Search Results (149)

Background and Objectives: Horse riding simulators (HRS) provide rhythmic, repetitive, and multidirectional movements analogous to horseback riding, which may facilitate postural control, balance, and functional abilities in children with cerebral palsy (CP). This study aimed to investigate the effects of the HRS application on the muscle tone of the lower extremity, gross motor function, trunk postural control, balance, gait functions, and functional independence in children with CP. Materials and Methods: A quasi-experimental study included 30 children with cerebral palsy (17 hemiparetic, 13 diparetic; mean age, 9.3 ± 3.2 years). All participants received Neurodevelopmental Therapy (NDT) for eight weeks, followed by eight weeks of HRS plus NDT, in a sequential design. Outcomes included the Modified Ashworth Scale (MAS), Myoton^®PRO, Gross Motor Function Measures (GMFM)-88, Pedalo^® Sensamove Balance Test (Pedalo^® SBT), Pediatric Balance Scale (PBS), Trunk Impairment Scale (TIS), gait analysis parameters, and Functional Independence Measure (WeeFIM). Assessments were made at baseline, the 8th, and the 16th week. Results: At week 16, after incorporating HRS, all MAS parameters demonstrated greater improvements compared to those achieved during the first eight weeks of NDT alone (ES: 0.728–0.931, p < 0.05). Myoton^®PRO measurements showed a significant reduction in gastrocnemius stiffness (ES = 0.672, p < 0.05) in hemiparetic children and decreases in hip adductor (ES: 0.649, p < 0.05) and gastrocnemius-soleus (ES: 0.766–0.865, p < 0.05) stiffness from week 8 to 16 in diparetic children following HRS intervention. Total scores on the GMFM-88, WeeFIM, TIS, and PBS improved significantly, with large effect sizes observed both from baseline to week 16 and from week 8 to 16 (ES: 0.771–0.886, p < 0.05). Additionally, Pedalo^® SBT scores increased following HRS intervention from baseline to week 16 (ES = 0.599–0.602, p < 0.05). Conclusions: HRS integrated with conventional NDT may improve muscle tone, motor function, balance, gait, and functional independence in children with cerebral palsy, representing a valuable adjunct to standard rehabilitation. These findings provide the first evidence that simulator-assisted interventions may benefit daily activities in children with cerebral palsy. Full article

Conventional vibrational systems associated with proprioception are mostly equipped with a single standard frequency and amplitude. This feature often fails to show kinesthetic illusion on different subjects, as different individuals respond to different frequencies and amplitudes. Additionally, different muscle groups may also require the flexibility of frequencies and amplitudes. We developed a custom vibrational system that is equipped with flexible frequency and amplitude, adapted to a custom graphical user interface (GUI). Based on the user’s criteria, the proposed vibrational system enables a wide range of frequencies and amplitudes that can be swept under a single platform. In addition, the system uses small linear actuators that are wearable and attach to the subject without the need for restrictive straps. The vibrational system was used to model trunk proprioceptive impairment associated with low back pain. Low back pain is the leading cause of disability worldwide. It is mostly associated with impaired postural control of the trunk. For postural control, the somatosensory system transmits proprioceptive (position sense) information from the sensors in the skin, joints, muscles, and tendons. Proprioceptive studies on trunk muscles have been conducted where the application of vibration at a set amplitude and frequency across all participants resulted in altered proprioception and a kinesthetic illusion, but not in all individuals. To assess the feasibility of the system, we manipulated the trunk proprioception of five subjects, demonstrating that the vibrational system is capable of modulating trunk proprioception and the value of customizing parameters of the system to obtain maximal deficits from individual subjects. Full article

