This review article maps methodological practices in disability studies through an analysis of 555 research articles published in Disability & Society between 2020 and 2025. While the field has long debated its theoretical identity, particularly in relation to the social model of disability and emancipatory research, less attention has been paid to how these principles are realised in concrete research practice. The findings reveal both connections and discrepancies between normative principles and methodological practices. On the one hand, diverse qualitative and innovative methods are used to capture non-verbal and experiential dimensions of disability, reflecting the field’s emancipatory and inclusive commitments. On the other hand, these commitments are unevenly enacted; participatory research remains a minority and is unevenly distributed across topics. By making these patterns visible, this article provides an empirical basis for more grounded methodological reflection and supports a more reciprocal relationship between principles and practices, allowing each to inform and refine the other.
Saudi Arabia has expanded social protection, rehabilitation, and assistive support for persons with disabilities; however, the open-data evidence related to these programs remains scattered across separate administrative tables. This study examined seven national open government datasets related to persons with disabilities to analyze service utilization and socioeconomic inclusion across age, gender, disability type, education, employment, and marital status. A secondary descriptive analytical design was used. Arabic CSV datasets were cleaned, translated, and harmonized. Exact-count datasets were summarized using beneficiary and device totals, percentages, cross-tabulations, chi-square tests, and Cramer’s V measures of association. Range-coded datasets were treated as ordinal reporting cells. Financial subsidy records included 847,194 beneficiaries, of whom 448,064 (52.9%) were recorded with physical disabilities. Medical assistive device records included 161,967 beneficiaries and 500,362 devices, with an average device-to-beneficiary ratio of 3.09. Residential care included 101,552 beneficiaries, with a strong concentration among males and adults aged 26-35 years. Vocational rehabilitation included 12,382 beneficiaries, concentrated mainly among adults aged 26-55 years and persons with no formal education. Range-coded education, employment, and marital-status tables showed repeated high-volume (>1000) cells, especially for physical disability, non-working status, and no formal education. These datasets provide a useful basis for national monitoring, although their current structure limits causal analysis and individual-level linkage. Stronger harmonization, exact-count reporting, regional indicators, and service-pathway identifiers would improve evaluation of disability policy.
Diabetic foot ulcers (DFUs) represent one of the most disabling complications of diabetes, frequently culminating in limb amputation, permanent mobility loss, and long-term physical disability when infection or ischaemia is not recognized early. Addressing this disability burden, the present study proposes a disability-focused deep learning framework for four-class DFU image classification, separating wounds into infection, ischaemia, both, and none. The method combines EfficientNetV2-S for local wound texture, DINOv2-Base for global visual context, and a Siamese metric-learning network trained with large margin cotangent loss and class-balanced focal loss. A dynamic sigmoid attention module fuses the two feature streams, and the final normalized embeddings are classified using eXtreme Gradient Boosting (XGBoost). Experiments were performed on the licensed Diabetic Foot Ulcer Challenge 2021 (DFUC2021) dataset, where targeted class-conditional augmentation was used to reduce severe imbalance. Compared with the k-nearest neighbour (KNN)-based baseline, the optimized XGBoost model improved overall accuracy from 64.16% to 65.57% and increased macro area under the receiver operating characteristic curve (AUC-ROC) from 0.7387 to 0.8257. The strongest gain was observed for ischaemia, reaching an AUC of 0.9324. These findings demonstrate that dual-backbone metric learning can support earlier DFU risk recognition, with the potential to support earlier identification of high-risk ulcers that may ultimately contribute to disability prevention and improved patient outcomes following prospective clinical validation.
Addressing consciousness after a stroke is essential because the level of consciousness is the key to the patient’s overall improvement, functional recovery, and independence. In this case, we used high-definition transcranial direct current stimulation (HDtDCS) to enhance consciousness. HDtDCS is a non-invasive electrical stimulation of the brain at the target location. We use low-intensity direct current to stimulate the brain. This intensity alters the membrane permeability and resting membrane potential of the cortical neuronal network. A 79-year-old male with acute midbrain infarcts presented in an unresponsive state to the tertiary care center. The hospital discharged the patient and admitted him to an inpatient rehabilitation facility for stroke rehabilitation. Here, we aim to improve the patient’s consciousness by administering HDtDCS and coma stimulation. The subject’s improvements in consciousness were recorded using outcome measures such as the Glasgow Coma Scale and the Coma Recovery Scale-Revised. In this single case of midbrain infarction, consciousness was improved by using HDtDCS targeting the dorsolateral prefrontal cortex with left-sided anodal stimulation.
