Search Results (2,456)

Sarcopenia, characterized by progressive loss of muscle mass and function, is highly prevalent among patients with heart failure (HF) and contributes to frailty, disability, and poor prognosis. Shared mechanisms—chronic inflammation, neurohormonal dysregulation, mitochondrial dysfunction, inactivity, and inadequate nutrition—promote anabolic resistance and accelerate muscle wasting. This narrative review summarizes current evidence on the interplay between HF and sarcopenia, focusing on practical strategies for integrated management. Exercise training, particularly combined aerobic and resistance programs, improves physical performance and quality of life, while targeted nutritional interventions ensure adequate energy and protein intake and mitigate malnutrition. Emerging evidence supports the synergistic benefit of coupling tailored dietary support with structured rehabilitation. Despite robust data, implementation of person-centered, multidisciplinary care remains limited. Routine screening for sarcopenia and nutritional risk should be embedded in HF pathways to enable early intervention, functional recovery, and improved long-term outcomes. Full article

In Uganda, in 2019, 6.8 million people experienced health conditions that are amenable to rehabilitation. This is largely due to musculoskeletal disorders such as low back pain (LBP). Measuring effective coverage of rehabilitation means assessing whether a population that needs rehabilitation services receives the interventions with sufficient quality to produce the desired health gain. This study reports on the first measurement of effective coverage of rehabilitation in Uganda and globally using chronic primary LBP as the tracer health condition. A population survey was conducted to administer the WHO global tracer indicator questions. The survey questions were used to identify respondents with chronic primary LBP experiencing limitations in functioning and to determine utilization of rehabilitation services. The WHO Disability Assessment Schedule (WHODAS) 2.0 12-item was used for the measurement of an improvement in functioning that is meaningful to service users. The questions were nested in the Iganga–Mayuge Health and Demographic Surveillance Site (IMHDSS) update round 22 in seven sub-counties in rural Eastern Uganda between June and September 2023. Data collection followed a training session on survey administration and data capture for enumerators, field supervisors, research managers and lead scientists from the Makerere University Centre for Health and Population Research and a pilot testing of the data collection tool. Survey administration resulted in data collection for 8645 respondents aged 18 years and above. Specifically, 15.2% of the respondents had experienced chronic LBP in the last 12 months, of which 88.5% had experienced pain that was severe enough to affect their usual household, recreational or work activities. A total of 46% of this population in need of rehabilitation had been utilizing rehabilitation services (crude coverage), with no difference between women and men. Only 7.05% of the respondents with chronic primary low back pain experiencing limitations in functioning had been managed with sufficient quality to produce the desired health gain, defined by a minimal but meaningful improvement in functioning (effective coverage). Full article

Background and Objectives: This research aimed to compare Type D personality characteristics and self-esteem between individuals with chronic NSLBP and healthy controls, while also exploring their relationships with functional status, psychological symptoms, and quality of life within the patient group. Materials and Methods: In this cross-sectional investigation, 34 patients with chronic NSLBP were compared with 34 healthy controls with similar age and sex distribution. Pain intensity was quantified via the Visual Analog Scale (VAS), while functional impairment was evaluated using the Oswestry Disability Index (ODI). Psychological profiling included the Type D Scale-14 (DS14) for personality traits, the Rosenberg Self-Esteem Scale (RSES) for self-worth, and the Hospital Anxiety and Depression Scale (HADS) for emotional distress. Health-related quality of life was captured through the 12-Item Short Form Health Survey (SF-12). Results: Type D personality was significantly more prevalent in the NSLBP group than in controls (50% vs. 20.6%, p = 0.011). Patients with NSLBP had significantly higher negative affectivity (NA) scores (p < 0.001) and anxiety scores (p = 0.007) and lower SF-12 Physical Component Summary scores (p < 0.001) than controls. Pain intensity and disability were positively correlated with Type D personality traits, particularly NA and the Type D composite score. In exploratory subgroup analyses, patients with Type D personality also had higher pain intensity, disability, anxiety, and depression scores and lower SF-12 Mental Component Summary (MCS) scores than those without Type D personality. In adjusted regression analyses within the NSLBP group, Type D personality was associated with higher VAS (p = 0.004) and ODI scores (p = 0.007) and lower SF-12 MCS scores (p = 0.003). Conclusions: Type D personality characteristics were more frequent in patients with chronic NSLBP than in healthy controls and were associated with higher pain intensity, greater disability, higher anxiety and depressive symptom scores, and poorer mental quality-of-life scores within the patient group. In contrast, self-esteem did not differ significantly between patients and controls. Due to the inherent constraints of a cross-sectional framework and the potential construct redundancy between NA and emotional distress, the current results signify correlational links rather than definitive causality. Consequently, subsequent prospective research is vital to delineate the temporal dynamics and the long-term predictive value of Type D personality traits in the progression of chronic NSLBP. Full article

