Children with neurodevelopmental disorders (NDDs) often face challenges in engaging in physical activities, necessitating tailored interventions. Existing game classification systems lack inclusivity as a whole, emphasizing the need for a comprehensive framework that integrates motor, cognitive, and social aspects. To synthesise the existing evidence on game classification systems and to identify the key health areas of concern for children with NDD. This scoping review followed the guidelines of the PRISMA-ScR and the framework of the Arksey and O'Malley Framework for the Assessment of Classification Systems for Games for Children with Neurodevelopmental Disabilities. A systematic search of PubMed and the Web of Science (from inception to January 2025) was carried out using the PCC. Data extraction was performed by two reviewers with expert consultations for a comprehensive analysis. This review analysed 14 game classification frameworks and found gaps in accessibility and therapeutic relevance for children with NDD's. The thematic analysis highlighted the lack of adaptive features, while the expert consultation highlighted key health determinants. The comprehensive review of game classification systems presented in this paper underscores the importance of developing a unique game classification system that addresses specific health needs of children with neurodevelopmental disabilities.
This systematic review and meta-analysis investigated the efficacy of action observation training (AOT) combined with conventional therapy in improving motor and functional outcomes in patients with Parkinson's disease (PD), particularly addressing freezing of gait (FOG) and overall quality of life. A comprehensive literature search was conducted across multiple databases, including MEDLINE, Cochrane Central, and Web of Science, for publications from 2013 to 2024. Six randomized controlled trials (RCTs) and one quasi-RCT involving patients with Hoehn and Yahr stages I-IV were included. The intervention groups received AOT alongside conventional therapy, whereas the control groups received conventional therapy alone. The outcome measures included motor severity (Hoehn and Yahr scale, Movement Disorder Society Unified Parkinson's Disease Rating Scale), balance (BBS), gait (TUG, 6MWT, 10MWT), quality of life (PDQ-39), and FOG episodes (FOG-Q, NFOG-Q). Meta-analyses were conducted using a random-effects model. The meta-analysis demonstrated significant improvements in several clinical measures in the AOT group compared with the controls. Improvements were noted in FOG episodes (FOG-Q: mean difference, -2.03), walking speed (10MWT: mean difference, 0.67), balance (BBS: mean difference, -1.08), and quality of life (PDQ-39: mean difference, 5.68). AOT groups showed enhanced motor recovery and reduced FOG episodes, supported by evidence of improved neuroplasticity and functional reorganization within motor-related brain circuits. Substantial heterogeneity was observed in a few outcomes, such as the 10MWT, reflecting variability in study protocols. AOT combined with conventional therapy represents an innovative approach to neurorehabilitation for PD, offering superior outcomes compared with conventional therapy alone. By leveraging mirror neuron system activation, AOT facilitates motor learning and functional recovery in stroke patients. Despite limitations, such as small sample sizes and short follow-up durations in some studies, the findings strongly support the incorporation of AOT into clinical physiotherapy regimens. Future research should focus on large-scale RCTs with extended follow-up periods to further validate the benefits of this integrative approach.
Overweight children exhibited poor postural balance which can be addressed by core stabilization exercises. The objective of this study is to explore the effectiveness of core stability training in improving postural stability and foot pressure distribution (FPD) in overweight children. Twenty children were randomly allocated into Group 1 (experimental) and Group 2 (control). For postural stability: Y-balance lower quarter and single Group 1 stance were used. Podia Scan Software for FPD on both feet was used. Within-group analysis showed significant improvement (p < 0.05) for Y-balance right-anterior, posterior-lateral, posterior-medial direction in Group 1 and in Group 2 anterior, posterior-medial; Y-balance left-anterior, posterior-medial direction. In Group 1 and in Group 2 posterior medial direction; single-leg stance eyes closed R, single-leg stance eyes closed L; foot pressure distributions in Group 1. Between-group analysis revealed statistically no significant improvement in all the outcomes except core strength.
Capacitive-resistive energy transfer (CRet) is a recognized treatment for musculoskeletal conditions; however, its effectiveness compared to other electrophysical agents is unknown. The aim is to review CRet and other electrophysical agents and present the findings of the literature review using a systematic review PRISMA approach. The databases used were PubMed, Trip Database, Science Direct, Google scholar, Cochrane library, and UpToDate. Sixteen articles met eligibility criteria, and the assessor evaluated their quality using the Physiotherapy Evidence Database for randomized controlled trials (RCT). After risk of bias analysis and meta-analysis, level of evidence assignment was done using the Oxford Centre for evidence-based medicine recommendations. Seven RCT studies were analyzed for risk of bias to obtain evidence recommendations on neck pain, knee osteoarthritis, low back pain, and pain pelvic syndrome. Non-RCT studies were on tendonitis, myofascial pain syndrome, muscle soreness, lateral ankle ligament sprain, shoulder pain, and proximal humerus fracture. Despite five of seven high- and moderate-quality RCTs showing pain reduction compared to sham controls, heterogeneity prevented data pooling. When combined with exercise, CRet showed significant improvements in clinical outcomes compared to exercise alone. The random-effects meta-analysis found no significant difference in pain, stiffness, and physical function scores of knee osteoarthritis between CRet and sham controls at the three-month follow-up. Additionally, CRet alone did not show significant differences in clinical outcomes when compared to ozone therapy, laser, cryo-ultrasound, or combined EPAs in any of the musculoskeletal conditions studied.