Neurogenic bowel dysfunction (NBD) is a common and disabling complication among individuals with neurological disorders, substantially affecting bowel continence, functional independence, quality of life, and caregiver burden. However, the characteristics of registered clinical research investigating NBD have not been comprehensively described. This study aimed to characterize completed clinical trials registered on ClinicalTrials.gov investigating NBD among individuals with neurological disabilities and to identify current research gaps. This registry-based cross-sectional descriptive study analyzed completed interventional studies registered on ClinicalTrials.gov . The registry was searched on July 1, 2026, using the exact search term “Neurogenic Bowel Dysfunction.” Eligible studies investigating NBD among individuals with neurological disabilities were included. Extracted variables included neurological disability population, intervention category, registered participant enrollment, study design characteristics, geographic distribution, and availability of posted summary results. Descriptive statistical analyses were performed to summarize study characteristics. Nineteen completed interventional studies involving 787 registered participants met the eligibility criteria. The median study enrollment was 28 participants (interquartile range: 11-52; range: 2-191). Spinal cord injury was the most frequently represented neurological disability population (11/19, 57.9%), followed by mixed neurogenic bowel populations (6/19, 31.6%). Device-based interventions were the most commonly investigated therapeutic approach (8/19, 42.1%), followed by other/mixed interventions (5/19, 26.3%), electrical stimulation (3/19, 15.8%), pharmacological interventions (2/19, 10.5%), and behavioral rehabilitation (1/19, 5.3%). Most studies enrolled small cohorts and were conducted primarily in North America and Europe. Only five studies (26.3%) had publicly available summary results posted on ClinicalTrials.gov , whereas 14 (73.7%) had no posted results. Completed ClinicalTrials.gov studies investigating NBD remain limited in number and are characterized by heterogeneous interventions, small study populations, uneven geographic representation, and incomplete public reporting of study results. These findings describe the characteristics of registered studies retrieved using the specified registry search strategy and highlight priorities for future multicenter research, standardized outcome reporting, and improved transparency.
Parkinson’s disease (PD) is an advanced neurodegenerative state with diverse degeneration of dopaminergic neurons, oxidative stress, mitochondrial dysfunction, and neuroinflammation. The present study aimed to evaluate the neuroprotective effect of cubebin against rotenone-induced Parkinsonism disability in Wistar rats. The animals were divided into four groups: the normal control group, the rotenone group, and the cubebin groups (10 and 20 mg/kg, p.o.) with rotenone for 28 days. Behavioural, biochemical, neurochemical, mitochondrial, and histopathological tests were conducted, using an open field test, a rotarod, catalepsy, grip strength, and akinesia tests. The motor deficits induced by rotenone administration were significant, and there was oxidative stress, a rise in nitrite levels, an increase in pro-inflammatory cytokines [tumour necrosis factor-α, interleukin (IL)-1β, IL-6, and nuclear factor-kappa B], mitochondrial dysfunction, and loss of dopamine (DA) and serotonin content. Cubebin treatment significantly reduced locomotor and motor coordination deficits, as well as catalepsy and akinesia. It was effective in restoring endogenous antioxidant defence in the form of an increase in superoxide dismutase, catalase, and glutathione and decreased malondialdehyde and nitrite accumulation. Cubebin also reduced neuroinflammatory markers and restored neurotransmitter levels, including DA, serotonin, glutamate, 3,4-dihydroxyphenylacetic acid, and homovanillic acid. Histopathological evaluation revealed good maintenance of neuronal architecture in cubebin-treated animals when compared with rats treated with rotenone. Cubebin was unable to fully correct inhibition of mitochondrial complexes I and II, but it was observed to dampen downstream oxidative and inflammatory pathways linked to neuronal degeneration. Based on these results, it is believed that cubebin may be an essential medicinal substance for the management of PD due to its anti-inflammatory and antioxidant properties, which also protect the nervous system from the effects of rotenone.
