Plantar tissue adaptation during activity is thought to contribute to diabetic foot ulceration (DFU), yet most existing studies only measure compressive quasi-static properties. This pilot study developed an ultrasound-loadcell measurement tool, PlantarSense , and used an infrared thermometer to measure dynamic compressive and shear energy dissipation ratio (EDR) and temperature of plantar-tissue at the first metatarsal head (1stMTH) and calcaneus in people living with and without diabetes at baseline, post-walk, and post-recovery. People living with diabetes showed significantly greater post-walk temperature increases (11.0 % vs 6.9% in controls at calcaneus, p=0.03) and less complete thermal recovery than controls. Baseline compressive EDR at the 1stMTH was significantly higher in people living with diabetes (67.8% vs 56.0% in controls, p=0.04). EDR modulation was greater from shear loading (21.5%) than compression (5.4%) and post-walk induced reductions in EDR were present in all participants, but people living with diabetes showed a 20% lower recovery than controls. Impaired thermoregulation and tissue adaptation in people living with diabetes was demonstrated by plantar temperature and EDR differences in post-walk and post-recovery. Future work is needed to test more participants with a greater range of diabetes progression to quantify statistically significant plantar tissue differences to inform DFU risk management.

Background: The Activity Time-Use Intervention (ATUS) is a novel occupational therapy theory informed intervention for adolescents with emerging mental health difficulties. Designed to empower 16- and 17-year-olds to reflect on their time use to achieve a healthier balance of activity within the context of their daily lives. Acceptability to healthy adolescents is explored in preparation for testing with the more vulnerable target population.Aim: To explore the acceptability of the ATUS intervention to healthy adolescents when delivered in a mainstream secondary school.Method: A pragmatic, non-randomised, mixed-method, pre- and post-, single-group, exploratory study. Analysis involved descriptive statistics and template analysis informed by Sekhon's theoretical framework of acceptability.Results: The ATUS was successfully delivered to healthy students. Nineteen sub-themes were identified based on the seven constructs of Sekhon's theoretical framework of acceptability. Feedback was positive, highlighting areas for modification. Online completion of measures ranged from 17 to 99.4% and took on average 12 minutes to complete. Change in well-being scores was most frequently observed.Conclusion: The ATUS is deliverable and acceptable to healthy adolescents; however, some components should be reviewed before delivering in the target population, and further work is required before feasibility testing.

ABSTRACT Objective To examine associations between volume and intensity of leisure time physical activity (LTPA) and fracture risk during mid-life and determine whether adherence to World Health Organization (WHO) physical activity recommendations was associated with fracture risk. Methods Cross-sectional analysis of UK Biobank participants aged 40–65 years using self-reported physical activity and fracture data. LTPA volume (LTPA V ) was derived from walking, moderate and vigorous activity. Participants were categorised into LTPA V quintiles and by adherence to WHO physical activity recommendations. Multivariable logistic regression examined associations with self-reported fracture within the previous five years, with sex stratified analyses. Results Among 322,749 participants, 53% were female with a mean age of 47 years. Fracture risk increased with higher LTPA V , although the association was non-linear and varied by age and sex. The strongest associations were in the highest quintile among men and women aged 40–49 years (OR 1.81, 95% CI 1.64–1.99 and OR 1.42, 95% CI 1.28–1.58 respectively). In mutually adjusted models, vigorous activity demonstrated the strongest independent association with fracture risk. Meeting WHO physical activity recommendations, without exceeding them, was not associated with increased fracture risk. Conclusions Higher fracture risk was observed in individuals undertaking higher volumes of leisure-time physical activity, with the association largely driven by vigorous-intensity activity. The association was strongest in adults aged 40–49 years and in men. Physical activity consistent with current WHO recommendations was not associated with increased fracture risk, supporting continued promotion of physical activity during mid-life. Summary Box What is already known on this topic Leisure-time physical activity (LTPA) has established health benefits but may also increase fracture risk, particularly at higher activity levels. Whether fracture risk differs according to age, sex, activity volume and intensity remains unclear. What this study adds Higher volumes of LTPA were associated with increased fracture risk, but this was confined to individuals undertaking the highest activity volumes and was strongest in men. Vigorous activity showed the strongest independent association with fracture risk, whereas activity levels consistent with current WHO recommendations were not associated with increased fracture risk in either sex. How this study might affect research, practice or policy These findings support continued promotion of WHO-recommended physical activity during mid-life, including around the menopause. For highly active individuals, future guidance may need to consider not only activity volume but also how vigorous activity is accumulated to reduce injury and fracture risk.