Dizziness poses significant challenges to daily functioning and quality of life in patients with vestibular dysfunction. Telerehabilitation has emerged as a promising avenue for delivering effective interventions remotely, potentially revolutionizing the management of vestibular disorders. This scoping review aims to explore the potential of telerehabilitation in managing dizziness among older adults with vestibular dysfunction and to map the existing research landscape in this field. A comprehensive literature search was conducted in PubMed, The Cochrane Library, PEDro, Ovid, and Scopus databases from their inception until October 2024. The initial search yielded 2159 published articles. After removing duplicates, 1585 articles were screened for relevance. Eight articles met the inclusion criteria and were selected for final review. This review follows the established method outlined by Arksey and O'Malley, Levac and colleagues, and the Joanne Briggs Institute. These include identifying research questions, relevant studies, selecting studies, charting data, and reporting results. Articles suggesting that telerehabilitation reduces dizziness and improve quality of life in individuals with vestibular dysfunction. The review provides an overview of digital tools and technologies being used, such as virtual reality (VR) and balancing exercises, demonstrated considerable improvement over traditional home workouts in terms of dizziness intensity, impairment level, and quality of life (QOL). Telerehabilitation, particularly using VR and balancing exercises, may effectively manage dizziness and improve QOL for older adults with vestibular dysfunction. These technologies could also promote engagement in physical activity. Further research is needed to establish long-term efficacy and implementation strategies.
Background: Knee osteoarthritis (KOA) affects many, particularly the elderly, leading to pain and reduced quality of life. Core muscle strength deficits are prevalent in KOA patients, worsening their functional impairment. Emerging evidence suggests that core muscle strengthening may help treat KOA. Purpose of the Study: This systematic review examined whether adding core muscle strengthening exercises effectively improves pain, function, and physical performance in KOA. Methods: Using systematic review methods, studies examining the use of core strengthening as a treatment modality in people with KOA were located, appraised, and synthesized. Two reviewers independently extracted data and assessed the methodological quality using the PEDro scale. The results of the studies were summarized for outcomes of pain, function, and physical performance following the interventions. Results: Four studies met the inclusion criteria, three of which were of high quality per PEDro scale. In general, pain was significantly reduced in three studies, whereas functional outcomes varied considerably among studies. Assessment of physical performance after the interventions was limited. Discussion: Prevalent research suggests that adding core muscle strengthening as a component of interventions for KOA has a favorable effect on knee function. However, changes in physical performance to contextualize the gains in pain and perceived functions have not been examined and must be explored in future research.
This systematic review aims to evaluate the effect of exercise training on sleep quality in COPD patients. PubMed and Scopus databases were searched through January 2025. Articles were selected if they described and evaluated the effects of exercise training on sleep quality in COPD patients, diagnosis of COPD done through GOLD criteria, included human trials, population above 18 years, and full text available in English. Exclusion criteria were diagnosis of COPD not done through GOLD criteria, if they included non-human trials, included people below 18 years of age, and if the articles were incomplete or unpublished. JBI Critical Appraisal Tool was used to assess the risk of bias. As a result, seven studies were included after carefully evaluating the articles. The compiled research on exercise training for patients with chronic obstructive pulmonary disease (COPD) reveals mixed outcomes regarding sleep quality and overall health. Inconclusive results were obtained regarding the effects on sleep quality in COPD patients.
Traumatic brain injury (TBI) represents the highest incidence of common neurological disorders. Depression, a common symptom after traumatic brain injury, delays recovery and decreases quality of life. The purpose of this systematic review was to determine the impact of physical activity on depressive symptoms for individuals who sustain a TBI. A literature search of PubMed, ProQuest, CINAHL (Cumulative Index of Nursing and Allied Health), and Springer-Link was conducted. Selection criteria: adults age 18 and older who sustained a TBI and received any type of physical activity intervention with at least one standardized outcome measure of depression. Each study was independently assessed for methodological quality by two reviewers who came to consensus using Oxford Centre for Evidence Based Medicine levels of Evidence (2011). A total of 246 articles were screened for eligibility and five articles met selection criteria. All studies administered physical activity interventions using 30-60 min of aerobic exercise three to five times per week at 50-70% age-predicted maximal heart rate with durations ranging from 8 to 24 weeks. All studies reported reductions in depressive symptoms after interventions. No adverse events were reported. Performance of moderate intensity aerobic exercise (both land-based and aquatic) appears to have the most benefit in lowering depressive symptoms in adults. Clinically meaningful changes in Beck's Depression Inventory (BDI) mean scores and Hamilton Depression Scale (HAM-D) improvements exceeded the minimal clinically important difference for each.