This study investigated the neuroprotective effects of luteolin (LUT) and luteolin-loaded nanoliposomes (LUT-LNPs) in a d -galactose ( d -gal)-induced rat model of hippocampal aging, focusing on ferroptosis, oxidative stress, inflammation, mitochondrial dysfunction, apoptosis, and neuronal integrity. Sixty male Wistar rats were randomly assigned to six groups: control, LUT, LUT-LNPs, d -gal, d -gal + LUT, and d -gal + LUT-LNPs. d -Gal administration induced hippocampal neurodegeneration, characterized by reduced levels of Klotho protein, dopamine, serotonin, and acetylcholine, and reduced antioxidant defenses, with increased acetylcholinesterase activity, lipid peroxidation, and inflammatory mediators. Mechanistically, d -gal suppressed nuclear factor erythroid 2-related factor 2 (NRF2)/heme oxygenase-1 (HO-1) signaling and activated nuclear factor kappa B (NF-κB), increasing tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-1β, and nitric oxide (NO) levels. It also induced ferroptosis, evidenced by Fe 2+ accumulation, increased ACSL4 expression, and reduced SLC7A11 and GPX4 expression. These changes were accompanied by mitochondrial dysfunction, impaired respiratory-chain complex activities, oxidative DNA damage, activation of caspase-3 and BAX, reduced Bcl-2, glial activation, and marked histopathological and ultrastructural damage in the hippocampus. LUT significantly attenuated these alterations, whereas LUT-LNPs produced greater neuroprotection. Notably, LUT-LNPs restored iron homeostasis, normalized the expression of ACSL4, SLC7A11, and GPX4, enhanced NRF2/HO-1 signaling, suppressed neuroinflammation, improved mitochondrial function, and reduced apoptosis and oxidative DNA damage. Histological and ultrastructural analyses confirmed substantial neuronal preservation in the LUT-LNP group. Overall, LUT-LNPs demonstrated superior neuroprotective efficacy compared with free LUT, highlighting their protective potential to prevent hippocampal aging-related neurodegeneration.
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder and the leading cause of dementia worldwide. Public knowledge and awareness of AD play an important role in early recognition, risk reduction, and support for affected individuals. This study aimed to assess AD-related knowledge among adults in Riyadh, Saudi Arabia, using the validated Alzheimer’s Disease Knowledge Scale (ADKS), and to identify sociodemographic factors associated with knowledge levels. A community-based cross-sectional study was conducted among 1282 adults recruited from public locations across Riyadh using a stratified convenience sampling approach. Data were collected through face-to-face interviews using a structured questionnaire and the 30-item ADKS. The scale assessed knowledge across seven domains: life impact, risk factors, disease course, assessment and diagnosis, caregiving, treatment and management, and symptoms. Descriptive statistics, independent-samples t -tests, one-way analysis of variance, Tukey’s post hoc analysis, and multiple linear regression were performed using SPSS version 25 (IBM Corp., Armonk, NY, USA). The mean total ADKS score was 17.09 ± 3.00 out of 30, corresponding to 56.95% correct responses, indicating moderate knowledge of AD among participants. The highest domain-specific knowledge scores were observed in assessment and diagnosis (66.25%) and treatment and management (66.25%), while the lowest scores were observed in caregiving (46.2%). Mean ADKS scores differed significantly by age group ( P = 0.037), gender ( P < 0.001), educational level ( P = 0.007), marital status ( P = 0.007), and family history of AD ( P < 0.001). Multiple linear regression analysis showed that female gender ( B = 0.952, P < 0.001), higher educational level ( B = 0.177, P = 0.012), increasing age category ( B = 0.229, P = 0.012), and having a family history of AD ( B = 0.800, P < 0.001) were independently associated with higher ADKS scores. Adults in Riyadh demonstrated moderate knowledge regarding AD, with notable knowledge gaps particularly related to caregiving and other disease-related domains. Sociodemographic characteristics, especially gender, education, age, and family exposure to AD, were associated with knowledge levels. Targeted community-based educational interventions addressing identified knowledge gaps are warranted to improve AD awareness and promote early recognition and supportive care in Saudi Arabia.
