Search Results (922)

Background: Global developmental delay (GDD) affects multiple domains of early childhood development, including gross motor, cognitive and communication skills. Early, intensive, family-centered rehabilitation is considered key to optimizing functional outcomes in affected children. Case Presentation: We report a female child with GDD who began rehabilitation at our institution at 15 months of age, presenting with generalized hypotonia with superimposed fluctuating episodes of hypertonia, poor postural control, absent independent sitting, markedly reduced spontaneous motor activity, and associated cognitive and communication delay. Brain MRI at 7 months showed no parenchymal abnormality, with mildly enlarged extracerebral cerebrospinal fluid spaces and ventricular system. The metabolic and genetic evaluation performed so far, including microarray/MLPA-based screening for common microdeletion syndromes and SMN1/SMN2 genotyping, has not identified a specific underlying etiology. Diagnostic work-up is ongoing. Rehabilitation was delivered as a comprehensive, multidomain program; this report focuses specifically on the child’s motor progression. Intervention: The child underwent the Early Intensive Stojčević-Polovina Rehabilitation Method (EIR-SPM), a high-intensity, continuous approach for children with cerebral palsy, at-risk infants, and other developmental disabilities, built on parental education enabling home-based continuity of therapy. Rehabilitation focus is selected according to the child’s optimal developmental stage—the milestone showing the least abnormal movement patterns and muscle tone—rather than chronological age, with positions progressively adjusted following the trajectory of typical motor development described by Vojta. Results: Gross motor function, monitored using the Gross Motor Function Measure–88 (GMFM-88) at four assessment points from 15 months to 6 years 6 months of age, improved progressively from 10.8% to 48.9%, 64.7%, and finally 73.9%. The child achieved independent kneeling, reciprocal crawling, independent sitting in all positions, independent standing and assisted stepping. Conclusions: In this child with GDD of undetermined etiology, more than five years of intensive, family-centered rehabilitation according to the EIR-SPM were accompanied by substantial and sustained gains in gross motor function and functional independence. This report suggests that meaningful progress remains achievable even when rehabilitation begins later than the period considered optimal within the EIR-SPM framework, and that a family-centered structure may be what makes therapy of this intensity and duration sustainable. Full article

Background: Stroke is the third leading cause of death and a major cause of long-term disability in Malaysia, where the continuity of post-stroke care depends heavily on unpaid, untrained informal family caregivers. These caregivers face a well-documented “discharge cliff,” assuming complex medical and rehabilitative responsibilities with minimal preparation. The locally developed “CaknaStrok” mobile health (mHealth) application was designed to bridge this support gap. However, the existence of a tool does not guarantee its use; sustained adoption depends on whether caregivers find the application acceptable and are willing to integrate it into an already demanding caregiving routine. Objectives: This protocol describes a study designed to determine the levels of acceptability and willingness to use the CaknaStrok application, to examine the associated predictors (effort expectancy, ability, digital health literacy, and intervention coherence), and to test the central mediating role of acceptability through a novel Integrated Acceptability–Willingness (IAW) Framework. Methods: An explanatory sequential mixed-methods design will be conducted at the Stroke Ward of Hospital Canselor Tuanku Muhriz (HCTM), a World Stroke Organization-certified Advanced Stroke Centre. In Phase I, a target of 200 informal primary caregivers will be recruited through consecutive sampling and surveyed using a validated, bilingual (Malay/English) self-administered questionnaire that operationalises the IAW constructs through three established instruments (UTAUT, the Digital Health Literacy Instrument, and the Theoretical Framework of Acceptability). Following a standardised facilitated onboarding, caregivers use the application ad libitum for four to six weeks before completing the questionnaire. Expected Results: The study will quantify caregiver acceptability and willingness to use, identify which factors most strongly drive acceptance, and empirically test whether acceptability mediates the relationship between the predictors and willingness to use. Qualitative themes will contextualise the statistical pathways, surfacing culturally specific mechanisms of adoption that single-method designs typically miss. Ethical approval was obtained from the UKM Research Ethics Committee (JEP-2024-392). Conclusions: This study is expected to generate context-sensitive evidence to guide the design of caregiver-facing mHealth interventions and inform future multi-site implementation and policy development efforts within the Malaysian stroke-care pathway. Full article