Existing clinical assessments of Parkinson’s disease (PD) primarily focus on stratifying symptom severity or progression rate, which limits their ability to capture changes in functional mobility—an important factor in evaluating rehabilitation outcomes. To address this gap, we developed a novel methodology, the Functional Mobility Assessment for Parkinson’s (FMA-P), which integrates motion capture and pressure-sensitive gait analysis to explore key aspects of functional mobility. Study 1. To develop the FMA-P, we conducted a pilot study involving 12 individuals with PD and 12 age-matched healthy controls, who each completed the FMA-P sequence three times. The sequence included the following tasks: rising from a chair, walking through a doorway, turning, bending to pick up and place an object, and returning to a seated position. Results from Study 1 demonstrated that the FMA-P is a sensitive tool for identifying functional impairments in PD. In particular, significant differences between people with Parkinson’s (PwP) and controls were observed during chair rise (higher peak trunk inclination, p = 0.006; lower mean trunk jerk, p = 0.003) and turning task (longer task duration, p = 0.026 and lower mean heel strike angle, p = 0.007), providing critical insights into postural stability. Study 2. To assess changes in functional mobility over time, we conducted a 12-week repeated-measures intervention study with 12 participants with PD. Results from Study 2 indicated notable improvements in turning stability and balance. Participants demonstrated reduced turning time (p = 0.006) and increased yaw rotation in the head (p = 0.001), trunk (p = 0.002), and pelvis (p = 0.012). In contrast, no significant changes were observed in standard clinical measures (i.e., Timed Up and Go and task duration). The FMA-P offers fine-grained insights into movement quality, making it a valuable tool for early diagnosis, monitoring intervention efficacy, and guiding rehabilitation strategies in individuals with PD. Full article

Background/Objectives: Standing training is essential for individuals with spinal cord injury (SCI), yet maintaining regular practice after acute rehabilitation remains challenging. To address the need for more practical and accessible standing equipment, we developed a novel spring-assisted standing training device designed to overcome barriers to regular standing practice. This study aimed to assess the safety and feasibility of our newly developed device in individuals with SCI. Methods: Six participants with chronic SCI (neurological level of injury T4-L3, American Spinal Injury Association Impairment Scale A-C; 2 females, mean age 41.7 ± 13.4 years) underwent a single session using our chair-based device incorporating passive gas spring mechanisms. We designed this device to enable independent sit-to-stand transitions without electrical power or complex controls. Primary outcomes included safety (adverse events) and feasibility (number of repetitions, Modified Borg Scale). Changes in Modified Ashworth Scale (MAS) scores were assessed as exploratory measures. Results: All participants successfully completed training without adverse events. Repetitions ranged from 5 to 60 (median 37), with Modified Borg Scale ratings of 0–4. Notably, the participant with T4 complete injury performed the training without requiring trunk orthosis, demonstrating the device’s inherent stability. MAS sum scores showed a reduction from median 8.75 to 4.25, though this did not reach statistical significance (p = 0.13). Conclusions: Our newly developed spring-assisted standing training device proved safe and feasible for individuals with SCI, including those with complete thoracic injuries. The device successfully enabled independent sit-to-stand transitions with low perceived exertion, potentially addressing key barriers to regular standing practice and offering a practical rehabilitation solution. Full article

Background/Objectives: This study investigated postural stability in male inmates of a semi-open correctional facility, with a specific focus on comparing individuals with and without a history of substance dependence. The aim was to identify how addiction-related neurophysiological changes impact postural control under varying sensory and biomechanical demands. Methods: A total of 47 adult male prisoners (mean age: 24.3 years) participated in this study. Nineteen inmates had a documented history of alcohol or drug dependence (addicted group), while twenty-eight had no such history (non-addicted group). All participants were physically able and free of neurological disorders. Postural control was assessed using a stabilometric platform and wireless IMU across six 30 s standing tasks of varying difficulty (bipedal/unipedal stance and eyes open/closed). Linear (center of pressure path and ellipse area) and nonlinear (sample entropy, fractal dimension, and the Lyapunov exponent) sway metrics were analyzed, along with trunk kinematics from IMU data. This study received institutional ethical approval; trial registration was not required. Results: The addicted group showed greater instability, especially in the eyes-closed and single-leg tasks, with increased sway and irregularity in the anterior–posterior direction. IMU data indicated altered trunk motion, suggesting impaired neuromuscular control. In contrast, non-addicted individuals demonstrated more efficient, targeted postural strategies, while addicted participants relied on broader, less selective movements, possibly reflecting compensatory or neuroadaptive changes from substance use. Conclusions: Substance dependence is associated with compromised postural stability in incarcerated men. Balance assessments may be valuable for detecting functional impairments and guiding rehabilitation within prison healthcare systems. Full article