Intellectual disability (ID) affects approximately 1-3% of the global population, with a higher prevalence reported in consanguineous populations due to autosomal recessive variants. The C22orf31 gene is one of the important candidate genes that is expressed in the brain and is associated with global developmental delays and ID. We aimed to identify the genetic basis of ID, seizure, and microcephaly in a Saudi consanguineous family. Whole exome sequencing was performed on the affected individual from a consanguineous Saudi family, followed by Sanger validation and bioinformatics prediction. Our results showed a novel homozygous 5-base pair (bp) deletion NM_015370.1 (c.433-1_436delGAGTA; p.Ser145Lysfs*9) in the C22orf31 gene. The gene is important and the identified mutation in the C22orf31 gene may disrupt the canonical splice acceptor site and cause a frameshift, leading to a premature termination codon (PTC) that is predicted to trigger nonsense-mediated decay and complete protein loss. The patient manifested developmental delays and seizures along with microcephaly. In conclusion, we report a novel 5-bp deletion in the C22orf31 gene in a Saudi patient. Functional studies and identification of additional families are needed to confirm the role of C22orf31 in disease pathogenesis. This novel finding expands the mutational and clinical spectrum of C22orf31 mutation-related neurodevelopmental disorders in Saudi Arabia.
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental condition characterized by persistent social communication deficits and restricted, repetitive behaviors. Gastrointestinal symptoms are common and often correlate with symptom severity, implicating the microbiota–gut–brain axis as a potential mechanism linking gut dysbiosis with neurodevelopment through neural, immune, endocrine, and metabolic pathways. This review summarizes current evidence on alterations in the gut microbiota in ASD and critically examines whether these changes contribute to disease pathogenesis or represent secondary effects. It highlights recent advances in multi-kingdom microbiome profiling, metabolomics, mechanistic studies of neuroinflammation, and neurotransmitter signaling and considers major confounding factors, including diet, medication, and gastrointestinal comorbidities. Emerging studies emphasize microbial function over taxonomy. In the largest multi-kingdom analysis, 31 microbial and functional markers distinguished children with ASD from neurotypical controls with an area under the curve of 0.91, driven primarily by ubiquinol-7 and thiamine diphosphate biosynthesis pathways rather than individual taxa. Metabolomic and genetic studies suggest that microbial metabolites may mediate behavioral effects. Microbiota transfer therapy and fecal microbiota transplantation have demonstrated sustained improvements in gastrointestinal and behavioral outcomes, whereas probiotics and dietary interventions have produced inconsistent results. Although alterations in the gut microbiome are consistently observed in ASD, specific microbial signatures remain heterogeneous, and causality remains unproven. Functional microbial pathways appear more informative than taxonomic composition for biomarker discovery and therapeutic development. Future progress requires prospective birth cohorts, pre-diagnostic sampling, mechanistic validation, and adequately powered randomized trials before microbiome-based diagnostics and therapies can be translated into clinical practice.
Aphasia remains under-documented in Saudi Arabia despite its burden after stroke and other neurological conditions. This mixed-methods scientometric and thematic review mapped Saudi-linked aphasia research indexed in Web of Science and Scopus. Using Biblioshiny (bibliometrix) and VOSviewer, we analysed 551 records (1951-2025) from 322 sources, showing 5.8% annual growth, 14.23 citations per document, and 24.3% international co-authorship; Aphasiology was the leading outlet. Collaboration centred on the UK and United States, with emerging links across Europe, the Middle East, and South Asia. Keyword co-occurrence revealed three clusters: clinical epidemiology/rehabilitation, psychosocial–communicative dimensions, and developmental/neurological comorbidities; themes since 2021 shifted towards rehabilitation, speech–language pathology, ischaemic stroke, and COVID-19. A thematic synthesis of 41 directly relevant studies identified 12 domains spanning epidemiology, causes, clinical characterization, Arabic assessment tools (Short Aphasia Test for Gulf Arabic speakers, Arabic Language: Evaluation of Function), public awareness, service delivery, rehabilitation, telehealth, cultural–linguistic barriers, empirical research, research capacity, and future directions. Persistent gaps include the lack of population-based incidence/prevalence data, limited standardized Arabic tools and normative datasets, and absence of national registries linking clinical, neuroimaging, and outcomes information. Overall, the field is moving towards culturally attuned, technology-enabled care; targeted investment in surveillance, tool development, workforce training, and hybrid telerehabilitation is needed to improve equitable diagnosis and treatment.