Mediterranean vernacular masonry houses embody centuries of accumulated environmental knowledge, yet many are currently threatened by abandonment, together with functional obsolescence. This study proposes a framework for the conservation-oriented upgrading of 19th-century Mediterranean stone houses that reconciles heritage preservation with contemporary environmental requirements. Using the vernacular settlement of Korogonianika, Peloponnese, Southern Greece, as a case study, the research combines documentation and analysis of the existing heritage regulatory framework, construction material discussions, building condition assessments, and outdoor microclimate evaluations through ENVI-met simulations. The study concludes with the development of conservation-compatible energy retrofit strategies. The microclimatic analysis examines representative winter and summer conditions to identify the influence of settlement morphology, orientation, building density, and traditional stone construction on thermal comfort. Results demonstrate that the fabric of the village plays an important role in thermal comfort. In particular, high thermal mass and passive bioclimatic characteristics of the settlement moderate seasonal thermal stress. These findings inform restoration interventions that preserve the environmental intelligence embedded in the vernacular architecture while improving building resilience. The proposed framework underscores that effective upgrading should be guided by both heritage values and local microclimatic conditions, offering a transferable methodology for the conservation and sustainable rehabilitation of Mediterranean vernacular masonry houses. Full article

Accurate actuator-space tracking is an important engineering requirement for repeatable motion delivery by parallel rehabilitation mechanisms, but controller performance should also be assessed under configuration-dependent dynamics and modeling uncertainty. This study evaluates a bounded fuzzy-supervised proportional–integral–derivative (FSPID) controller for a three-chain 3STC+S parallel rehabilitation mechanism. CAD-derived inverse kinematics generated the three prismatic-joint reference trajectories, while closed-loop behavior was simulated using a Simscape Multibody model including rigid-body mass and inertia properties, gravity, closed-loop constraints, and external force/moment loading. Three fixed-gain PID loops formed the baseline. The FSPID supervisor used zero-order Sugeno inference to adjust proportional and derivative gains within prescribed bounds, while the integral action remained fixed and was implemented with a leaky integrator. Under the nominal 1° trajectory at 0.2 Hz, FSPID reduced mean root-mean-square error (RMSE), maximum absolute error, and integral absolute error (IAE) by 0.25%, 0.37%, and 0.21%, respectively. Under sustained external loading, maximum-error reductions reached 9.33–10.20%, with mean actuator-wise peak-force changes within approximately ±2%. Additional simulations examined trajectory amplitude, synthetic measurement noise, viscous damping, and combined nonidealities. The results support FSPID as a conservative simulation-level refinement of fixed-gain PID; experimental validation remains necessary. Full article

The seismic rehabilitation of existing buildings has become a major challenge in structural engineering due to the ageing of the global building stock, increasing seismic risk, and the growing demand for sustainable and resilient infrastructure. Although numerous retrofit techniques have been developed, most existing reviews classify solutions according to construction materials or individual technologies, providing limited guidance for selecting appropriate rehabilitation strategies in engineering practice. This review proposes a strategy-oriented framework that classifies seismic rehabilitation according to primary structural objectives rather than constituent materials. Five principal strategies are critically assessed: capacity enhancement, stiffness enhancement, ductility enhancement, seismic demand reduction, and hybrid rehabilitation. Their governing structural mechanisms, representative retrofit techniques, advantages, limitations, applicability, and sustainability implications are comparatively evaluated. Building on this classification, a decision-oriented framework is introduced that links structural typology, governing deficiencies, target performance objectives, rehabilitation strategies, and representative retrofit techniques, providing a structured basis for preliminary engineering decision-making before detailed structural design and verification. The review demonstrates that effective seismic rehabilitation depends primarily on the compatibility between the selected strategy and the characteristics and deficiencies of the existing structure rather than on any individual retrofit technique. It also highlights the growing importance of hybrid interventions, performance-based design, sustainability, functional recovery, and long-term resilience. By combining a comprehensive synthesis of current knowledge with a strategy-oriented classification and practical decision-support framework, this review provides a structured methodology for comparing and selecting rehabilitation strategies across diverse building typologies and project-specific constraints. Full article