Introduction: Painful diabetic neuropathy (PDN) is a frequent diabetic complication with significant impact on the patient's daily life. However, available pharmacologic treatments lack efficiency leading to many therapeutic alternatives being tested. Materials and methods: The objective of this comprehensive narrative review is to summarize all relevant nonpharmacological therapies of PDN with emphasis on recommendations, indications, and risks. Mechanisms through which therapies alleviate pain were also described. Results: Four main categories of alternative treatments were found; respectively, exercise therapy, electric stimulation therapy, complementary and other physical therapies, and surgical therapy. Most therapies belong to physical therapies. While high frequency spinal cord stimulation has a class 1 recommendation, exercise therapy (including yoga), transcutaneous electrical nerve stimulation, and photobiomodulation also emerge as alternatives. Whole body vibration and surgical interventions had limited results due to small groups, while ozone therapy and dorsal root ganglion stimulation show pain improvement only in animal studies. Most traditional Chinese therapies had insufficient data, low quality studies, or questionable safety as important counterarguments. Conclusions: Despite the recurrent limitations given by insufficient standardization associated with therapy categories, a decent number of non-pharmacological treatments proved useful in PDN treatment by evading medicamentous side effects. The prototype remains high frequency spinal cord stimulation.
Several studies have demonstrated the efficacy of brain-computer interface (BCI) systems combined with functional electrical stimulation (FES) in post-stroke rehabilitation, particularly for upper limb recovery. However, evidence regarding their effectiveness in lower limb rehabilitation remains limited. This narrative review aims to synthesize current research findings on the effectiveness of BCI-FES systems in the rehabilitation of stroke survivors, with a focus on both upper and lower limb impairments. A comprehensive literature search was conducted in PubMed Medline, the Cochrane Library, and the Web of Science Core Collection between March and April 2025. Eligible studies included randomized controlled trials (RCTs), non-randomized trials, pilot RCTs, pilot studies, and clinical trials involving BCI-FES interventions. The methodological quality of controlled studies was assessed using the Physiotherapy Evidence Database (PEDro) scale guidelines. Fifteen studies comprising a total of 337 participants were included. These studies reported improvements in functionality, mobility, range of motion, balance, spasticity, gait performance, and also in brain activity and neuroplasticity. BCI-FES systems appear to have beneficial effects in stroke rehabilitation. However, current evidence, particularly for lower limb interventions, is still limited, precluding firm conclusions. BCI-FES systems may constitute an effective strategy for post-stroke rehabilitation across acute, subacute, and chronic stages. They show significant potential in improving upper and lower limb function, enhancing daily living activities, and promoting cortical reorganization.
The study aimed to explore the feasibility and efficacy of neurophysiological facilitation (NPF) techniques in improving respiratory dysfunction in preterm and term infants. It was conducted in two phases. Phase 1 involved 18 infants with respiratory dysfunction who received a single session of NPF, which included intercostal stretch, maintained manual pressure, and peri-oral pressure techniques. Primary outcomes, such as respiratory rate (RR) and oxygen saturation (SpO2), were measured before and after the intervention at multiple time points, including 24 hours post-treatment. Phase 2 involved nine neonates who underwent six sessions of NPF over three days, with additional assessments using the Silverman-Andersen Score (SAS). The results revealed significant improvements in both phases. The intervention led to significant improvements in respiratory and oxygenation parameters. Respiratory rate (RR) decreased significantly, and oxygen saturation (SpO2) increased immediately following the intervention (p < 0.01), with improvements in SpO2 maintained for up to 24 hours. Additionally, SpO2 showed an overall improvement of 5.78%, and Silverman-Andersen scores (SAS) decreased by 4.34 points after six sessions (p< 0.05). The intervention was well tolerated, with no significant adverse events, and all safety protocols were adhered to throughout the study. The findings suggest that NPF techniques can safely enhance respiratory function in neonates with respiratory distress, indicating their potential clinical application for neonatal respiratory therapy.
Knee osteoarthritis (OA) is a common condition affecting millions of people globally. Recent research suggests that prolonged loading (forces) on the knee can be a potential factor affecting articular cartilage and deform knee structures, ultimately leading to the development and progression of medial knee OA. Hence, reducing loading is a common theme in preventing and managing medial knee OA. Current non-pharmacological interventions known to reduce knee include the use of canes, laterally wedged insoles, knee braces, muscle strengthening exercises, and gait modifications. More recently, gait modifications have incorporated the use of augmented feedback from knee kinetic forces to reduce knee loads. This article aims to explore the influences of loading on the knee and techniques for adjusting these loads relative to medial knee OA. The secondary objective is to provide insight into future directions for the comprehensive management of knee OA.
