy (PEMF), repetitive transcranial magnetic stimulation (rTMS), Multiwave Locked System (MLS) laser, and shortwave diathermy show promising but still limited clinical evidence, whereas oncology-specific evidence remains insufficient for interferential currents, diadynamic currents, high-intensity laser therapy (HILT), Super Inductive System (SIS), and transfer of capacitive and resistive energy (TECAR) therapy. Conclusions: Electrotherapy in oncology rehabilitation should be considered a prescription-based therapeutic intervention rather than a group of interchangeable physical modalities. As with pharmacological therapy, treatment efficacy and safety depend on selecting the appropriate modality, establishing the correct indication, and prescribing appropriate dosimetry and treatment parameters. Current evidence supports an individualized, evidence-informed approach that integrates the biological effects of each modality with the patient’s oncological status, rehabilitation goals, and overall clinical condition, with the ultimate aim of improving function, symptom control, and quality of life. Full article

Background/Objectives: Lower-limb exoskeletons require reliable movement recognition mechanisms to support adaptive locomotor assistance and rehabilitation. Electromyographic (EMG) signals provide valuable information on muscle activation and user intention, enabling safe and responsive human–exoskeleton interaction. This study aims to develop and experimentally validate an EMG-based platform for intelligent lower-limb movement recognition and locomotor assistance applications. Methods: The proposed platform integrates multichannel EMG acquisition, embedded signal processing, and artificial intelligence for movement classification. EMG signals associated with six movement classes (left/right kneeling, stepping, and dash) were acquired from ten healthy male participants aged 19–24 years. Signal preprocessing, normalization, dataset generation, and model training were performed using a dedicated processing framework. Continuous EMG acquisition without threshold-based segmentation was employed to preserve complete neuromuscular information and improve dataset consistency. Movement classification was implemented using a lightweight one-dimensional convolutional neural network (1D-CNN). Model performance was evaluated using Stratified 5-Fold Cross-Validation and Leave-One-Subject-Out (LOSO) protocols. Results: A dataset containing 608 multichannel EMG recordings was generated for training and validation. The proposed 1D-CNN model achieved an accuracy of 92.43 ± 1.69% and a macro F1-score of 0.9093 ± 0.0247 under Stratified 5-Fold Cross-Validation. LOSO evaluation yielded an accuracy of 62.11 ± 23.26%, highlighting the significant impact of inter-subject variability on classification performance. Conclusions: The developed platform provides an effective framework for EMG-based lower-limb movement recognition in intelligent exoskeleton systems. The results demonstrate the feasibility of integrating multichannel EMG sensing and AI-based inference into adaptive locomotor assistance systems while emphasizing the importance of improving subject-independent generalization. The proposed platform also establishes a foundation for future research on multimodal sensing and real-time adaptive exoskeleton control. Full article