Background:Fatigue is common in many long-term medical conditions. Interventions to date have largely been in single conditions. Objective:To conduct a mixed-methods evidence synthesis of the clinical and cost-effectiveness and acceptability of non-pharmacological interventions for fatigue in adults with long-term medical conditions. Methods:Randomised controlled trials, cost-effectiveness studies, or qualitative studies of non-pharmacological interventions for fatigue in long-term medical conditions where fatigue was either a criterion for inclusion, the primary target of the intervention, or the primary or coprimary outcome. Studies of post-infectious, post-traumatic, cancer-related or idiopathic fatigue were excluded. Information sources:Searches used the MEDical Literature Analysis and Retrieval System, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature, and American Psychological Association PsycInfo® (American Psychological Association, Washington, DC, USA) databases. We used systematic CLUSTER searching for qualitative studies and Epistemonikos for systematic reviews. Involvement of patients:We held three rounds of five focus groups involving people with fatigue in long-term conditions to ensure that assumptions in, and reporting of, the research had validity with the patient population. Risk of bias:Risk-of-bias assessment of all studies included in the network meta-analysis was undertaken using an adapted version 2 of the Cochrane risk-of-bias tool for randomised controlled trials. Synthesis of results:Clinical effectiveness evaluation used random effects network meta-analyses at three time points. The cost-effectiveness analysis involved a de novo analysis of interventions identified as clinically effective. The qualitative synthesis involved a thematic synthesis of primary studies of interventions and a mega-synthesis of reviews of patient experience of fatigue across different conditions. Focus groups were analysed by thematic analysis, and findings from all work packages were integrated in a final synthesis by the research team. Results:The clinical effectiveness review included 88 randomised controlled trials, involving 27 interventions, with 6636 participants included at end of treatment, 1849 in the short term and 2322 in the long term. Synthesis of results:Compared to usual care at long-term follow-up, cognitive-behavioural therapy-based interventions and physical activity promotion showed statistically significant reductions in fatigue (standardised mean difference -0.4, 95% credible interval -0.63 to -0.21, 9 studies; and -0.52, -0.86 to -0.18, 2 studies), respectively. Effective interventions provided positive net monetary benefit versus usual care, particularly when delivered in a group format, when valuing a quality-adjusted life-year at £20,000. Individuals vary in their experience of fatigue in ways that are not simply due to their medical condition, indicating that interventions need to be adaptable to individuals' experiences and capabilities. Discussion:The evidence base is relatively small, heterogeneous and includes studies at moderate to high risk of bias. More than half of the included trials were in multiple sclerosis. Interpretation:Interventions for fatigue that support people to increase physical activity or are based on cognitive-behavioural therapy are acceptable and effective in reducing fatigue in people with different long-term medical conditions, with the potential to be cost-effective. Based on the qualitative synthesis, we propose a three-stage component model for interventions. Future work:Future trials should focus on the feasibility and effectiveness of transdiagnostic fatigue services, fatigue interventions in multimorbidity, and investigations of emerging non-invasive stimulation interventions. Funding:This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR154660.

