Search Results (763)

Background: Anterior cranial fossa dural arteriovenous fistulas (ACF DAVFs) usually receive ethmoidal dural supply. Pial arterial supply has been described in intracranial DAVFs, including ACF DAVFs, but a dominant orbitofrontal pial feeder can create diagnostic overlap with mixed pial-dural arteriovenous malformation and make endovascular treatment hazardous. Case Presentation: A 75-year-old man with atrial fibrillation presented with right middle cerebral artery occlusion and underwent intravenous thrombolysis followed by mechanical thrombectomy. During right internal carotid angiography, transient arterial-phase opacification of a contralateral frontal draining vein through the anterior communicating artery prompted post-recanalization angiography. A high-grade left ACF DAVF was diagnosed, with dominant supply from the left orbitofrontal artery, minor anterior ethmoidal supply, two venous drainage routes, cortical venous reflux, and a varix. Although the DAVF was incidental to the ischemic presentation, it was considered to require treatment because of high-risk angioarchitecture, including Borden type III/Cognard type IV drainage, cortical venous reflux, and venous ectasia. No intraparenchymal nidus or normal venous-phase use of the refluxing veins was identified. Because pial transarterial access and complete transvenous closure were considered unsafe or uncertain, microsurgical draining-vein disconnection was performed. Postoperative angiography confirmed complete obliteration. Conclusions: In this case, microsurgical disconnection achieved angiographic cure, and the patient was transferred for rehabilitation with a modified Rankin Scale score of 1. The central diagnostic and therapeutic issue in pial-feeder-dominant ACF DAVF is not rarity alone, but angiographic differentiation from mixed pial-dural arteriovenous malformation and assessment of whether the shunt can be closed without compromising normal pial arteries or venous outflow. The thrombectomy angiogram provided the route to diagnosis, whereas pial arterial dominance and divided venous drainage determined the curative strategy. Full article

The objective of this study was to evaluate the efficacy of a novel digital platform (Visitrain VG, Alicante, Spain) as a visual rehabilitation tool for patients with convergence insufficiency (CI), in comparison with conventional in-office vision therapy (VT) supplemented with home reinforcement exercises. A retrospective comparative study was conducted comprising 33 patients diagnosed with CI, allocated into two groups: a digital group (DG; n = 16) receiving treatment with the aforementioned digital platform and a conventional group (CG; n = 17) undergoing conventional vision therapy. Binocular vision clinical parameters were assessed at baseline, one month, and three months of follow-up, including near point of convergence (NPC), positive fusional vergence (PFV), and binocular accommodative facility (BAF). Both groups demonstrated significant improvements following three months (p < 0.050). At the one-month evaluation, the CG showed a more rapid clinical response, with statistically significant between-group differences being observed in the NPC (p = 0.004) and near PFV (p = 0.040) compared with the DG. Nevertheless, at the three-month follow-up, no significant differences were found between the groups (p ≥ 0.060). The digital platform under investigation appears to constitute an effective therapeutic alternative to conventional vision therapy, albeit with a comparatively slower initial clinical response rate. It may be particularly indicated for patients requiring greater scheduling flexibility or those with limited access to in-office clinical care. Prospective controlled clinical trials are warranted to corroborate these preliminary outcomes. Full article

Background: Echo intensity (EI) has emerged as a promising and accessible tool for tracking changes in skeletal muscle quality; however, its utility during early-phase rehabilitation has not been studied. Using an observational cohort design, we examined changes in quadriceps muscle strength, size, and quality, along with self-reported knee function, 2, 6, and/or 10 weeks following anterior cruciate ligament reconstruction (ACLR). Methods: Thirteen participants (4 males, 9 females; mean age = 23 years) were assessed for bilateral isometric peak torque and cross-sectional area (CSA) and corrected EI of the vastus lateralis and rectus femoris. Self-reported knee function was measured using the International Knee Documentation Committee (IKDC) questionnaire. Results: Quadriceps peak torque was significantly lower in the surgical limb at 2 weeks following surgery but increased from weeks 2 to 10, while the nonsurgical limb remained stable. IKDC scores improved significantly over time. Vastus lateralis CSA decreased in the surgical limb between weeks 2 and 6, while rectus femoris CSA increased between weeks 6 and 10 in both limbs. Corrected EI values did not change over time. No significant correlations were observed among changes in muscle strength, size, quality, or self-reported knee function. Conclusions: We conclude that quadriceps strength, size, quality, and self-reported knee function change independently and do not follow a shared recovery trajectory. Full article