Background and Objectives: Stroke and hemiplegia disrupts symmetrical activation of skeletal and abdominal muscles, impairing trunk control and functional movement. Although asymmetry is also present in healthy adults, its magnitude and patterns differ with neurological impairment. Understanding trunk muscle symmetry across functional tasks in healthy individuals and patients with stroke is essential for targeted rehabilitation strategies. Materials and Methods: A comparative cross-sectional study was conducted including healthy adults and patients with stroke. Muscle activation symmetry of the rectus abdominis, external oblique, internal oblique, and multifidus was analyzed across four trunk movements: flexion, extension, and lateral flexion to the dominant or non-dominant side. A two-way repeated measures ANOVA examined main and interaction effects of condition, muscle, and group. Results: Trunk muscle symmetry was significantly influenced by the movement conditions, and patterns of change differed between groups. While no consistent differences were observed across muscles, specific interactions revealed condition-dependent variations, particularly between abdominal and deep spinal muscles. Lateral flexion elicited the greatest asymmetry, with distinct response patterns in healthy individuals compared with patients with stroke. Conclusions: This study highlights the importance of addressing movement-specific demands in trunk rehabilitation. Rather than focusing on isolated muscles, interventions should consider the dynamic and condition-dependent nature of symmetry to optimize functional recovery in patients with stroke. Full article

(1) Background: Upper limb (UL) function plays a central role in daily life, enabling essential tasks such as reaching, grasping, and eating. While numerous tools exist to evaluate UL kinematics, their application in pediatric populations is often limited by a lack of age-specific validation. This study presents a novel motion analysis protocol featuring a customized marker set, aimed at assessing UL movements in the three anatomical planes across different age groups, with a focus on pediatric applicability. (2) Materials and Methods: A SmartDX motion capture system was used, with 30 markers positioned on the upper body, referencing the trunk as the root of the kinematic chain. Ten healthy participants (mean age: 18.69 ± 12.45 years; range: 8.0–41.4) without UL impairments were recruited. The broad age range was intentionally selected to assess the protocol’s transversal applicability. (3) Results: Results showed excellent intra-operator reliability for shoulder and wrist kinematics (ICC > 0.906) and good reliability for elbow movements (ICC > 0.755). Inter-operator reliability was good to excellent (shoulder ICC > 0.958; elbow ICC > 0.762; wrist ICC > 0.826) Usability, measured via the System Usability Scale, was rated as good (83.25). (4) Conclusions: The proposed protocol demonstrated strong reliability and practical usability, supporting its adoption in clinical and research settings. Its design allows for adaptability across motion capture platforms, promoting wider implementation in pediatric UL functional assessment. Full article