Inclusive digital accessibility tools are increasingly needed to transform audiovisual materials into content that is usable by viewers with disabilities. In this context, the description of music in captions is a key accessibility feature that can inform the design of more adaptive, user-centered captioning tools. Using qualitative content analysis, this study investigates how music is described in the subtitles for the deaf and hard of hearing provided for three Saudi films on Netflix. The analysis examines the extent to which these features align or differ across languages. The study thus identified six types of description: the presence of music and its changes; sonic qualities, such as volume; instruments; genre; culture and language; and emotional qualities. The findings showed that descriptions of the presence of music and of emotional qualities were consistently the most frequent across films and languages. The analysis also showed that the Arabic captions described music more frequently but contained fewer descriptors. The Arabic subtitles thus repeated descriptors more often than their English counterparts. The Arabic captions also combined many of these descriptors to increase specificity. The English captions contained more diverse descriptors, many of which were more specific than the wordings found in Arabic. The results, therefore, indicate differences in priorities and stylistic choices between the two languages. This indicates that audiences from different backgrounds do not receive this service to the same standards. Such findings can inform the development of inclusive digital accessibility tools that generate more meaningful and user-centered music descriptions for deaf and hard-of-hearing viewers.
The rapid emergence of generative artificial intelligence (GenAI) tools and large language models (LLMs) since late 2022 has introduced new possibilities for rehabilitation and disability services. However, no review has systematically mapped the scope and nature of evidence on GenAI applications specifically in these contexts. This scoping review aimed to map the evidence on GenAI and LLM applications in rehabilitation and disability services, examining the tools applied and their purposes (SQ1), populations and service contexts represented (SQ2), reported outcomes, benefits, and concerns (SQ3), and evidence gaps with implications for future research, practice, and policy (SQ4). Sources published from late 2022 to May 2026 in English, addressing the application of GenAI or LLMs within rehabilitation, disability, or special education service contexts, involving persons with disabilities, rehabilitation professionals, special educators, or related stakeholders. Scopus, Web of Science, and Lens were searched in May 2026. Screening reliability was assessed computationally (Cohen’s κ = 0.938). Data were extracted using Elicit across 10 variables and reviewed by the principal investigator. Synthesis followed a narrative and descriptive approach organised by the four sub-questions. Ninety-six studies published between 2023 and 2026 were included. ChatGPT was referenced in 85.4% of studies. The dominant purposes were assistive and adaptive technology (40.6%), professional training (21.9%), and content generation (21.9%). Higher education rehabilitation programmes (51.0%) and school-level special education (28.1%) were the most common service contexts. Learning disabilities (17.7%), autism spectrum disorder (14.6%), and visual impairment (11.5%) were the most specified disability types, though 56.2% of studies did not specify a disability diagnosis. Reported benefits included measurable improvements in learning outcomes under structured, educator-guided conditions, significant time savings for special educators and rehabilitation professionals, and enhanced autonomy for students with disabilities. Concerns included clinical reasoning accuracy limitations, AI-generated accessibility failures, readability exceeding health literacy thresholds, and equity barriers in low-resource settings. Critical gaps included the near-total absence of longitudinal outcome data, very limited direct patient-facing clinical evidence, sparse representation of complex disability profiles, and no governance or institutional policy research. The evidence supports cautious, educator-guided integration of GenAI in rehabilitation and special education training, with structured pedagogical design and human oversight as critical conditions for benefit. The evidence does not yet support conclusions about patient outcomes, long-term competency development, or population-level equity effects. Future research should prioritise longitudinal designs, direct patient-facing clinical studies, under-represented disability populations, and disability-inclusive AI governance frameworks.
