Purpose To examine the feasibility of implementing voluntary hypoventilation at low lung volume (VHL) training during the 2024 Paralympic Games’ preparation of an elite SH6 (short-stature) para-badminton athlete and characterize associated arterial oxygen saturation (SpO 2 ) and heart rate (HR) responses. Methods During a 5-week intervention, 9 VHL-based training sessions were added, consisting of either repeated running-shuttle sprints or badminton-specific exercises performed with maximal end-expiratory breath holding (EEBH). SpO 2 and HR were monitored, rating of perceived exertion (RPE) was recorded, and hypoxic dose was quantified. Within-participant variability and response patterns across training conditions were characterized using visual inspection of the complete time-series data and summary descriptive metrics. Results In both training types, a marked decrease in SpO 2 occurred from the first to the last repetition of each set. Mean nadir SpO 2 was higher during repeated running-shuttle sprint sessions vs . badminton-specific exercise sessions (81.8 ± 2% vs . 76.3 ± 3%) due to a shorter EEBH duration (7.2 ± 0.7 s vs . 9.8 ± 0.9 s). Mean session SpO 2 , HR, and RPE did not differ between training types, but RPE decreased significantly across sessions, indicating improved tolerance to the VHL-induced hypoxic stimulus. Conclusions This case report demonstrates that VHL-based training with maximal EEBH is feasible, well tolerated, and capable of eliciting robust hypoxemic stimuli in an elite SH6 para-badminton athlete.
This study presents a case-based application of the Clinical Limits of Use Tool (CLOUT), specifically its clinical device testing component, to evaluate an off-road mobility device, the Invacare Top End Force CC handcycle. This component of CLOUT was operationalized into measurable variables and standardized test procedures through collaboration among therapists, engineers, and advisory expert users. The evaluation included structured interviews and controlled off-road testing assessing assembly, seating and positioning, transfers, obstacle negotiation, slope performance, terrain interaction, and safety. Results The results demonstrated that the handcycle performed effectively on moderate terrain, including dirt, gravel, and grass, and successfully navigated slopes up to approximately 29° and smaller obstacles. Performance limitations were identified in larger obstacle negotiation due to low ground clearance, as well as in transfers due to low seat height and limited support. Device performance was influenced by user strength and environmental conditions. This case study demonstrates how CLOUT can be applied as a structured and reproducible framework to evaluate mobility device performance in non-clinical environments. The findings highlight the importance of aligning user ability, device characteristics, and environmental demands to support safe and effective mobility. This approach may inform clinical decision-making, user training, and future development of standardized evaluation methods for off-road mobility technologies and beyond.
Users with Severe Speech Motor Impairment (SSMI) face difficulties interacting with digital systems due to limited speech and motor control. To address this, we present an eye gaze-based system that enables users with SSMI to generate short music using eye gaze control. The system combines a webcam-based eye-tracking with a music generation system that transforms user-selected images into music. A user study was conducted with 15 participants with SSMI across 74 sessions. The results show that the participants were able to interact with the system using gaze-based control, with an average engagement time of 61.38 seconds per session. Eye-tracking calibration accuracy varied across participants, reflecting individual differences in gaze control. These findings demonstrate the feasibility of gaze-based generative music interaction as an accessible assistive system for users with SSMI.
Purpose:Following upper limb amputation (ULA), resuming everyday activities is a primary goal for patients. In many cases, a prosthesis can assist patients by increasing physical function and overall well-being. This study aimed to investigate the relationship between prosthesis receipt and two domains - Ability to Participate in Social Roles and Activities (APSRA) and Pain Interference (PI). Materials and methods:A retrospective cross-sectional review of outcomes collected across private prosthetic clinics in the United States was performed. Individuals were included if they had an outcome collected before prosthesis receipt and within twelve months after prosthesis receipt. There were no exclusions based on level of amputation, etiology, or device type. Results:Univariate model results demonstrated a significant improvement in average APSRA (Baseline: 41.5±8.2 and Follow-up: 46.7±9.1, p<0.001). Additionally, PI significantly improved (Baseline: 58.5±8.5 and Follow-up: 54.9±9.3, p<0.001). These significant differences persisted when accounting for confounders such as age, hours worn, sex, amputation level, time since amputation, and time from first prosthesis delivery to follow-up. Conclusions:Prosthesis receipt improved individuals' ability to increase their activity and participation. This coincided with improvements in pain interference. Results from this study can aid clinical decision-making for clinicians and patients as they explore interventions following ULA.