Background/Objectives: Normal-weight obesity describes those with a normal body mass index (BMI) and high body fat percent. Older adults with normal-weight obesity (NWO-O) are at increased risk for cardiovascular disease (CVD), but underlying mechanisms remain unclear. This pilot study examined whether NWO-O had an unfavorable cardiometabolic response to acute high-fat meal intake compared to normal BMI, low body fat percent individuals that were both older (NWL-O) and younger (NWL-Y). Methods: Participants (N = 29) with a normal BMI were grouped as follows: NWL-Y (18–35 years, low body fat percent; n = 12), NWL-O (≥60 years, low body fat percent; n = 9), and NWO-O (≥60 years, high body fat percent; n = 8). All participants completed an abbreviated fat tolerance test (75 g fat). Fasting and 4 h blood samples were collected to measure lipids (triglycerides and high-density lipoprotein cholesterol [HDL-C]), biomarkers of intestinal permeability (lipopolysaccharide binding protein [LBP] and soluble cluster of differentiation [sCD14]), and the inflammatory marker interleukin (IL)-6. Results: NWO-O had higher percent, absolute, and trunk fat compared to NWL-Y and NWL-O (p’s ≤ 0.01). Conversely, percent lean mass was lower in NWO-O versus both NWL groups (p’s ≤ 0.01). NWO-O had higher fasting triglycerides than NWL-Y (p < 0.05), but all groups were in the clinically normal range on average (≤107 mg/dL). However, NWO-O had higher 4 h triglycerides (239.4 ± 101.0 mg/dL) compared to NWL-Y and NWL-O (p < 0.01), consistent with an adverse response. The absolute change in triglycerides was higher in NWO-O relative to NWL-Y (p < 0.01), but not compared to NWL-O (p = 0.06). Fasting IL-6 was higher in NWO-O relative to NWL-Y (p < 0.05). Fasting and 4 h sCD14 were similarly higher in NWL-O and NWO-O versus NWL-Y (p’s < 0.01). Conclusions: NWO-O had an exaggerated postprandial triglyceride response compared to younger and similar-aged NWL individuals, which could reflect hepatic very low-density lipoprotein overproduction or impaired triglyceride clearance. Future work should continue to investigate the role of postprandial dyslipidemia in NWO-O’s reported CVD risk. Full article

In Paralympic sports, to guarantee fair competition, it is necessary to identify those peculiar abilities that characterize the discipline and the motor limitations that may or may not most affect the athlete’s performance in a specific sports task, assigning an appropriate classification to the level of impairment. This study proposes a minimally invasive assessment system based on a single inertial sensor to support the investigation of the peculiarities of water polo with disabilities by analyzing players’ trunk inclinations during a simulated match and angular speeds in swimming tests. By comparing a small group of athletes of various classes and those without disabilities, we intended to evaluate whether athletes with lower limb disabilities may be disadvantaged compared to athletes with upper limb disabilities. The results suggest no difference in the mean percentage of time in vertical and horizontal positions when comparing players with and without disabilities, although specific impairments led to distinct behaviors (Δ = 0.9%, p = 0.841). Interesting insights emerged in swimming and turning situations in the water. Strong correlations (r > 0.7, p < 0.05) were found between swimming performance metrics and classification points. Furthermore, players with spasticity exhibited lower smoothness in turning movements, suggesting less fluid execution than those with other impairments affecting the same limbs. These findings highlight the IMU system’s potential to provide objective, quantitative data for refining WPA classification protocols. Full article

Upper limb (UL) impairment after stroke negatively influences stroke survivors’ quality of life (QOL). This study aims to evaluate, through clinical assessment and accelerometric measures, the efficacy of anodal Transcranial Direct Current Stimulation (a-tDCS) combined with the Graded Repetitive Arm Supplementary Program (GRASP) in post-acute stroke UL rehabilitation. Subjects were enrolled if they were aged ≥18 years and had a first stroke diagnosis, UL motor impairment and adequate trunk control. The subjects underwent combined administration of intensive a-tDCS and GRASP (15 sessions/30 min each). Before and after treatment, a subgroup of subjects was evaluated through wearable accelerometers. A total of 30 subjects were included in this study (mean age 68.34 ± 14.08 years; 19 males/11 females). Medical Research Council (MRC), Hand Grip Strength (HGS), Nine-Hole Peg Test (9HPT), Box and Block Test (BBT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores significantly improved after treatment. The accelerometric-derived measurements all revealed a significant increase in the affected UL activity as indicated by the Vector Magnitude value. No side effects were reported. In conclusion, an intensive a-tDCS and GRASP application proved to be effective and safe in UL rehabilitation after stroke. The association of accelerometric monitoring might be of paramount importance for the evaluation of UL recovery. Full article