Background/Objectives: Toileting-related falls may arise from interacting urinary symptoms, impaired mobility and balance, cognitive or psychological factors, environmental hazards, and caregiver limitations that are often managed separately. This study aims to evaluate the implementation, safety, and 6-month clinical outcomes of an integrated multidisciplinary prevention, treatment, and rehabilitation pathway for older adults and people with disabilities at risk of toileting-related falls. Methods: This multicenter, prospective, single-arm implementation study will enroll 300 adults aged ≥18 years across 15 centers. Participants will undergo standardized assessment of urinary function, gait and balance, physical function, psychological/cognitive factors, activities of daily living, fall history, and toileting-related environmental risks. Prespecified risk domain criteria will guide individualized urinary, rehabilitation, psychological/cognitive, caregiver, and environmental interventions, with reassessment and adjustment during follow-up. The primary outcome will be the 6-month cumulative incidence of at least one toileting-related fall. The secondary outcomes will include nighttime and total falls, urinary symptoms, nocturia, mobility, and functional independence. The implementation will be evaluated using RE-AIM and intervention fidelity measures. Expected Results: The study will characterize pathway reach, adoption, delivery, fidelity, safety, follow-up performance, data completeness, clinical event rates, and within-participant change. Conclusions: The findings may support a reproducible multidisciplinary care pathway and inform subsequent comparative evaluations of effectiveness, sustainability, component contributions, and resource use. Full article

Persistent post-concussion syndrome (PPCS) develops in 10 to 30 percent of patients following mild traumatic brain injury (mTBI), yet the most effective management approach remains an open question. This report describes a 37-year-old female who sustained a motor vehicle collision and was followed prospectively over 27 months. Structured evaluation at baseline identified dysfunction across oculomotor, vestibular, autonomic, cognitive, and neurophysiological domains. An intensive multimodal rehabilitation programme was associated with an 86 percent reduction in symptom burden (Post-Concussion Symptom Scale: 80 to 11) by the six-month mark. Thereafter, symptoms gradually returned in spite of continued treatment, and at 27 months the patient still reported moderate-to-severe headache (6 to 7 out of 10), persistent dizziness (5 to 6 out of 10), and meaningful functional limitations. The trajectory observed here, marked by initial gains followed by progressive relapse, illustrates the fluctuating and often incomplete recovery seen in a subgroup of PPCS patients. Clinicians should anticipate this pattern and frame outcome expectations accordingly, while building sustained, adaptive management strategies into long-term care plans. Full article

Soil contamination represents a pervasive and multifaceted threat to environmental integrity, public health, and sustainable land use. In response to this challenge, this systematic review synthesizes recent advancements in sustainable soil remediation techniques, with an emphasis on bioremediation, nature-based solutions (NBSs), innovative physicochemical methods, and multidimensional assessment frameworks. Utilizing the adapted PRISMA methodology, 3222 peer-reviewed articles published between 2015 and 2025 were initially identified, with 53 studies selected for in-depth evaluation based on methodological rigor, innovation, and relevance to sustainability. The findings reveal a pronounced research trajectory toward biologically mediated remediation strategies, including microbial bioremediation, phytoremediation, and vermiremediation, as well as hybrid systems that incorporate biochar and nano-enabled materials to enhance efficacy. Concurrently, emerging physicochemical techniques, such as stepped steam heating and composite stabilization using fly ash demonstrate potential for high-efficiency contaminant immobilization with reduced environmental trade-offs. The integration of computational tools, particularly machine learning for remediation optimization, and the application of life cycle assessment (LCA) and Multi-Criteria Decision Analysis (MCDA), are redefining how sustainability is quantified and operationalized. In addition to technical innovation, the review underscores critical policy and socio-economic dimensions, including regulatory fragmentation, funding asymmetries, and stakeholder engagement. Comparative analyses of EU and US regulatory frameworks highlight the impact of governance structures on implementation scalability and public acceptance. The review concludes by advocating for a paradigm shift toward holistic, transdisciplinary remediation approaches that are ecologically resilient, economically viable, and socially just aligned with the Sustainable Development Goals (SDG 15.3) and the Paris Agreement. This review provides a comprehensive and integrative perspective on the current state and future directions of sustainable soil remediation, offering a strategic foundation for researchers, policymakers, and practitioners engaged in the restoration of contaminated lands. Full article