The Neck Disability Index (NDI) is widely used to assess neck-related disability, but its factor structure remains debated. This study aims to examine the structural validity of the Arabic NDI using confirmatory factor analysis (CFA). A cross-sectional study was conducted in 118 adults with neck pain, the majority of whom were female (61%) and had chronic symptoms (81%), recruited from outpatient physical therapy clinics in Riyadh, Saudi Arabia. Participants completed the Arabic NDI at their first visit. CFA was performed using a robust diagonally weighted least squares mean and variance adjusted estimator. Model fit was assessed using key indices: chi-square statistic (χ 2 ), root mean square error of approximation (RMSEA), standardized root mean square residual (SRMR), Tucker–Lewis Index (TLI), and Comparative Fit Index (CFI). Initial CFA results suggested a reasonable, although not fully acceptable, fit to the unidimensional model (χ 2 = 66.84, df = 35, RMSEA = 0.088, SRMR = 0.072, TLI = 0.93, CFI = 0.95). After allowing the residuals of the reading and concentration items to correlate, the modified model demonstrated an acceptable fit [χ 2 = 56.43, df = 34, RMSEA = 0.075 (90% confidence interval = 0.055-0.120), SRMR = 0.067, TLI = 0.95, CFI = 0.96]. All NDI items demonstrated significant factor loadings (0.33-0.79), supporting a single underlying construct of neck-related disability. The findings provide evidence supporting the unidimensional structure of the Arabic NDI and support the interpretation of the total score as a measure of neck-related disability. These findings support its use in clinical and research settings with confidence in the total score as a valid measure of neck disability. Future research should extend validation efforts across broader populations and explore additional psychometric properties.
Despite continuous advances in wheelchair technologies, not all technologies and features are widely accepted by users and stakeholders. Understanding the factors influencing acceptance is important to support the successful adoption and implementation of wheelchair technologies. This review aims to identify factors influencing wheelchair technology acceptance, the theoretical frameworks applied, and the types of wheelchair technologies investigated in empirical studies. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Searches were conducted in PubMed, Scopus, and Web of Science between 25 and 29 August 2025 to retrieve all relevant studies indexed up to the search date, without publication year restrictions. Eligible studies included peer-reviewed empirical journal articles and conference papers related to wheelchair technology acceptance. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 771 records were identified, of which 13 studies met the inclusion criteria. The included studies applied frameworks such as the technology acceptance model (TAM), the unified theory of acceptance and use of technology (UTAUT/UTAUT2), and grounded theory. The reviewed technologies included manual and powered wheelchairs, intelligent wheelchair systems, wearable mobility support technologies, and assistive safety systems. Overall, 26 factors influencing acceptance were identified and grouped into individual, technological, socioeconomic, environmental, and organizational domains. The most frequently reported factors were cost, ease of use, usefulness, and safety. The findings also indicated that the importance of these factors varied across geographical, socioeconomic, and user contexts. In conclusion, wheelchair technology acceptance is influenced by multiple context-dependent factors beyond technical performance alone. Future research should apply standardized evaluation frameworks and investigate acceptance across diverse populations and real-world settings to support more user-centered wheelchair technology development and implementation.
The cerebellum, located at the back of the brain, is connected to the brainstem’s midbrain, pons, and medulla oblongata through superior, middle, and inferior cerebellar peduncles. Depression is a mental health condition with variable degrees of severity that is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM) and neuroimaging to identify brain and cerebellar volume abnormalities. The severity of depression is assessed using standardized diagnostic criteria recognized internationally. The gray and white matter volumes of the cerebellum were measured in 236 patients with depression (123 males, 113 females; age 20-40 years), with a mean age of 24 years [± standard deviation (SD) 5.51], and 159 sex- and age-matched controls (87 males, 72 females), with a mean age of 24 years (±SD 4.91), using BrainSuite version 18a.021 (64-bit Windows) on magnetic resonance imaging scans acquired with a Siemens 1.5 Tesla MAGNETOM Avanto System. T1-weighted images were obtained using three-dimensional acquisition by magnetization-prepared rapid acquisition. In males, the mean volumes were 1289.9 cm 3 and 2817.9 cm 3 (patients and controls) for gray matter, and 346.8 cm 3 and 811.6 cm 3 for white matter, respectively. In females, the corresponding values were 105.4 cm 3 and 2373.8 cm 3 for gray matter, and 39.5 cm 3 and 718.6 cm 3 for white matter. Our findings indicate that cerebellar gray and white matter volumes were significantly lower in patients with depression than in healthy controls, with an apparent sex-related difference in the magnitude of volume reduction. As this was a cross-sectional study, these findings reflect an association between depression and reduced cerebellar volume rather than a causal relationship.