Background/Objectives: Left/right discrimination (LRD) training is increasingly being used in the treatment of chronic low back pain (CLBP). However, it is unclear whether trunk LRD-performance is impaired in CLBP patients and whether clinical parameters are related to LRD-performance. Therefore, this cross-sectional study aimed to examine (1) whether LRD-performance differs between CLBP patients and pain-free individuals; (2) whether these differences depend on the low back pain (LBP) history in pain-free individuals; (3) if clinical factors are related to LRD-performance; (4) whether LRD-task difficulty influences these results. Methods: Participants included 150 pain-free persons (107 with no LBP-history; 43 with past LBP) and 150 patients with CLBP. All participants performed the LRD-task in a simple and complex condition. Outcomes were reaction time and accuracy. Results: CLBP patients were significantly slower (Cohen’s d = 0.47 to 0.50, p < 0.001) and less accurate (Cohen’s d = 0.30 to 0.55, p < 0.001) than pain-free individuals without LBP-history, but not compared to those with past LBP (Cohen’s d reaction time = 0.07 to 0.15, p = 0.55; Cohen’s d accuracy = 0.03 to 0.28, p-value = 0.28). All participant groups were slower and less accurate in the complex condition, but between-groups differences were independent of task difficulty. Linear mixed models showed that older age and lower education were independently associated with less accuracy. When controlling for demographics, pain intensity, disability, fear of movement, pain-related worry and pain duration were not related to LRD-performance in patients with CLBP. Conclusions: Patients with CLBP showed impaired trunk LRD-performance compared to pain-free persons without LBP history, but not compared to those with past LBP. When controlling for demographics, clinical parameters were not related to LRD-performance in patients with CLBP. Our findings indicate that LRD-performance may remain impaired after recovering from LBP. Full article

Background and Objectives: Cerebral palsy (CP) is a non-progressive neurological disorder characterized by motor impairments such as spasticity and poor postural control. Among these, trunk control plays a critical role in maintaining balance and enabling functional mobility. Since spasticity is known to interfere with motor coordination and posture, evaluating its response to trunk-focused interventions may offer additional clinical insights. This systematic review and meta-analysis evaluated the effectiveness of trunk-focused interventions on trunk control, gross motor function, balance, and spasticity. Materials and Methods: A systematic search was conducted in PubMed, Embase, Web of Science, MEDLINE, and CINAHL for randomized controlled trials (RCTs) published in the last 10 years up to 11 April 2023. Studies targeting trunk-specific interventions in children with CP were included. Meta-analyses were performed using RevMan 5.3, calculating standardized mean differences (SMDs) with 95% confidence intervals (CIs). Study quality was assessed using the PEDro scale. Results: Fifteen RCTs involving 454 children were included. Trunk control improved significantly (SMD = 3.67; 95% CI: 3.10–4.25; I² = 0%). Gross motor function showed a small but significant improvement (SMD = 0.49; 95% CI: 0.06–0.92; I² = 44%). Balance exhibited a large, though not statistically significant, effect (SMD = 0.90; 95% CI: −0.00 to 1.79; I² = 81%). Subgroup analysis indicated that interventions performed more than four times per week produced a significant effect on balance (SMD = 0.54; 95% CI: 0.08–1.01). Only one study assessed spasticity and found no group difference. Conclusions: Trunk-based interventions significantly improve trunk control and gross motor function in children with CP. While improvements in balance were inconsistent, higher-frequency interventions yielded more favorable results. Further research is warranted to clarify effects on spasticity and optimize intervention protocols for clinical application. Full article