Lower-limb impairment caused by neurological injury, musculoskeletal disorders, or reduced mobility often requires repetitive rehabilitation exercises, but continuous therapist-assisted therapy may be difficult to access in low-resource settings. In this study, we developed and preliminarily evaluated a low-cost, lightweight, portable hip-knee exoskeleton prototype capable of generating controlled hip and knee joint motion for rehabilitation-oriented range-of-motion training. The prototype was constructed mainly of 3D-printed polylactic acid parts and powered by a pair of high-torque servo motors in the hip and knee joints. A Bluetooth-connected Android app was programmed to offer two modes: rehabilitation mode for independent joint control and a gait-inspired sinusoidal mode that generates coordinated hip and knee joint trajectories. The cost of the materials used to construct the prototype is estimated to be USD 155 with a weight of about 2.1 kg. Joint motion performance was assessed through time-angle measurements at three predefined speed settings. The hip joint (approximately 60° movement) was achieved in 2.2, 1.6, and 1.1 s and the knee joint (approximately 140° movement) was achieved in 3.0, 2.0, and 0.6 s for slow, medium and fast modes, respectively. The trial-to-trial variation in commanded servo position remained below ±1° under the tested conditions. The results demonstrate the feasibility of generating repeatable commanded hip and knee joint motion under controlled laboratory conditions. However, further investigations involving quantitative load-bearing evaluation, safety assessment, user studies, and clinical trials are required before the system can be considered for practical rehabilitation applications.
Objective Return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) is commonly guided by time-based milestones and isolated functional pass/fail criteria. However, many athletes return with persistent biomechanical deficits that can increase the risk of reinjury and contribute to long-term joint degeneration. This study aims to synthesize time-specific changes in gait and running biomechanics at 6, 12, and 18 months after ACLR, and to propose an integrated, multidimensional RTS decision-making model that links rehabilitation fidelity with serial biomechanical assessment. We critically discuss whether the injury-to-surgery time (early vs delayed) may influence locomotor recovery trajectories. Materials & Methods This is an editorial review. Evidence from the ACLR rehabilitation and biomechanics literature is reviewed narratively to summarize task-dependent recovery patterns in gait and running and to highlight the limitations of conventional RTS batteries. Based on this synthesis, two practical tools are presented: (i) a milestone-based table of gait and running biomechanical deficits at 6, 12, and 18 months post-surgery, and (ii) a multidimensional RTS decision-making framework integrating three domains of clinical, functional/neuromuscular, and biomechanical readiness. Results Biomechanical recovery after ACLR appears nonlinear and task-specific. Gait parameters may be normal up to 12 months, whereas running mechanics, frontal-plane control, limb-loading symmetry, and neuromuscular coordination can remain impaired beyond this time. Athletes may therefore pass hop or strength symmetry thresholds while still demonstrating compensatory landing strategies, reduced knee extensor contribution, trunk/pelvic compensations, or persistent underloading of the surgical limb features associated with increased reinjury risk. Serial gait and running analyses at 6, 12, and 18 months post-surgery can help identify early protective strategies, detect deceptive recovery at mid-term follow-up, and reveal residual high-demand deficits at later stages (e.g. under speed, fatigue, and cutting). The literature on early versus delayed ACLR remains mixed, underscoring the need for more granular, time-specific evaluation of who benefits from differences in post-surgical time. Conclusion Successful RTS after ACLR should be viewed as a continuum rather than a single clearance event. Time since surgery is necessary but insufficient. For RTS decision-making, it should integrate clinical status, psychological readiness, strength and sensorimotor recovery, movement quality, and sport-specific performance, with gait and running biomechanics serving as a clinically meaningful bridge between progression in anterior cruciate ligament rehabilitation and safer RTS decision-making.