Abstract Background Transcranial direct current stimulation (tDCS) is increasingly used as an adjunct to rehabilitation for young people with cerebral palsy (CP), yet considerable variability exists in clinical response. Individualised electric field modelling provides an opportunity to estimate the distribution of electrical fields generated by the stimulation delivered to the brain and explore potential relationships with functional outcomes. Methods Structural MRI scans from nineteen participants (10-16 years) from a previously published randomised controlled trial ( ISRCTN74235136 ) investigating the effects of tDCS combined with motor training, underwent participant-specific finite element modelling using SimNIBS. Electric field strength was quantified within anatomically defined motor regions of interest, including the primary motor cortex (M1), dorsal premotor cortex (PMd), supplementary motor area (SMA), and a combined motor network. Global grey matter electric field metrics and stimulation focality were also extracted. Results Estimated electric field strength differed significantly across motor regions (p<0.001), with PMd receiving significantly greater stimulation than both M1 and SMA. Electric field strength within a control region (primary visual cortex) was significantly lower than within M1 (p<0.001). Despite inter-individual variability in regional and global electric field metrics, no significant associations were observed between estimated electric field strength or focality and changes in function following intervention. Conclusion Individualised electric field modelling demonstrated that an M1-targeted tDCS montage preferentially stimulated PMd rather than M1 in young people with CP. These findings highlight the importance of subject-specific modelling when characterising current distribution and suggest that variability in electric field strength alone does not explain variability in behavioural response. Highlights Individualised modelling characterised tDCS electric fields in paediatric CP. M1-targeted tDCS produced greater electric field strength in PMd than M1. Motor regions received greater electric field strength than control visual cortex. Electric field strength did not predict upper- or lower-limb functional change.

Background/Objectives: Recovery of function and mobility after stroke is frequently improved through physical rehabilitation that incorporates multiple therapeutic approaches. However, access to rehabilitation services remains limited globally, particularly for individuals living in rural areas or those with restricted transportation options. These barriers highlight the need to explore technology-enabled approaches to delivering rehabilitation care, including telerehabilitation interventions. This study aimed to explore the experiences and perspectives of people with stroke, their carers, and physiotherapists toward the development and implementation of telerehabilitation interventions after stroke in Saudi Arabia. Methods: Semi-structured interviews were conducted with six people with stroke and their carers and ten physiotherapists between March 2025 and July 2025. Purposive sampling was employed, and reflexive thematic analysis was used. Results: Three themes were identified. The first theme focused on self-efficacy in the use of telerehabilitation, emphasising the barriers that influence it and what is required to enhance self-efficacy and confidence. The second theme related to motivation to use and engage in telerehabilitation was shaped by various barriers and strategies that promote motivation. The final theme explored cultural aspects and approaches that affect self-efficacy and motivation and support the use and implementation of telerehabilitation interventions in clinical practice. Conclusions: Telerehabilitation adoption for people with stroke in Saudi Arabia is influenced by self-efficacy and motivation, which are shaped by cultural factors and barriers such as digital inequity, limited awareness, insufficient training, cultural norms, and preference for in-person care. However, with appropriate training, family involvement, culturally sensitive approaches, and hybrid models, telerehabilitation can support continuity of rehabilitation.

Physical activity (PA) levels in young people with cerebral palsy (YPwCP) remain consistently low. Previous research suggests that fitness parameters such as muscular strength and cardiovascular capacity are interrelated with mobility and PA levels in YPwCP. This study aimed to (1) describe fitness parameters and PA levels in YPwCP, (2) explore associations between fitness parameters and PA, and (3) evaluate the reliability of accelerometer-based PA measurement.