Exposure to ionizing radiation for medical purposes is the largest source of exposure to the general public. Patients with disabilities or special needs face unique physical, communication, and organizational barriers that may affect their radiation safety, image quality, and access to care. The objective of this study was to evaluate computed tomography (CT) imaging practices for patients with disabilities, examine the challenges encountered by radiology professionals, and offer evidence-based recommendations to improve clinical practice. A structured, expert-validated questionnaire evaluated facility readiness, protocol adjustments, immobilization methods, sedation use, staffing support, radiation dose optimization strategies, and specialized training. Data analysis involved descriptive statistics and chi-square tests, with a significance threshold at P < 0.05. There was a significant association between the use of customized positioning aids and the adoption of faster scanning protocols (χ 2 = 19.395, P = 0.022). A highly significant correlation was found between the number of immobilization devices and the reported challenges (χ 2 = 31.895, P < 0.001). No significant links were observed between faster scanning protocols and sedation, staffing, specialized training, or adaptive iterative reconstruction technology. CT practices for patients with disabilities differ across institutions. Some facilities employ positioning aids with motion-reduction protocols, but gaps remain in training standardization and in the implementation of dose optimization. Radiogenic risks from CT procedure increased due to the reparative exposure for patients with disabilities. Enhancing disability-specific education and standardizing protocols are crucial for safe, accessible, and equitable imaging services.
Despite advances in critical care that have reduced acute sepsis mortality, a considerable proportion of survivors develop post-sepsis syndrome and post-intensive care syndrome, characterised by persistent physical, cognitive, and psychological impairments that substantially diminish health-related quality of life (HRQoL). Routine acute-phase biomarkers, including C-reactive protein (CRP), procalcitonin (PCT), lactate, and the neutrophil-to-lymphocyte ratio, are widely accessible and cost-effective tools used in clinical practice for a range of clinical functions, including the diagnosis of bacterial infection, serial monitoring of treatment response, risk stratification of severity, and prediction of short-term mortality and acute organ failure; however, their capacity to serve as long-term disability predictors remains largely unexplored. This narrative review examines the prognostic utility of routine infection biomarkers in adult and paediatric sepsis, with particular emphasis on their capacity to predict long-term functional impairment and HRQoL. A comprehensive literature search was conducted across PubMed/MEDLINE, Embase, and the Cochrane Library, covering January 2000 to the present. Prospective and retrospective cohort studies, randomised trials with biomarker sub-studies, and systematic reviews were assessed for the prognostic utility of routine biomarkers and their association with long-term functional or HRQoL outcomes. This review was conducted in accordance with the Scale for the Assessment of Narrative Review Articles (SANRA) criteria. Dynamic biomarker trajectories, including lactate clearance [area under the receiver operating characteristic curve (AUROC) 0.703], PCT clearance (AUROC 0.843), and serial CRP changes (AUROC 0.903), demonstrate superior predictive performance for 28- to 30-day mortality compared with single baseline measurements. Machine learning approaches achieve AUROC values of 0.74-0.92 for mortality. Nevertheless, dedicated prognostic models targeting long-term disability remain largely absent from the literature; prospective studies formally linking early biomarker kinetics to validated functional outcomes at 6 months or beyond are sparse and methodologically heterogeneous. To address this gap, a conceptual causal framework is proposed, mapping the progression from early host immune and metabolic dysregulation to acute organ dysfunction, intermediate complications (including intensive care unit-acquired weakness), and eventual long-term disability. Although routine biomarkers are well-established tools for early sepsis prognostication, their capacity to predict long-term disability has not been formally evaluated in dedicated prospective cohorts. The proposed framework and predictor variable set offer a biological and clinical rationale for future longitudinal research directed at developing population-calibrated screening tools to facilitate early rehabilitation and structured survivorship follow-up care.