Objective The cognitive orientation to daily occupational performance (CO-OP) approach emphasizes the importance of learning transfer to new tasks. However, few studies have examined its effect on learning transfer in children with specific learning disorders (SLDs). This study aimed to examine the effect of the CO-OP approach on acquisition performance in trained tasks compared to untrained tasks in children with SLDs. Materials & Methods This is a single-group clinical trial with a pre-test/post-test/follow-up design conducted on 10 children aged 7-10 years with SLDs and motor based occupational performance difficulties. Using the Canadian occupational performance measure (COPM), each child selected five goals, three were designated as trained tasks, and two as untrained tasks. The performance quality rating scale (PQRS) and the Bruninks-oseretsky test of motor proficiency-second edition (BOT-2) were other outcome measures. Results The Wilcoxon test results revealed statistically significant improvements in trained tasks after intervention, as rated by both parents and children (regarding performance and satisfaction with performance based on the COPM score) and therapists (the PQRS score). However, no significant improvement was observed in untrained tasks in COPM (performance and satisfaction) and PQRS scores after intervention (P>0.05). Additionally, the BOT-2 score demonstrated significant improvements post-intervention compared to pre-intervention score (P=0.005). Conclusion The CO-OP intervention can improve the acquisition performance of children with SLDs in trained tasks, but has no significant effect on their performance in untrained tasks. To confirm these results and identify the variables that may affects learning transfer, futures studies with larger sample sizes are required.
Objective Osteoporosis is widely recognized as a prevalent skeletal condition among women after menopause, resulting in reduced bone mineral density (BMD) and a heightened risk of fractures, and reduced quality of life (QoL). Impaired back extensor muscle function can exacerbate postural deformities, pain, functional limitations, and reduced social participation. Despite growing evidence on muscle function, the specific roles of back extensor muscle strength and endurance in different QoL domains remain unclear. This study aimed to investigate the associations between back extensor muscle strength and endurance and multiple domains of QoL in postmenopausal women with osteoporosis. Materials & Methods In this cross-sectional study, 56 postmenopausal women aged 50–70 years with osteoporosis (T-score ≤ -2.5) were recruited via convenience sampling from an outpatient osteoporosis clinic. Back extensor muscle strength was measured using a back–leg–chest dynamometer, and endurance was assessed with the timed loaded standing test. QoL was evaluated using the QUALEFFO-41 questionnaire covering pain, physical function, social function, general health, and mental health. Descriptive statistics (mean±SD) summarized demographic and clinical characteristics. Pearson correlation coefficients (PCC) were used to examine relationships between muscle function and QoL domains, with significance set at P<0.05. Results Participants had a mean age of 64.09±6.42 years and a mean body mass index (BMI) of 26.34±12.3 kg/m². Muscle endurance showed significant negative correlations with pain (PCC=-0.622, P<0.001), physical function (PCC=-0.501, p < 0.001), social function (PCC=-0.409, P =0.007), mental health (PCC=-0.441, P=0.003), and total QoL score (PCC=-0.628, P <0.001). Muscle strength had weaker negative correlations with pain (PCC=-0.350, P=0.023), physical function (PCC=-0.452, P =0.003), and total QoL (PCC=-0.351, P =0.023), and was not significantly associated with other domains. Neither strength nor endurance showed significant associations with general health (P >0.05). Conclusion Back extensor muscle endurance is more strongly and broadly associated with multiple QoL domains than muscle strength in postmenopausal women with osteoporosis. These findings highlight the importance of prioritizing endurance training in rehabilitation programs to enhance physical, psychological, and social well-being and to promote functional independence in this population.
Objective This systematic review explores the transformative role of artificial intelligence (AI) in gait biomechanics, aiming to categorize current methodologies and evaluate their clinical efficacy. Materials & Methods By searching major databases including PubMed, Scopus, and Web of Science, the study analyzed research published between 2020 and 2025. Following rigorous selection criteria focusing on experimental studies of human gait using AI, wearable sensors, or motion capture 13 high-quality articles were selected and assessed via the Downs and Black scale. Results The findings highlight that wearable sensors are the predominant data collection tool (53.8%), followed by markerless systems and deep learning frameworks. The synthesis of evidence indicates that integrating wearable technology with machine learning (ML) models specifically stack and support vector regression (SVR) is exceptionally effective for classifying gait episodes, achieving a high mean sensitivity of 0.961 and a mean absolute error (MAE) of under 2.1% for primary biomechanical parameters. Advanced architectural combinations also showed significant promise; for instance, the ResNet101 and Naïve Bayes hybrid proved highly reliable for posture classification (sensitivity 0.87). Similarly, long short-term memory (LSTM) networks demonstrated remarkable accuracy in short-term gait path prediction within virtual reality settings, though long-term forecasting remains dependent on multi-modal data, such as eye-tracking. Finally, the application of smart insoles paired with random forest (RF) algorithms suggests substantial potential for identifying digital biomarkers in conditions like sarcopenia. Conclusion In conclusion, while AI-driven approaches offer high precision in gait analysis, current research is often limited by small sample sizes. Future studies should prioritize larger cohorts to validate these models and enhance their clinical translation. This review confirms that AI, particularly when paired with high-fidelity sensor data, represents a powerful frontier for diagnosing and managing diverse neurological and musculoskeletal pathologies.