Urban regeneration has become a central focus in global urban studies, increasingly linked to the dual imperatives of sustainability and urban resilience. According to Christopher Alexander’s theories of living structure and pattern language, traditional built environments emerge through progressive adaptation rather than top-down design. Moreover, historic urban fabrics evolve through continuous refinement of spatial solutions that simultaneously respond to environmental, functional, and social needs. Therefore, this study situates urban regeneration within a theoretical framework that recognizes traditional settlements as complex adaptive systems rather than static heritage. Chinese urban villages (Chengzhongcun) and Spanish Suelo Urbano no Consolidado (SUNC, Unconsolidated Urban Land) areas represent two contrasting forms of urban socio-spatial systems engulfed by urban expansion, both characterized by dense, historically rooted morphologies and incomplete infrastructure. As Chinese urban villages shift from a demolition–reconstruction model toward more sustainable regeneration approaches, this study compares Beijing’s Cuigezhuang and Málaga’s El Perchel through spatial analysis and stakeholder surveys. Alexander would argue that the demolition–reconstruction model disrupts the evolutionary processes that generate coherent urban fabrics. The research evaluates how differing planning systems foster or constrain sustainable development and social-spatial resilience in regeneration processes. Urban resilience is explicitly defined here as the capacity of urban communities and spatial structures to adapt to change, withstand pressures, and maintain social cohesion, accessibility, and local identity, while ecological and economic resilience are not measured in this study. Findings demonstrate that Spain’s incremental, participatory approach—anchored in Planes Especiales de Reforma Interior (PERI, special plans for inner urban renewal) and land readjustment (equitable distribution of costs and benefits) mechanisms—significantly outperforms China’s state-led demolition-based model in supporting long-term sustainability, heritage integrity, community cohesion, and spatial continuity. Spain’s legally embedded participation and in situ rehabilitation strategies offer transferable lessons for China’s evolving sustainable and resilience-oriented regeneration paradigm. Full article

Background: Exercise-based cardiac rehabilitation (CR) is a cornerstone of secondary cardiovascular prevention and improves functional capacity, quality of life, and clinical outcomes. However, maintaining long-term participation remains a major challenge in routine clinical practice. Adapted Physical Activity (APA) programs represent a community-based strategy to promote continued exercise after outpatient cardiac disease, although evidence regarding long-term retention and functional outcomes in real-world settings remains limited. The aim of this study was to evaluate attrition patterns during a 12-month APA follow-up pathway following cardiac rehabilitation and to explore longitudinal changes in functional outcomes among participants who remained under follow-up. Methods: This retrospective longitudinal observational study included 78 consecutive patients referred to an APA program following outpatient cardiac rehabilitation for myocardial infarction or other cardiovascular conditions. Assessments were performed at baseline (T0), 2 months (T1), 6 months (T2), and 12 months (T3). The primary outcome was attrition, operationally defined as failure to attend scheduled follow-up assessments. Secondary outcomes included walking speed during the 1 km Treadmill Walk Test, lower-limb functional performance, handgrip strength, balance, pain, and self-reported physical activity. Longitudinal changes were analyzed using linear mixed-effects models adjusted for age and sex. Results: Seventy-eight patients were enrolled (48 men, 29 women, one participant with missing sex data; mean age 64 ± 11 years). Follow-up attendance progressively declined from 81% at 2 months to 27% at 6 months and 18% at 12 months. Among participants with available follow-up data, significant improvements were observed in walking speed, lower-limb performance, balance, and motor pain during the early supervised phase of the program, with the most robust changes evident at the 2-month assessment (all p < 0.001). Although favorable values were also observed at later assessments, the marked loss to follow-up substantially limited interpretation of the 6- and 12-month estimates. Handgrip strength showed no significant longitudinal changes, while self-reported physical activity increased at 6 months but remained highly variable across participants. Conclusions: In this real-world APA follow-up pathway after cardiac rehabilitation, substantial attrition was observed, with fewer than one-fifth of participants attending follow-up assessments at 12 months. The most robust secondary finding was the short-term improvement in functional outcomes during the initial supervised phase. Long-term functional estimates should be considered exploratory because of the high attrition rate and potential survivor/selection bias. These findings highlight long-term retention as a key outcome for future community-based exercise programs and support the development of strategies aimed at improving sustained participation after cardiac rehabilitation. Full article