Objectives To evaluate the feasibility, clinical effectiveness, and economic impact of the EvolvRehab MoveWell virtual therapy through an AI-based system and real-time feedback in community stroke rehabilitation services. Design The study was structured into 2 stages: an initial codesign phase and a feasibility clinical trial. The trial used a before-and-after 6-week longitudinal study design to assess the system's impact. Setting The research was conducted across 5 NHS community stroke services in England, supplemented by recruitment from stroke support groups and local charities. Participants Fifty-five people with chronic stroke (aged 63.5±16y) were recruited between May 2023 and February 2024, with 50 completing the outcome measures collection. Thirty-seven patients were recruited from 5 NHS community stroke services in England, and 18 participants were recruited from the communities, including stroke support groups and local charities. A total of N=15 participants were interviewed and provided feedback. Interventions Participants completed a 6-week virtual rehabilitation program. A certified physiotherapist assessed their performance at baseline and week 6. The system included a range of exercises and exergames designed to improve upper limb function through virtual therapy sessions. Main Outcome Measures Fugl-Meyer Assessment scores for upper extremity motor function, feasibility and acceptability of telerehabilitation method, and participant feedback. Results Clinical outcome: Fugl-Meyer Assessment results showed significant improvements in upper extremity motor function, with mean scores ± SD increasing from 22.54±6.69 at baseline to 24.78±6.78 at 6 weeks (P<.001). Feasibility: A high completion rate (91%) for outcome measure collection was achieved with an average of 17.6±18.4 sessions, an average of 1449±2108 repetitions executed, and average activity time of 211.2±320.9 minutes, indicating strong feasibility for future trials. Stakeholder Feedback: Interviews with patients, carers, and therapists identified both benefits, such as improved mobility and confidence, and challenges, including technical issues and setup difficulties. Conclusions The EvolvRehab MoveWell system shows potential for supporting stroke rehabilitation in community settings, demonstrating significant clinical improvements and high feasibility. However, further research is necessary to establish its long-term clinical and economic benefits. Disclosures none.

Handwriting impairment is a cardinal symptom of Parkinson’s. However, treatment options are limited. Here we evaluate the utility and estimate effects of a novel low-resource handwriting intervention (Clinicaltrials. gov NCT03369587). Forty-eight people with Parkinsons with self-reported handwriting problems were recruited to an exploratory, assessor-blind two-arm parallel randomized trial to either diverging (n = 24, n = 19 analysed) or parallel (n = 24, n = 20 analysed) groups. Both received a six-week, five times a week, handwriting program: writing a daily diary on lined paper (diverging: 10 mm increasing to 13 mm apart, parallel: 10 mm apart). Outcomes were measures of impairment (cursive ‘el’, single and dual-task), handwriting function (sentence and free writing) and self-reported difficulties. Median diary entries (31, IRQ: 17.5–39) were greater than requested (30) with no differences between groups, p = 0.302. No adverse events were reported. Regardless of group, improvements were found in writing ‘el’ speed (single task: d = −0.90, 95% CI: −1.41: −0.38, p = 0.001; dual task: d = −0.72, 95% CI: −1.24: −0.21, p = 0.09) and amplitude (single task: d = 1.07, 95% CI: 0.49: 1.66, p < 0.001; dual task: d = 0.86, 95% CI: 0.35: 1.37, p = 0.002). Sentence amplitude (d = 0.80, 95% CI: 0.30: 1.29, p = 0.003) and perceived difficulties also improved (OR = −3.6, 95% CI: −12.6: −1.0, p = 0.047). Between-group effects were small (d = 0.11 to 0.48). Large improvements to handwriting, which required less attention, were found after self-directed well-adhered-to practice. Potential additional benefits of exaggerated cueing were small.

Background: Parkinson’s disease (PD) affects both motor and non-motor functions, but their interactions are understudied. This study aims to explore the relationships between non-motor and motor effects of PD, focusing on depression, fatigue, gait parameters, concentration, and physical function. Methods: This is a secondary analysis of baseline data from a randomized feasibility study using a commercially available Heel2Toe™ sensor, providing auditory feedback for gait quality. The sample included PD patients with gait impairments who walked without aids. Non-motor measures were depression, fatigue, and concentration, while motor measures included gait quality (angular velocity and variability during heel strike, push-off, foot swing) and physical function (6MWT, Mini-BESTest, Neuro-QoL). Path analysis was used to assess direct and indirect effects. Results: Among 27 participants, fatigue impacted heel strike, which affected Neuro-QoL. Mood influenced push-off and Neuro-QoL, with a direct link to 6MWT. Foot swing affected Mini-BESTest and Neuro-QoL directly. Conclusions: Non-motor PD effects directly influenced specific gait parameters and physical function indicators, highlighting potential digital biomarkers of fatigue and mood for targeted interventions.