Purpose: Access to assistive technology (AT) is a fundamental human right and a critical component of Universal Health Coverage (UHC). In the Middle East and North Africa (MENA) region, the scarcity of trained professionals remains a significant barrier to AT service provision. This study evaluates the effectiveness and perceived usefulness of the Assistive Technology Training Program (ATTP), a specialized continuing education initiative designed to build workforce capacity among rehabilitation and healthcare professionals. Methods: A convergent mixed methods design was used to analyze quantitative pre/post-test scores and qualitative focus group open-ended responses. Quantitative data were gathered from 386 participants across 11 MENA countries using a pre- and post-test assessment of AT knowledge. Qualitative utility and participant satisfaction were assessed through a 5-point Likert scale survey evaluating content relevance, trainer expertise, and facilities. Association tests (ANOVA and t-tests) were conducted to identify factors influencing knowledge gain. Results: Participants demonstrated a statistically significant improvement in AT knowledge, with the overall mean score increasing from 3.67 ± 1.13 to 7.50 ± 1.25 (p < 0.001). High levels of satisfaction were reported, with 92% of participants rating the training as “Very Good” or “Excellent” regarding its relevance to clinical needs. Association tests revealed that professional background (p < 0.001), employment status (p = 0.0017), level of education (p = 0.011), and prior training experience (p = 0.026) were significant factors in the magnitude of improvement, although all subgroups achieved significant learning gains. Qualitative thematic analysis per the focus group discussions using the WHO-GATE 5 P framework identified three major themes: (1) Structural Challenges: Issues with Products and Provision point toward a need for better infrastructure and localized supply chains. (2) Human Capital: Personnel barriers emphasize that training shouldn’t just be for professionals, but should extend to caregivers as well. (3) Systemic and Social Change: Policy and People focus on the “soft” side of AT moving toward user-involved guidelines and fighting social stigma to ensure rights are upheld. Conclusions: The ATTP is an impactful educational intervention that significantly enhances the foundational competencies of healthcare professionals in the MENA region. By addressing knowledge gaps and fostering practical skills, the program serves as a preliminary model that demonstrates potential for building regional capacity and supporting the United Nations’ Sustainable Development Goal (SDG) #3 related to health and wellbeing and SDG #4 related to quality education and lifelong learning opportunities for all. Further research is required to evaluate its long-term scalability and clinical impact. Full article

The burden of disability is rising rapidly in Africa, where a severe shortage of rehabilitation professionals and limited infrastructure create a major treatment gap. Immersive virtual reality and serious games have shown promise for upper limb rehabilitation, but current extended reality (XR) solutions lack personalization, cultural adaptability, real-time feedback, and scalability. This perspective paper proposes a conceptual AI-enhanced XR framework tailored to African low- and middle-income countries. We identify how generative AI, large language models, multiagent systems, and explainable AI can address specific rehabilitation barriers. The framework integrates these four pillars into a three-layer architecture covering content creation, interaction, and decision support. We analyze implementation considerations specific to African contexts—infrastructure, capacity building, cultural adaptation, ethics, and financing—and outline a detailed research agenda with near, medium, and longer term priorities. Realizing this vision requires co-design with African communities, investment in local capacity, adaptation to infrastructure constraints, and development of ethical frameworks. AI-enhanced XR has the potential to democratize access to quality rehabilitation across Africa, but this potential must be validated through rigorous, context-sensitive research. Full article