Background: Upper limb spasticity after stroke occurs due to neural hyperexcitability and secondary alterations in muscle properties. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive technique used to reduce spasticity. This study aimed to compare the effects of rPMS versus sham stimulation on upper limb spasticity and muscle stiffness using shear wave elastography (SWE). Methods: This prospective, double-blind randomized controlled trial included 32 stroke patients with upper limb spasticity (Modified Ashworth Scale (MAS) ≥ 2 in the elbow flexors), who received rPMS or sham stimulation in addition to conventional rehabilitation (n = 16 per group). Spasticity was assessed using MAS, and muscle stiffness using SWE. Results: The rPMS group showed a transient short-term reduction in upper limb spasticity compared with the control group at the end of treatment (p = 0.045); however, this effect was not sustained at the 2-week follow-up. No significant between-group differences were observed in muscle stiffness, upper limb motor function, or activities of daily living. Conclusions: This study provides preliminary evidence that rPMS may produce a transient, short-term reduction in upper limb spasticity after stroke. However, this effect was not sustained at follow-up or accompanied by significant improvements in muscle stiffness or functional outcomes. Full article

Background: Pediatric traumatic brain injury (TBI) is the leading cause of acquired disability in childhood and is associated with post-concussive symptoms (PCS) that may negatively impact recovery and long-term outcomes. Despite the importance of follow-up care after TBI, families from marginalized racial and ethnic backgrounds are less likely to receive follow-up care and rehabilitation. This study examined the association between PCS and follow-up care, as well as the types of follow-up care received, among young, racially and ethnically diverse children with TBI. Methods: Data were collected from 36 families of children ages 2–5 years with a confirmed TBI in the past 3–6 months who completed screening procedures as part of a larger study. Parents reported demographic and injury characteristics, PCS, and whether they sought follow-up care after their child’s emergency department visit. Regression analyses examined associations between PCS and follow-up care. Results: Participants were 55.6% female, with a mean age of 3.60 years (SD = 1.22). Most children sustained mild injuries due to falls (77.8%). Headaches, drowsiness, balance difficulties, feeling slowed down, and behavior changes were individually associated with seeking follow-up care. In a regression model including all significant main effects, balance difficulties (B = 0.46) and drowsiness (B = 0.42) remained significant [F(5,30) = 6.11, p < 0.001]. Only 44.4% of parents sought follow-up care, and 33.3% of them followed up with a TBI specialist. Conclusions: Findings highlight low rates of post-injury follow-up and specialty care among young children with TBI, underscoring the need for improved caregiver education and first-line provider training. Full article