PURPOSE:Using systematic review methodology, we set out to describe the evidence for physical activity and nutrition interventions for children and adolescents with cerebral palsy (CP) as compared with no intervention or exposure that reports physical health and cognitive outcomes. METHOD:Quantitative, primary studies that explored the effectiveness of these interventions, replicable in school and home contexts, in comparison to any other or no intervention or exposure in children and adolescents between the ages of 6-18 years old with a diagnosis of cerebral palsy were included (PROSPERO CRD42022322143). Risk of bias was assessed by Joanna Briggs Institute and QualSyst. RESULTS:A total of 16 international heterogeneous studies (13 physical activity and 3 nutrition) with interventions ranging from a single exposure to 8 months, with quality 58% to 89% and effectiveness, D = 0.03 to 0.97, were included. Outcome measures were varied. CONCLUSION:The review brings together a number of high-quality studies on physical activity and nutrition interventions and promising findings of impact on cardiovascular, musculoskeletal, and cognitive outcomes. Evidence supports implementation of these interventions in community contexts. Future research would benefit from agreement on the use of core outcome measures for meta-synthesis.

ObjectiveThis study adopted a novel approach to exploring the content validity, safety, usability, and user experiences of different games for telerehabilitation purposes from the perspective of physiotherapists and stroke survivors.DesignA cross-sectional content validity and usability study.SettingLab and online.Participants23 participants were recruited; 11 neuro-physiotherapists and 12 chronic stroke survivors.OutcomesContent validity and safety were assessed using a bespoke state evaluation questionnaire. The usability was evaluated using the system usability scale (SUS) and user experience questionnaire (UEQ). House of Quality analysis was conducted to identify the priority aspects for improvement.ResultsPhysiotherapists perceived the usability of the games as good to excellent for three games, median SUS = 80%, and poor for two games SUS < 68%. Three games had a mean average content validity index (CVI) > 0.8, and all games were safe to be administrated at home; mean CVI-safety item = 0.90. Stroke survivors with Fugl-Meyer Assessment of Upper Extremity function mean (SD) = 41(19.4), and mild to moderate spasticity perceived usability as very good to excellent for four games (median SUS = 85%). UEQ scale showed good to excellent acceptance among most of the games. House of Quality analysis revealed that clear instructions, avatar quality, motivational exercise scenarios, and clinical assessment tools are important criteria that should be considered throughout the development.ConclusionThis study demonstrated the value of exploring patient and physiotherapist perspectives for better telerehabilitation interventions co-development. Clinical trials should be conducted after further refinement of the games to investigate their feasibility and potential efficacy as a telerehabilitation tool for arm and balance training.

OBJECTIVE:We aimed to examine the extent to which current perceived demand for energy and affect predict subsequent physical activity and fatigue in people with Long Covid using an intensive longitudinal method (ecological momentary assessment). METHODS:Analysis of data from a study of 69 adults with self-reported Long Covid combining 3-hourly self-report data perceived energy, and fatigue, on a smartphone app with continuous physical activity recording. We tested three hypotheses derived from cognitive behavioural and neuroscientific models of fatigue. These related to expectation, current affect and recalled emotional demand. Analysis used linear mixed effects models with fatigue and physical activity as outcomes. RESULTS:Expectation of energy need for the next 3 h was predictive of physical activity, fatigue and recalled demandingness of the period. (p-values 0.005 to <0.0001). Currently feeling positive was predictive of slightly more subsequent physical activity and less fatigue 3 h later (p = 0.01). Feeling negative was not predictive of physical activity or subsequent fatigue but was predictive of subsequent recall of the period being emotionally demanding. Feeling more anxious was predictive of greater fatigue 3 h later (p = 0.001) but not of reduced physical activity. Absolute effects were small: a one-point increase in anticipated demand (on a scale of 1-7) was associated with an extra 2.2 min of moderate or vigorous physical activity and a one standard deviation increase in anxiety was associated with a one-point increase in fatigue (0-100 scale). CONCLUSION:In the day-to-day experience of Long Covid expectation and affect have little detectable effect on subsequent physical activity or fatigue.