Background: The present study aimed to determine whether the protocolized use of pneumatic splints within neurodevelopmental therapeutic approaches produces a positive effect on sensorimotor impairments of the hemiplegic upper extremity in patients. Methods: A randomized clinical single-blind trial was conducted. Stroke patients were recruited and randomized into an experimental group, which completed a treatment protocol of splinting plus physiotherapy for 45 min per session, two sessions per week for four weeks; or a control group, which received the same type of conventional physiotherapy treatment for the same period of time. The patients were evaluated by Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) and the Trunk Control Scale. Secondary variables were Mini-BEStest, the modified Ashworth scale for ankle flexors, and computerized measurements of upper limb functional parameters performed by Armeo Spring^® robotic systems and Amadeo^®. All variables were measured pre- and post-treatment. Results: Twenty stroke patients with subacute and chronic stroke completed the protocol. Mann–Whitney U tests showed statistically significant differences between groups for the FM sensation variable (Z = −2.19; p = 0.03). The rest of the variables studied in the comparison between the two study groups did not present statistically significant differences (p > 0.05). Conclusions: The use of air splints in combination with physiotherapy treatment produced improvements in exteroceptive and proprioceptive sensitivity in post-stroke adult patients in the subacute and chronic phases. Full article

Background: Patients with chronic kidney disease (CKD) have a substantially higher risk of developing cognitive impairment (CI) than the general population. Patients with CKD undergoing haemodialysis (HD) treatment also have an elevated risk of developing cerebrovascular and cardiovascular diseases. This study aims to investigate the relationship between the cognitive performance of haemodialysis patients and cerebral and carotid haemodynamic indices. Methods: This study was a non-interventional observational study; the sample consisted of 32 patients (age 65 ± 12 years) undergoing chronic HD treatment. The patients underwent neuropsychological and haemodynamic instrumental investigations, including Supra-Aortic Trunk Echodoppler (SAT) and Transcranial Doppler (TCD). Results: Patients were 17% deficient at Montreal Cognitive Assessment (MoCA), 45% deficient at Frontal Assessment Battery (FAB), 55% deficient at Trail-Making Test-A (TMT-A) and 65% deficient at TMT-B. The TCD investigation detected a decrease in flow (MFV) and an increase in Breath Hold Index (BHI) predominantly in the right cerebral arterial district. The SAT investigation revealed an altered IMT, plaques and the presence of severe carotid stenosis. A strong association between cerebral and carotid indices and cognitive scores was also observed. Correlation analyses reported statistically significant correlations between TMT-A and TMT-B and cerebral flow indices. Conclusions: Among haemodialysis patients, there is a high percentage of cognitive impairment associated and correlated with alterations in cerebral and carotid haemodynamics. Cerebral haemodynamics are a factor to be taken into consideration as a possible pathological mechanism underlying cognitive impairment in haemodialysis. Full article

This study investigated the effects of virtual reality (VR)-based training combined with preliminary trunk stabilization education on postural control and balance in stroke patients. A single-blind randomized controlled trial enrolled 30 participants, randomly divided into a trunk stabilization group (n = 15) and a control group (n = 15). The trunk stabilization group engaged in 10 min of trunk stabilization education followed by 20 min of VR-based training, three times weekly for three weeks. The control group participated only in VR-based training. Outcomes were assessed using the Korean Trunk Impairment Scale (K-TIS), Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), limit of stability (LOS), and center of pressure (COP) measurements. Both groups significantly improved in all measured outcomes post-intervention (p < 0.05). Notably, the trunk stabilization group exhibited significantly superior improvements in the K-TIS, PASS, BBS, LOS, and COP path length compared to the control group (p < 0.05). These results highlight the enhanced effectiveness of integrating trunk stabilization education with VR-based training, suggesting that it not only yields statistically significant improvements but also provides clinically meaningful benefits for functional postural control and balance recovery in stroke rehabilitation. Full article