Background/Objectives: Orofacial myofunctional therapy (OMT) is a system of targeted neuromuscular exercises and behavioral retraining intended to optimize tongue, lip, jaw, and airway function during rest, breathing, swallowing, and sleep. Historically associated with tongue thrust and abnormal swallowing, OMT is now applied across an expanding range of clinical contexts, including sleep-disordered breathing (SDB), tongue-tie rehabilitation, orthodontic stability, and perioperative functional recovery. As its use has broadened, persistent questions have followed: what is myofunctional therapy, where did it originate, and how did a set of oral exercises evolve into an intervention increasingly integrated with airway health, sleep medicine, and surgical care? Methods: This article presents a narrative historical review with a perspective component, synthesizing foundational literature, interdisciplinary contributions, and selected contemporary evidence to examine the evolution of OMT from ancient functional practices to modern clinical science. It is written to trace recurring clinical observations, shifts in educational frameworks, and key inflection points that shaped how OMT has been taught and applied over time. Results: OMT did not emerge from randomized controlled trials or standardized protocols. It arose from repeated clinical encounters with patients with atypical craniofacial development, relapse of structural correction, persistent mouth breathing, and/or unresolved swallowing and speech dysfunction despite technically successful treatment. These patterns suggested that anatomy alone could not account for outcome variability. Over time, clinical attention expanded beyond isolated tongue function to include breathing patterns, posture, neuromuscular tone, and airway behavior. In the past two decades, controlled trials, cohort studies, and systematic reviews have supported selected applications of OMT, particularly in SDB and adjunctive airway care, while also revealing ongoing challenges related to training variability, terminology, scope of practice, and standardization. Conclusions: OMT has historically been described as a system of targeted neuromuscular and behavioral interventions aimed at modifying orofacial rest posture and function. Over time, the field has expanded beyond localized muscle retraining toward a broader functional framework that integrates airway physiology, craniofacial growth, sleep, and interdisciplinary rehabilitation. Full article

Muscle oxygen nation impairment, defined as a mismatch between oxygen delivery, distribution, and oxidative utilization in active skeletal muscle, contributes to exercise intolerance and functional decline. Near-infrared spectroscopy (NIRS) has emerged as the leading non-invasive tool for monitoring local muscle oxygenation, but its clinical translation and optimal exercise-based management remain incompletely defined. This scoping review aimed to (1) synthesize the pathophysiology of muscle oxygenation impairment across the oxygen transport cascade, (2) evaluate NIRS-based diagnostic protocols, and (3) review exercise-based interventions targeting muscle oxygenation. The review followed PRISMA-ScR guidelines and was prospectively registered in OSF (DOI: 10.17605/OSF.IO/QW8R3) and PROSPERO (CRD420261365040). PubMed, Web of Science, Scopus, Cochrane CENTRAL, EMBASE, PEDro, and ClinicalTrials.gov were searched through to April 2026. Methodological quality was appraised using the PEDro scale, the Downs and Black checklist, and the Newcastle–Ottawa Scale. A total of 61 studies (2003–2025) were included, with fair-to-good methodological quality (PEDro 3–8, mean 5.3; Downs and Black 15–24, mean 18.6; Newcastle–Ottawa 5–8, mean 6.5). Regarding pathophysiology, muscle oxygenation impairment is a cascade-level phenomenon with four mechanistically distinct phenotypes corresponding to the dominant site of impairment, each with characteristic NIRS signatures. Regarding diagnostic assessment, NIRS has shown value in selected contexts including a validated threshold for peripheral artery disease, but most studies report group-level correlations without deriving receiver operating characteristic curves at validated thresholds, which together with device and calibration heterogeneity limits clinical translation. Regarding exercise-based interventions, adaptations align with the underlying cascade lesion, sprint and high-intensity interval training enhance oxidative capacity, while walking-based and vascular-targeted programs preferentially improve microvascular function. These findings support a unifying framework in which the site of cascade impairment guides diagnostic protocol selection and exercise prescription. The proposed cascade lesion phenotyping schema is hypothesis-generating and requires prospective validation. Full article