Objective Cervical muscles play an accessory role in pulmonary ventilation and through their musculoskeletal, fascial, and neural connections with the thoracic spine and diaphragm, may influence respiratory function. However, limited evidence exists regarding the association between cervical structures and respiratory indices in healthy individuals. This study aimed to investigate the relationship between cervical muscle size, spirometric indices, and chest wall mobility in healthy adults. Materials & Methods This cross-sectional investigation employed 50 healthy adults (28 women and 22 men) with a mean age of 41±10 years. The thickness of the multifidus, longus colli, sternocleidomastoid, and anterior scalene muscles was measured using ultrasonography. Respiratory volumes were assessed using spirometry, and chest wall mobility during both maximal inhalation and exhalation was evaluated with a measuring tape. Associations between variables were examined using Pearson or Spearman correlation tests, depending on data distribution. Results Analysis of the relationship between cervical muscle size and respiratory volume indices demonstrated that multifidus muscle thickness was positively and significantly associated with forced vital capacity (FVC) (r=0.35, P=0.01) and forced expiratory volume in one second (FEV1) (r=0.37, P=0.008). Anterior scalene muscle thickness was found to be positively and significantly associated with all spirometric parameters. Additionally, sternocleidomastoid muscle thickness was positively correlated with FVC (r=0.31, P=0.02) and FEV1 (r=0.31, P=0.02). Chest wall mobility also demonstrated statistically significant positive associations with the thickness of the anterior scalene and sternocleidomastoid muscles. Conclusion The results of the present investigation indicate that respiratory function, even in healthy individuals, is influenced by the structure and thickness of cervical muscles. These associations may be attributed to the anatomical, fascial, and neural continuity between the cervical and thoracic regions. The present results highlight the importance of assessing and strengthening cervical muscles in training and rehabilitation programs aimed at improving respiratory function. Further studies in clinical populations are recommended to confirm these findings.
Customized wheelchair components that are designed to fit the individual user and consider their preferences can greatly improve the user’s quality of life, but are often cost-prohibitive using traditional manufacturing methods. 3D printing technology is advancing rapidly and has been used to manufacture assistive devices, but there is limited research on whether these methods are viable for load-bearing structural components in wheelchairs. We designed a progressive anti-tipper, an anti-tipper that provides a spring-loaded response to backwards rotation of the wheelchair. This prototype avoids the hard impact of rigid anti-tippers, and also provides increased range of motion of up to 20° rearward tip, allowing the front casters to rise far enough to climb curbs. We 3D printed our prototype using four different 3D printing methods in five materials (PLA, ASA, Resin, Onyx (Nylon+carbon fiber composite), and stainless steel). We performed function tests, ISO 7176-8 strength tests, and UTM destructive tests. The Onyx and stainless steel 3D prints passed our function and strength requirements, indicating that 3D printed parts show potential for load bearing components in wheelchairs. Further fatigue, strength, and real-world use studies are warranted to explore the viability of this technology.
Objective The primary aim of this study is to evaluate the effectiveness of ultrasound-guided urethral balloon dilation (UBD) in improving voiding function in patients with spinal cord injury (SCI)-related urinary retention, and the key secondary aims are to assess the impact of UBD on psychological status and health-related quality of life. Materials & Methods A randomized controlled trial based on the Zelen design will be conducted. A total of 74 patients with SCI-related urinary retention will be recruited and randomized into a conventional rehabilitation group or a UBD treatment group. Primary outcomes include post-void residual (PVR) urine volume, voiding diary data, and urodynamic parameters. Secondary outcomes include quality of life (SF-Qualiveen), bladder symptom scores (neurogenic bladder symptom score [NBSS], core lower urinary tract symptom score [CLSS]), psychological status (the hospital anxiety and depression scale [HADS]), and ultrasonographic assessments of urethral structure and mobility (e.g. external urethral sphincter thickness, urethral width, sphincter volume, and urethral mobility). Results This is a protocol paper; results are not yet available and will be reported in the primary publication. Conclusion This protocol aims to evaluate whether ultrasound-guided UBD is a feasible and clinically useful option for managing urinary retention after SCI. The findings will provide preliminary evidence to inform its future clinical application.