Background and Objectives: Multiple sclerosis (MS) is characterized by progressive disability and a spectrum of motor and cognitive impairments. Exergames and virtual reality (VR) are proposed as motivating exercise tools, potentially useful for improving adherence and expanding access to rehabilitation. The objectives are to explore the feasibility and safety of a supervised rehabilitation program based on a high-intensity exercise program with immersive virtual reality (IVR) in people with MS and to describe its effects on physical, cognitive, and functional domains, as well as on the serum biomarker neurofilament light chain (sNfL). Materials and Methods: Pre–post exploratory study in five volunteers from a local MS Association [Vigo, Spain]. Intervention: 8 weeks, two sessions/week, 10 min/session of an IVR boxing-based exergame combined with usual rehabilitation, supervised by a physiotherapist. The variables studied were safety (Simulator Sickness Questionnaire [SSQ]), usability (System Usability Scale [SUS]), disability (Expanded Disability Status Scale [EDSS]), gait (25-Foot Walk Test [25FWT]), manual dexterity (9 Hole Peg Test [9HPT]), cognition (Symbol Digit Modalities Test [SDMT]), and axonal damage biomarker (sNfL). Results: The intervention could be feasible and safe (100% adherence, no adverse events (without SSQ symptoms), 95% usability [SUS]). There were positive changes in all variables studied (mean ± SD): EDSS −0.5 ± 0.9; 25FWT −4.9 ± 9.8 s; right 9HPT −3.3 ± 0.9 s; sNfL −4.4 ± 4.5 pg/mL, except for left 9HPT +0.5 ± 5.0 s and cognition (SDMT −2.4 ± 1.3 points). Conclusions: A brief, supervised exercise program combing an IVR exergame with standard rehabilitation was feasible and safe in people with MS. Although the results seem promising with the proposed design, the clinical and biological changes are merely exploratory, and it is not possible to infer their efficacy. Our findings open the door to future controlled studies including perceived high-intensity exercise programs and larger sample sizes to explore efficacy and estimate clinically relevant effect sizes. Full article

Limb movement is an important component of control during safety-critical tasks such as driving. Restricted movement, such as limitations associated with an injury or surgery to the upper limb, may impact driving safety. However, the degree of upper limb movement required for driving is not well described outside of traditional laboratory settings. There is a need for new affordable, accessible, reliable and accurate measures of normative limb movement to guide decisions about driving capacity. This feasibility study applied a volume estimation approach to wrist-worn triaxial accelerometry data to quantify upper limb movement during naturalistic driving in a young adult population. A sample of 89 participants wore accelerometers while engaging in daily driving activity over a two-week period. Results demonstrated a distribution of movement volumes, consistent with variation in individual driving behaviour. This volume estimation approach has strong potential for further development as both a research tool and clinical assessment method, particularly in rehabilitation and return-to-driving assessments following upper limb injury or surgery. Full article

Robot-assisted telerehabilitation (RAT) combines rehabilitation robotics with digital health workflows to extend access to upper-limb (UL) therapy after stroke. Mixed reality (MR) may support therapist–patient interaction and task visualization; however, early-stage systems require rigorous evaluation of safety and usability before deployment in the home. In a formative, mixed-methods usability study conducted in a controlled setting using a telerehabilitation workflow, six individuals post-stroke (≥3 months) and six occupational therapists (OTs) completed a single supervised session with a desktop-mounted end-effector type therapeutic robot (iTbot) integrated with Microsoft HoloLens 2. Participants performed structured passive and active UL exercises while therapists supervised and interacted with the system via the MR control interfaces. Safety was evaluated by documenting observed adverse events and safety-stop activations. Usability and user experience were assessed using the System Usability Scale (SUS), study-specific satisfaction questionnaires (reported with scale ranges), and semi-structured follow-up interviews analyzed using thematic analysis. All participants completed the session without observed adverse events or safety-stop activations. Overall usability was favorable, with a mean (SD) SUS total score of 78.3 (15.9) out of 100 (stroke: 74.2 [18.1]; occupational therapists: 82.5 [13.5]). Qualitative feedback indicated that MR was perceived as engaging and intuitive by many users, while also identifying implementation needs relevant to real-world telerehabilitation, including clearer onboarding, simplification of certain MR interactions, and improved physical interfaces (e.g., handle options). Therapists highlighted workflow considerations for remote supervision and patient independence. Together, these findings support progression to multi-session, in-home studies to quantify remote assistance needs, technical reliability, adherence, and clinical outcomes. Full article

In recent years, hand exoskeleton robots have attracted extensive attention from researchers and practitioners due to their potential to rehabilitate, assist, and enhance hand movements, particularly for stroke patients. With an ageing population increasingly affected by strokes, there is a growing demand for patient-centred interventions which place less demand on clinicians, especially wearable devices that can enhance hand function. Advances in artificial intelligence have opened new avenues for developing more reliable and adaptive assistive systems. This study presents a systematic literature review, following the PRISMA protocol on the design elements of hand exoskeleton robots, acknowledging the emerging perspectives on AI integration and ethical considerations. The study provides a comprehensive foundation for future research and development in rehabilitation technologies by systematically synthesising the current mechanical architecture, actuation, sensors, material, weight, and cost aspects of soft hand exoskeleton robots for rehabilitation. The results show important patterns and trade-offs in various design dimensions, providing useful information to direct the development of more accessible and efficient rehabilitation solutions in the future. Full article