Objective: To systematically evaluate the rehabilitation effect of brain-computer interface (BCI)-controlled hand robot training on post-stroke motor functions, especially upper limb functions. Methods: PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, WanFang Data, and VIP Database were searched from inception to 13 March 2026. Randomized controlled trials (RCTs) with dose-matched designs were included, where the test group underwent BCI-controlled hand robot training and the control group received either pure hand robot training or routine rehabilitation. Meta-analysis was performed on RevMan 5.4. Results: Totally 11 RCTs involving 380 patients were included. Compared with hand robot training alone, BCI-controlled hand robot training significantly improved Fugl-Meyer Assessment for Upper Extremity (FMA-UE) scores (MD = 4.87, 95% CI: 1.04 to 8.69) and FMA-UE proximal scores (MD = 4.44, 95% CI: 0.15 to 8.74), and significantly reduced finger flexor spasticity (MD = −0.44, 95% CI: −0.68 to −0.21), but showed no significant difference in distal upper limb motor function or Action Research Arm Test (ARAT) scores. Compared with routine rehabilitation, BCI-controlled hand robot training significantly improved FMA-UE scores (MD = 6.55, 95% CI: 3.49 to 9.61). Conclusions: BCI-controlled hand robot training can effectively improve overall upper limb and proximal motor function after stroke and alleviate finger flexor spasticity, but the evidence for distal hand function and long-term efficacy remains limited. Full article

Background: Hashimoto’s thyroiditis (HT) is a common autoimmune disorder characterized by chronic inflammation and metabolic alterations. Mitochondria-derived peptides (MDPs), particularly mitochondrial open-reading frame of the 12S rRNA-c (MOTS-c), have emerged as key regulators of cellular metabolism, insulin sensitivity, oxidative stress, and inflammatory responses. This study aimed to investigate the association between circulating MOTS-c levels and HT and to explore its potential role in thyroid autoimmunity and metabolic regulation. Methods: In this cross-sectional study, patients diagnosed with HT (n: 90) were compared with age- and sex-matched healthy controls (n: 90). Results: A total of 180 participants were included, comprising 90 patients with HT and 90 age- and sex-matched healthy controls. Circulating MOTS-c levels were significantly lower in patients with HT compared to controls (p < 0.001). MOTS-c levels demonstrated significant inverse correlations with body mass index, fasting glucose, HbA1c, HOMA-IR, thyroid-stimulating hormone, C-reactive protein, and thyroid autoantibody levels (all p < 0.05). In subgroup analyses, these associations remained significant within the HT cohort, particularly for HOMA-IR and thyroid autoantibodies. Multivariable regression analysis identified HT (β = −30.04, p < 0.001) and HOMA-IR (β = −0.85, p < 0.001) as independent determinants of reduced circulating MOTS-c levels. Levothyroxine (LT4) use was not associated with significant differences in MOTS-c concentrations. Conclusions: Circulating MOTS-c levels are markedly reduced in patients with HT and are independently associated with insulin resistance and autoimmune burden. These findings suggest that impaired mitochondrial signaling may play a role in the pathophysiology of thyroid autoimmunity and highlight MOTS-c as a promising biomarker linking metabolic dysfunction and immune dysregulation. Full article

Oral and Maxillofacial Surgery (OMFS) is a surgical specialty with a distinctive position at the intersection of medicine and dentistry. This unique expertise enables reliable reconstructions of complex head and neck defects, with a focus on function, esthetics, and quality of life. This review examines the historical progression, current practices, and prospective directions of head and neck reconstruction, with particular emphasis on the essential contributions of Oral and Maxillofacial Surgeons (OMSs). Beginning with early reconstructive efforts in ancient civilizations and progressing through the transformative advancements of the Renaissance, the introduction of anesthesia and antiseptics, and innovations during periods of war, the specialty has evolved in response to increasing clinical complexity. The contemporary era is characterized by the integration of microvascular reconstruction, dental rehabilitation, and advanced imaging modalities, enhancing the restoration of occlusal function, facial aesthetics, and overall quality of life. Emerging innovations such as patient-specific three-dimensional printed hardware, tissue engineering, regenerative medicine, artificial intelligence, and supermicrosurgical techniques are expected to further reshape reconstructive approaches. These technological advances aim to reduce the number of surgical steps, improve biological reconstruction, and enhance diagnostic and planning capabilities. However, they also raise ethical considerations and validation challenges that warrant careful assessment. In conclusion, Oral and Maxillofacial Surgeons continue to play a central and expanding role in head and neck reconstruction and rehabilitation. Owing to comprehensive training and technological expertise, the specialty is uniquely positioned to advance value-based, multidisciplinary care while persistently striving to improve functional, aesthetic, and quality-of-life outcomes for patients with complex craniofacial defects. Full article