Health 5.0 increasingly involves medical robots and haptic systems that sustain physical interaction with patients and clinicians. This proof-of-concept study examined fatigue-related surface electromyography (sEMG) spectral changes during a 400 s repetitive haptic-writing task in 20 adults. Five upper-limb muscles were monitored at 1000 Hz, and mean frequency (MNF) and median frequency (MDF) trajectories were summarized by fitted start-to-end spectral decline and combined into arm-level indices. MDF had the higher association with the archived participant-level fatigue-analysis score ($r=0.954$ versus $r=0.783$; $\Delta r=0.171$; Holm-adjusted $p=0.0035$). Small-sample influence analysis supported the stability of this within-sample ordering: after omitting each participant in turn, $\Delta r$ remained positive in 20/20 analyses (range 0.125–0.218), although the exact paired label-swap sensitivity test remained inconclusive ($p=0.082$). Exploratory leave-one-participant-out calibration produced lower held-out error for MDF (MAE 4.38, RMSE 5.87 percentage points) than for MNF (MAE 9.24, RMSE 12.02 percentage points). The raw seven-category Q2 responses and the archived 0–100 analysis score are reported as separate data products because they are not numerically equivalent under direct linear rescaling. Accordingly, the results identify MDF as the more promising spectral summary for prospective validation in this task, rather than establishing universal superiority or numerical replacement of subjective fatigue. The experiment was a laboratory haptic-writing study and did not test a surgical robot, rehabilitation robot, patient population, or clinical controller; Health 5.0 is therefore presented as a translational motivation rather than a demonstrated application. Full article

The growing need to ensure the safety, resilience, and sustainability of existing building structures has accelerated the adoption of artificial intelligence (AI) for structural condition assessment and rehabilitation. This critical narrative review synthesizes 82 retained sources, including 33 application-oriented sources, through a transparent, structured literature search and study-selection process; it is not a formal systematic review or meta-analysis. To organize this fragmented evidence base, the review introduces the Data-to-Decision (D2D) Continuum, a unifying conceptual framework that traces eight engineering stages from data acquisition through damage detection, localization, quantification, condition and performance assessment, prognosis, reliability and risk assessment, to rehabilitation decision support. Classical machine learning, deep and temporal models, physics-guided and probabilistic approaches, and emerging foundation models are examined according to the engineering output required at each stage. The strongest evidence concerns bounded defect detection and localization, whereas uncertainty-aware prognosis, risk-informed rehabilitation selection, multi-site validation, and governed deployment remain markedly less mature. By integrating existing monitoring, digital-twin, life-cycle risk, and maintenance-decision concepts into an interface-centered evidence chain, the D2D framework clarifies what must be validated before an AI output can responsibly influence an intervention. Full article

Introduction: Cardiac rehabilitation (CR) is an evidence-based secondary prevention strategy that improves functional capacity, quality of life, and cardiovascular outcomes. However, adherence to CR programs remains suboptimal, limiting their effectiveness. Methods: A retrospective multicenter cohort study was conducted among patients enrolled in outpatient CR programs at two specialized cardiovascular centers. Adherence was defined as attendance at ≥70% of the prescribed sessions (≥25 of 36 sessions). Bivariate analyses were performed to compare adherent and non-adherent participants. Variables with p < 0.20 were included in a multivariable logistic regression model to identify factors independently associated with adherence. Results: A total of 210 participants were included, of whom 77.6% (163/210) were classified as adherent. The median age was 68 years (IQR 60.3–75.0), and 64.3% were men. Most participants (70.5%) completed more than 30 rehabilitation sessions. Adherence rates were highest among patients undergoing surgical myocardial revascularization (80.6%) and valve surgery (76.0%). In multivariable analysis, program duration was the only factor significantly associated with adherence (OR = 4.59; 95% CI: 2.46–8.59; p < 0.001). History of dyslipidemia showed a non-significant trend toward higher adherence (OR = 3.29; 95% CI: 0.91–11.90; p = 0.069). Educational level, left ventricular ejection fraction, and health insurance affiliation were not independently associated with adherence. Conclusions: Adherence to CR was high in this cohort. Longer participation in the program was the only independent predictor of adherence, highlighting the importance of strategies that promote sustained engagement throughout the rehabilitation process. Full article