Patients with speech impairment often require specialized medical imaging procedures to diagnose and monitor underlying conditions. However, these procedures involve exposure to ionizing radiation, which can pose potential health risks. This study intended to estimate patient effective dose during fluoroscopic barium swallow examinations performed for speech and swallowing impairment and to propose a preliminary local diagnostic reference level (DRL). This retrospective observational study included 25 consecutive adult examinations performed at King Khalid Hospital, Alkharj, Saudi Arabia, during the 2-year study period. Demographic variables and exposure parameters were extracted from hospital records and dose reports. Recorded variables included age (year), sex, height (cm), weight (kg), body mass index (kg/m 2 ), fluoroscopy time (s), kerma-area product (KAP, mGy·cm 2 ), entrance surface air kerma (ESAK, mGy), and peak tube voltage (kVp). Effective dose (mSv) was estimated from KAP using an adult videofluoroscopic swallowing study conversion coefficient of 0.20 mSv/Gy·cm 2 derived from published literature. The local DRL was defined as the 75th percentile of the KAP distribution. Of the 25 examinations, 14 (56%) were performed in female patients and 11 (44%) in male patients; the mean age was 65.9 ± 20.4 years. Mean fluoroscopy time was 2.1 ± 1.0 min (range, 1.0-5.1 min), mean KAP was 102.2 ± 60.0 μGy·cm 2 (range, 25.3-330.5 μGy·cm 2 ), mean ESAK was 1.4 ± 0.9 mGy (range, 0.4-4.9 mGy), and mean effective dose was 0.20 ± 0.12 mSv (range, 0.05-0.70 mSv). The proposed local DRL was 1.18 Gy·cm 2 (118 μGy·cm 2 ). Effective dose showed a moderate positive correlation with fluoroscopy time ( r = 0.42) and a very strong positive correlation with ESAK ( r = 0.95). Fluoroscopic barium swallow examinations in this cohort were associated with relatively low effective dose, although measurable variability existed across examinations. These findings provide baseline local data for dose optimization and support the use of KAP-based DRLs for quality assurance in swallowing fluoroscopy.
Sickle cell disease (SCD) causes chronic anaemia, haemolysis, and recurrent vaso-occlusion, leading to cardiopulmonary complications that contribute to physical disability and reduced quality of life. This systematic review evaluated how medical imaging detects cardiopulmonary abnormalities associated with functional limitations in patients with SCD. A search of PubMed, Scopus, Web of Science, and ScienceDirect for 2020-2026 identified 239 records; after duplicate removal, 123 articles were screened, and 17 peer-reviewed studies met the inclusion criteria. Eligible studies enrolled patients with any SCD genotype, used a cardiopulmonary imaging modality, and reported at least one functional, exercise, oxygenation, or morbidity outcome measure. Echocardiography was the most used imaging modality (16/17 studies), whereas cardiac magnetic resonance and dual-energy computed tomography were used less frequently. Tricuspid regurgitant velocity, ventricular morphology, and tissue Doppler indices were the most frequently assessed parameters. The strongest evidence linked pulmonary hypertension, elevated tricuspid regurgitant velocity, right ventricular dysfunction, and left ventricular hypertrophy with reduced 6-min walk distance, oxygen desaturation, impaired pulmonary function, and mortality. Intervention studies have shown that cardiopulmonary imaging metrics may improve after arginine therapy, exercise training, or haematopoietic cell transplantation. Furthermore, serial imaging helps monitor therapeutic response, disease progression, and cardiopulmonary remodelling following interventions such as hydroxyurea therapy, chronic transfusion, or haematopoietic cell transplantation. Direct physical disability instruments were rarely used; most studies relied on exercise capacity, hypoxemia, functional class, or hospitalisation as proxies. Overall, medical imaging provides critical prognostic and functional information on SCD. Future research should standardise combined imaging–function protocols and include validated patient-reported disability measures to strengthen the evidence for clinical decision-making.