Background/Objectives: Functional near-infrared spectroscopy (fNIRS) has emerged as a non-invasive, implant-compatible imaging modality capable of capturing cortical hemodynamics during ecologically valid auditory and linguistic tasks. Its silent operation and tolerance to electrical artifacts make it particularly well suited to the study of hearing-impaired individuals, including cochlear implant (CI) users. However, evidence on the application of fNIRS to investigate speech perception, cognitive performance, and proxy of cortical activation patterns in patients with hearing loss (HL) remains fragmented. This systematic review aims to provide a structured, population-stratified description of current fNIRS literature on auditory and cognitive processing in adults with age-related hearing loss (ARHL) and CI users. Methods: A systematic search on PubMed Central, Web of Science and Scopus, based on PRISMA (2020) guidelines, was conducted to identify original studies that evaluate speech perception by means of fNIRS to assess auditory and cognitive process in hearing-impaired populations. Results: Across studies, fNIRS consistently detected activation of superior temporal and frontal cortices during speech-related tasks. In ARHL, increased dorsolateral prefrontal cortex (DLPFC) recruitment during speech-in-noise indicated compensatory yet inefficient processing. Longitudinal auditory training led to reduced prefrontal overactivation and enhanced temporal–frontal connectivity. In CI users, cortical responses to phonological and comprehension tasks show partially overlapping activation patterns with normal hearing (NH) peers, although arising within different neurobiological contexts, and are modulated by device experience and residual hearing (AV) speech, and stimulus-level effects further shape cortical responses. When interpreted in light of developmental evidence, these findings may be contextualized as reflecting distinct trajectories of cortical reorganization, rather than a common mechanism. Conclusions: fNIRS provides a tool to investigate auditory and cognitive responses in distinct hearing-impaired populations under ecologically valid conditions. It detects maladaptive frontal inefficiency in ARHL, tracks neuroplastic changes after rehabilitation, and captures population-specific cortical recruitment patterns in CI users. These findings are descriptive and context-dependent, and do not support cross-population mechanistic generalizations. Standardized protocols and longitudinal pediatric studies are needed to clarify the potential clinical relevance of fNIRS-derived cortical measures. Full article

Heart failure (HF) is a heterogeneous clinical syndrome with increasing prevalence among adults worldwide. It is characterized by complex central and peripheral alterations that contribute to exercise intolerance, fatigue, dyspnea, and reduced quality of life. Inspiratory muscle weakness (IMW) plays a key role in this vicious cycle by exacerbating symptoms and further limiting functional capacity. Inspiratory muscle training (IMT) has emerged as a potential adjuvant in comprehensive HF management and is a physiologically grounded and promising tool in the contemporary HF therapeutic toolkit. Its integration into multimodal rehabilitation programs may mitigate the cycle of dyspnea and deconditioning in patients with HF. On this basis, we provide an overview of the pathophysiological mechanisms underlying IMW and present the practical characteristics of IMT programs, synthesizing current evidence regarding its clinical efficacy and implementation challenges. Full article

Rationale and objectives: Parkinson’s disease (PD) significantly affects visual function, especially convergence and eye movements, impacting tasks such as reading. The objective was to investigate preliminarily the impact of the use of digital visual training in PD patients with associated convergence insufficiency (CI). Materials and methods: Pre–post pseudo-experimental pilot study to evaluate the impact of a novel digital therapy system (video game for use on a mobile phone or tablet) in 13 patients with PD and CI, with a mean age of 67 years. A comprehensive visual assessment was performed before and after a 6-week home-based visual rehabilitation, including measurement of near point of convergence (NPC), near positive fusional vergence (PFV), oculomotor tests (NSUCO and King-Devick tests), and symptom assessments with two validated questionnaires (CISS and SQVD). Results: Treatment adherence was variable, ranging from 0.8% to 124.7%. Despite this, significant improvements were found after therapy in break (p = 0.022) and recovery points of the NPC (p = 0.007), as well as break (p = 0.003) and recovery points in near PFV (p < 0.001). In the NSUCO test, the total score improved significantly from 23.9 ± 4.2 to 26.2 ± 3.7 after therapy (p = 0.003). Furthermore, a significant reduction in the total King-Devick test time was observed, decreasing from 79.4 ± 28.8 s to 69.0 ± 21.5 s with therapy (p = 0.034). Finally, symptom questionnaire scores also decreased significantly with therapy (CISS p = 0.037, SQVD p < 0.001). Conclusions: The digital vision therapy system evaluated seems to improve oculomotor control and reduce visual symptoms associated with CI in PD patients. Studies with larger sample sizes and a control group are needed to fully validate the therapeutic effectiveness of this tool. Full article