Background: Speech-language pathology (SLP) and audiology services are essential components of multidisciplinary rehabilitation, particularly for individuals with developmental, neurological, and communication-related disorders. National-level data describing the distribution and utilization of these services in Saudi Arabia remain limited. This study aimed to examine national patterns of rehabilitation service utilization, with a focus on SLP and audiology services in comparison to other rehabilitation specialties. Methods: A retrospective cross-sectional analysis was conducted using publicly available national open data released by the Saudi Ministry of Health (MOH). Aggregated rehabilitation service encounters (n = 1,872,328 to 1,930,695) from 2023–2024 were analyzed by specialty, geographic region, sector (MOH clusters versus private sector), and pediatric age groups. Descriptive statistics were used to characterize utilization patterns and regional variation. Results: Rehabilitation services were widely delivered across both public and private sectors, with physiotherapy representing the largest share of encounters. SLP and audiology services contributed a smaller proportion of total rehabilitation encounters compared to other specialties. Service distribution varied regionally, with higher volumes concentrated in major urban areas including Riyadh, Makkah, and the Eastern Region. Pediatric service encounters were highest in early childhood (ages 3–7), with SLP and audiology services forming a consistent component of rehabilitation during this period. Conclusions: This study provides a descriptive overview of rehabilitation service utilization in Saudi Arabia, highlighting the distribution of SLP and audiology services relative to other specialties and across regions. Findings emphasize the importance of addressing regional variation, supporting workforce development, and enhancing national rehabilitation data systems to inform planning and ensure comprehensive access to communication and hearing services. Full article

Background: Standard clinical scales for pediatric and adolescent ataxia lack biomechanical granularity, limiting precision rehabilitation. This study aimed to identify compensatory gait phenotypes using unsupervised machine learning and establish a robust, highly accessible clinical decision model. Methods: Spatiotemporal gait data from 51 youths (31 ataxia and 20 healthy controls) were analyzed. To ensure pathological specificity, Principal Component Analysis (PCA) and hierarchical clustering were applied exclusively to 13 biomechanical variables from the ataxia cohort (n = 31) to extract underlying domains and identify patient subgroups. Healthy controls were subsequently used as a normative reference. A Classification and Regression Tree (CRT) algorithm was developed for clinical translation. Results: Two distinct phenotypes reflecting the evolution of compensatory strategies were identified: a “Rapid Rhythm” strategy (n = 24) and a severe “Prolonged Stance” strategy (n = 7). Unlike previous assumptions, the phenotypes strongly correlated with clinical severity (Scale for the Assessment and Rating of Ataxia (SARA) scores: 9.79 vs. 16.78, p = 0.012) and exhibited significantly different gait speeds (p < 0.001). The CRT model identified the stance phase duration as the primary discriminator. A recalibrated critical cut-off of >69.68% effectively classified the severe Prolonged Stance phenotype. This threshold sits distinctly above the healthy pediatric norm, achieving an overall cross-validated accuracy of 96.8%, with 100% specificity. Conclusions: Gait phenotypes in pediatric and adolescent ataxia represent progressive stages of neuromechanical compensation driven by disease severity. The established 69.68% stance-phase threshold provides clinicians with a powerful, single-variable biomechanical red flag to identify severe pathological gait and guide phase-specific precision rehabilitation. Full article

Background: Hybrid cardiac rehabilitation (CR) combining supervised and home-based phases with wearable monitoring may improve access and outcomes after myocardial infarction (MI). Objective: To assess the impact of a 14-week hybrid CR program on functional class, exercise capacity, hemodynamics, body composition, and physical activity in post-MI patients with NYHA class II symptoms. Methods: Sixty-six adults post-MI underwent 2 weeks of in-hospital initiation followed by 12 weeks of home-based rehabilitation via a smartwatch–smartphone platform. Within-subject changes from baseline to week 14 were analyzed using appropriate paired statistical tests. Results: NYHA class improved significantly, with 39% of participants downgrading their class (p < 0.001). Body weight decreased by 1.27 ± 2.51 kg (p < 0.001). Systolic and diastolic blood pressures declined (both p ≤ 0.002). Maximal METS rose markedly (25.7% increase; p < 0.001), and watts/kg improved (p < 0.001). Resting heart rate decreased (p = 0.002); peak exercise heart rate change was non-significant. Fat mass declined and skeletal muscle mass increased (mean gain 0.98 kg; p < 0.001). Daily step count increased from 5550 ± 2026 to 7267 ± 2500 steps (p < 0.001). Total body water also increased (p < 0.001). Conclusions: The hybrid CR program produced significant improvements in functional class, exercise capacity, blood pressure, body composition, and physical activity in post-MI NYHA II patients, supporting its effectiveness as a remotely enabled secondary prevention strategy. However, the results are based on hypotheses and randomized controlled trials must confirm the benefits especially with a control group. Nonetheless, it is a feasible and potentially effective alternative to conventional programs in resource-limited settings. Full article