PurposeTo explore the perceptions and experiences of children and young people with Demyelinating Syndromes (DS) in living with the condition and maintaining a healthy lifestyle.Materials and methods16 young people with DS took part in semi-structured interviews investigating their perceptions of weight gain, exercise, diet, health, and lifestyle. Interviews were conducted virtually, audio-recorded, and transcribed. Inductive thematic analysis was employed for data analysis. Rigour and credibility were established through detailed immersion, reflexivity and inter-researcher triangulation.FindingsFive overarching themes were identified: 1) the influence of the diagnosis and condition on the young person's wellbeing, 2) the implication of the treatment, access to services and effects of steroids, 3) the interplay between Physical Activity (PA), diet, lifestyle and DS, 4) challenges to identity and selfhood, and 5) the impact of family and peer support on how the young person navigates their condition.ConclusionsDiagnosis and treatment appeared to produce a multitude of intersecting effects on the young people interviewed with drastic implications for PA and lifestyle. Those who maintained or improved their PA levels were able to manage their disease course more effectively, despite a lack of information or guidance on PA, nutrition or lifestyle.

Objectives This study aims to provide an in-depth analysis of the symptoms, coexisting conditions and service utilisation among people with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID. The major research questions include the clustering of symptoms, the relationship between key factors and diagnosis time, and the perceived impact of National Institute for Health and Care Excellence (NICE) guidelines on patient care.Design Cross-sectional survey using secondary data analysis.Setting Community-based primary care level across the UK, incorporating online survey participation.Participants A total of 10 458 individuals responded to the survey, of which 8804 confirmed that they or a close friend/family member had ME/CFS or long COVID. The majority of respondents were female (83.4%), with participants from diverse regions of the UK.Primary and secondary outcome measures Primary outcomes included prevalence and clustering of symptoms, time to diagnosis, and participant satisfaction with National Health Service (NHS) care, while secondary outcomes focused on symptom management strategies and the perceived effect of NICE guidelines.Results Fatigue (88.2%), postexertional malaise (78.2%), cognitive dysfunction (88.4%), pain (87.6%) and sleep disturbances (88.2%) were the most commonly reported symptoms among participants with ME/CFS, with similar patterns observed in long COVID. Time to diagnosis for ME/CFS ranged widely, with 22.1% diagnosed within 1–2 years of symptom onset and 12.9% taking more than 10 years. Despite updated NICE guidelines, only 10.1% of participants reported a positive impact on care, and satisfaction with NHS services remained low (6.9% for ME/CFS and 14.4% for long COVID).Conclusions ME/CFS and long COVID share overlapping but distinct symptom clusters, indicating common challenges in management. The findings highlight significant delays in diagnosis and low satisfaction with specialist services, suggesting a need for improved self-management resources and better-coordinated care across the NHS.