The growing integration of rehabilitation robotics and artificial intelligence has created new opportunities for developing control strategies that better support clinicians during patient therapy. This study investigates machine learning and deep learning approaches for classifying upper limb motion using encoder-based biomechanical data, with the goal of identifying a model suitable for implementation in a rehabilitation exoskeleton. Several classical algorithms such as k-Nearest Neighbors, Random Forest, multiclass logistic regression, XGBoost, and an SVM classifier were evaluated alongside three deep learning architectures: convolutional layers, GRU and LSTM units. Models were trained and tested on two types of datasets using both standard cross-validation and leave-one-subject-out validation. The analysis included assessments of class separability, signal features’ importance, and comparative performance based on F1-score, accuracy, and confusion matrices. Results showed notable differences between validation strategies, with LOSO evaluation revealing limitations of the available dataset and emphasising the need for broader data collection. Overall, the findings indicate that, in the LOSO evaluation of the five-class multi-subject dataset—the most clinically realistic validation scenario—the LSTM-based model achieved the highest generalisation performance (accuracy 92.8%, macro-F1 0.927), supporting its suitability for integration into exoskeleton control systems aimed at detecting and mitigating compensatory movements. 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

This narrative review explores the potential role of cognitive–motor dual-task training (CMDT) approaches within training methods used in sports clubs, with particular emphasis on soccer clubs, to support performance enhancement, recovery, and injury prevention; improve agility, decision making, and functional readiness; and enhance training quality and specificity. The review discusses how CMDT may be integrated as part of the broader and more comprehensive planning of the club’s full training program, including during the preseason period, as part of preparation for training and competition, within recovery sessions, during periods of high load, and throughout the rehabilitation process and the transition back to team training and contact exposure, while also potentially contributing to variety, mental stimulation, enjoyment, and player engagement. The review also emphasizes the importance of implementing CMDT within a coordinated professional framework, through collaboration and synchronization within the professional and medical staff of the club, and in broad alignment with club goals, player characteristics, and sport-specific demands. The key insight is that CMDT has the potential to serve as a practical, complementary approach that helps bridge the gap between controlled training and rehabilitation settings and the dynamic demands of soccer participation. Based on this review, practical recommendations and future research directions are presented, while emphasizing that CMDT should be applied with caution, through gradual and context-specific progression, and in line with established training, recovery, and rehabilitation principles. Full article

Deep brain stimulation (DBS) with implantable pulse generators (IPGs) is widely used in the treatment of movement disorders. Rechargeable IPGs (RC-IPGs) were developed to extend device longevity and address the limitations of battery life in non-rechargeable IPGs. However, data regarding patient compliance and device-related complications remain limited. Therefore, this retrospective observational study evaluated compliance, satisfaction, and complications in patients with RC-IPGs. Compliance in 42 patients with RC-IPGs was evaluated using the Timmermann questionnaire together with additional questions regarding device preference, complaints, and complications. Statistical analyses were performed using NCSS software (Number Cruncher Statistical System, version 2020; NCSS LLC, Kaysville, UT, USA). Although a substantial percentage (42.9%) of patients needed help during recharging, the overall satisfaction score was high (96% of the maximum possible score), and 95.2% of patients preferred RC-IPGs if a repeat DBS would be required, and the rate of RC-IPG complications (7.1%) was low. The patients rated the display screen with the lowest scores (54.05%), mainly those who underwent two or more DBS surgeries. The training subscore showed a statistically significant negative correlation with age (r = −0.531, p = 0.001), and dystonia patients, constituting the youngest group in the cohort, rated training with higher points. This study provides additional data on patient compliance and safety of RC-IPGs. These findings may contribute to a better understanding of patient experience and factors affecting compliance with rechargeable systems. Full article