Objective: This study examines whether access to basic services is associated with health-related social participation among people with disabilities, with a particular focus on participation in cultural and sports activities. Methods: Using data from the 2022 census of people with disabilities in X Province, China, we estimated Probit models to assess the association between access to three types of basic services—rehabilitation, social welfare, and social assistance—and participation in cultural and sports activities. Results: Greater access to basic services was associated with a significantly higher likelihood of participation in cultural and sports activities. Among the three service categories, rehabilitation services showed the strongest positive association. The positive association was stronger among individuals with lower disability severity. Conclusions: Access to disability-related basic services, especially rehabilitation services, may promote health-related social participation and social integration among people with disabilities. These findings highlight the importance of service access and rehabilitation support for disability healthcare, community inclusion, and quality of life. Full article

Traumatic spinal cord injury (TSCI) frequently necessitates prolonged ventilatory support, raising the clinical dilemma of early versus late tracheostomy. Despite decades of debate, no randomized controlled trials (RCTs) have been conducted exclusively in TSCI populations, and evidence remains largely observational. This review synthesizes contemporary evidence on the timing and outcomes of tracheostomy in acute TSCI. Across multiple cohort studies and meta-analyses, early tracheostomy (≤7 days) is consistently associated with shorter mechanical ventilation duration, shorter ICU length of stay, reduced sedation exposure, and fewer immobility-related complications. Data suggested a lower incidence of ventilator-associated pneumonia, though mortality outcomes remain unchanged. Importantly, cervical-level injuries appear to derive the most significant benefit, while variability in defining “early” versus “late” complicates direct comparisons. Despite methodological limitations, including reliance on retrospective data, inconsistent definitions, and lack of long-term follow-up, cumulative evidence indicates that early tracheostomy improves short-term outcomes. The optimal timing of tracheostomy in TSCI remains uncertain. Current observational evidence suggests that early tracheostomy in cervical SCI is associated with a reduction in the duration of mechanical ventilation, ICU stay, and respiratory complications. These benefits might come from better access to the airways, less anatomical dead space, better clearance of secretions, less need for sedation, together with earlier mobilization and rehabilitation. Mortality outcomes remain inconclusive. In the absence of randomized trials and long-term data, individualized decisions based on injury level, clinical course, and institutional expertise are essential. Full article

This work explores the key capabilities of emerging sensing technologies in the context of Structural Health Monitoring (SHM) of civil infrastructures, aiming to contribute to research on integrated and intelligent systems for more accessible and efficient monitoring solutions. As a case study, it focuses on the analysis of the static and dynamic behavior of the Edgar Cardoso stay-cable bridge during its rehabilitation, using fully customized transducers and equipment. The developed system integrates sensors capable of measuring accelerations, displacements, and temperature, which are connected to an autonomous data acquisition and transmission network. A digital interface was also developed to store, process, and visualize the collected data, enabling remote access for subsequent interpretation and analysis. The main contribution of this research lies in the use of optimized wireless monitoring systems with extended autonomy. This is achieved by employing edge computing techniques to minimize energy consumption during data transmission, as well as by managing the sleep modes of the sensor nodes. At same time, a methodology was proposed for the automatic and real-time estimation of axial forces in cables. This approach relies on the use of innovative edge computing tools, combined with the taut string theory as a simplified modelling framework. The results confirm the effectiveness of the developed system in achieving long-term operation without compromising monitoring performance. In addition, the developed system enabled the identification of the structure’s dynamic properties, particularly natural frequencies. The temperature profiles in critical sections, as well as displacements in the expansion joint were also measured and evaluated. The results demonstrate the potential of customized sensing solutions as effective tools for the management, maintenance, and long-term preservation of strategic infrastructures. Full article