PURPOSE:Cerebral Palsy (CP) is the commonest cause of childhood motor disability. Transcranial direct current stimulation (tDCS) is a promising adjuvant therapy, but research targeting upper and lower limbs simultaneously is needed. We aimed to pilot tDCS with upper/lower limb motor training, estimate the potential effect on motor function, and investigate brain imaging correlates of function. MATERIALS AND METHODS:Participants (10-16 years) with CP affecting upper and/or lower limbs were randomised (online software) to 10 sessions of active (n = 14) or sham (n = 13) tDCS combined with motor training. The primary outcomes were upper and lower limb function assessed at 1-week post-intervention using the Jebson Taylor hand function (JTT) and Timed Up and Go (TUG) tests. Secondary, imaging outcomes included baseline tractography, grey matter volume, and resting state connectivity. RESULTS:Adherence was good: 74% completed all intervention sessions, 100% completed the primary outcome assessment. There were no between-group differences (1-week post-intervention, intention-to-treat; group-by-time JTT: F(1,25)=1.189,p = 0.286, partial-eta-squared = 0.05; TUG: F(1,25)=1.605,p = 0.217, partial-eta-squared = 0.06). Imaging showed subtle associations between better JTT at baseline and higher grey matter volume (caudate nucleus) and stronger sensorimotor resting state connectivity. CONCLUSIONS:The trial was well tolerated, but effect sizes were small. Larger studies are needed to further explore tDCS for CP.

We go beyond cross-sectional studies of executive functioning (EF) to investigate intraindividual dynamics of accuracy and response-times. Forty-three 8-11 year-old children (Mage = 9 years 11 months, 51.2 % boys) completed the Mixed block (including both congruent and incongruent trials) of the Hearts and Flowers task on tablets twice per school-day during two weeks (nti = 651). Specifying Residual Dynamic Structural Equation Models (RDSEM) novel findings emerged. Children became less accurate and respond faster over time. Both state-accuracy and state-response-time were relatively stable over time. State-accuracy-on-response-time-slopes showed that children with a relatively lower trait-accuracy performed more accurately when they slowed down. In contrast, children with a relatively higher trait-accuracy performed at the same level of accuracy regardless whether they accelerated or decelerated. An intraindividual approach to EF provides an important window into the children's accuracy-speed trade-off and cognition in a naturalistic school context. Educational relevance: While developmental trends of children's executive functions and between-person differences are relatively well established in the literature, we know less about the processes from situation to situation in everyday learning environments. For learning, children rely on their self-monitoring and self-regulation to adjust their pace in learning contexts, for example slowing down for new topics, or speeding up for known contents. Teachers monitor children's accuracy both as immediate and longer-term outcomes, and can provide feedback to them in case they need to slow down, or nudge them to speed up in learning situations. In order to understand how children regulate this speed/accuracy trade-off from one lesson to another, from one day to another, we investigated how their executive functions (EF) unfolded during lessons and days at school. In particular, we investigated the dynamics between accuracies (how correctly they responded) and response times (how fast they responded) when they completed the Mixed bock of the Hearts and Flowers executive function task up to twice a day for ten school days. Importantly we found when children with lower overall accuracy performed more accurately when they slowed down, while speed had no impact on the accuracy of children with higher overall accuracy. This speed/accuracy trade-off is as important for learning tasks at school as it is for completing EF tasks. Understanding how this speed/accuracy trade-off ebbs and flows lesson-to-lesson and dayto-day for different children gives unique insights into variability in cognitive capacities that teachers encounter each lesson. It is in this situation-to-situation context that teachers interact with, get involved with, dedicate resources to, and provide support to children depending on their need for slowing down or speeding up.

Purpose: Myalgic Encephalomyelitis (ME) is a "complex, acquired multi-systemic disease with a profound dysfunction /dysregulation of the neurological control system" affecting >250,000 people in the UK, this compares to 100,000 people with Multiple Sclerosis and Parkinson's Disease. Although the causative mechanisms are unclear, most cases are triggered by a viral infection including COVID19. With cases of LongCOVID estimated to be over 2 million in the UK and evidence showing that ~50% of people with LongCOVID will develop ME potentially the numbers of people with ME (PwME) could soon double.

Purpose: Aim: To determine whether there is a link between child-reported perception of hand function and objectively measured hand function following an intensive physiotherapy intervention in children with Cerebral Palsy.