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Abstract Background Total knee arthroplasty (TKA) successfully alleviates pain from knee osteoarthritis, but muscle strength and function are reduced for a long period postoperatively. Postoperative active resistance exercise may play a relevant role. Purpose To systematically evaluate effects of lower-limb active resistance exercise (ARE) on mobility, physical function, muscle strength and pain intensity in patients with TKA. Methods A search was conducted in PubMed, EMBASE, and Cochrane Library databases from inception to September 2023. Only randomized controlled trials (RCTs) that compared the effects of ARE and no intervention or other rehabilitation program without PRE were included. The outcome variables were mobility (Maximal walking speed [MWS]/6-Minute Walk Test[6MWT]), physical function (Stair Climb Test [SCT]/Timed Up and Go [TUG]), knee extension/ flexion power(KEP/KFP), joint range of motion (ROM) and pain. Standardized Mean Differences (SMD) or Mean Differences (MD) and 95% confidence intervals (CI) were calculated and combined in meta-analyses. The Cochrane Collaboration’s Handbook were used for the methodological quality assessments. GRADE was used to assess the quality of evidence. The meta-analysis was performed using the RevMan 5.4 software. Results A total of 14 randomized controlled trials, involving 880 patients, were finally included. The lower-limb ARE exhibited significantly greater improvement in MWS (MD 0.13, 95%CI 0.08–0.18, P

Abstract Introduction The use of visual and proprioceptive feedback is a key property of motor rehabilitation techniques. This feedback can be used alone, for example, for vision in mirror or video therapy, for proprioception in focal tendon vibration therapy, or in combination, for example, in robot-assisted training. This Electroencephalographic (EEG) study in healthy subjects explored the distinct neurophysiological impact of adding visual (video therapy), proprioceptive (focal tendinous vibration), or combined feedback (video therapy and focal tendinous vibration) to a motor imagery task. Methods Sixteen healthy volunteers performed 20 mental imagery (MI) tasks involving right wrist extension and flexion under four conditions: MI alone (IA), MI + video feedback observation (IO), MI + vibratory feedback (IV), and MI + observation + vibratory feedback (IOV). Brain activity was monitored with EEG, and time-frequency neurophysiological markers of movement were computed. The emotions of the patients were also measured during the task. Results In the alpha band, we observed bilateral ERD in the visual feedback conditions (IO, IOV). In the beta band, the ERD was bilateral in the IA, IV and IOV but more lateralized in the IV and IOV. After movement, we observed strong ERS in the IO and IOV but not in the IA or IV. Embodiment was stronger in conditions with vibratory feedback (IOV > IV > IA and IO) Conclusion Conditions with visual feedback (IO, IOV) recruit the mirror neurons system (alpha ERD) and provide more accurate feedback of the task than IA and IV, which triggers motor validation pathways (beta rebound analysis). Vibratory feedback enhances the recruitment of the left sensorimotor areas, with a synergistic effect in the IOV (beta ERD analysis), thus maximizing embodiment. Visual and vibratory feedback recruits the sensorimotor cortex during motor imagery in different ways and can be combined to maximize the benefits of both techniques Trial registration https://clinicaltrials.gov/study/NCT04449328 .

Abstract Background Digital health technologies are increasingly used by healthcare professionals working in pediatric hospital and rehabilitation settings. Multiple factors may affect the implementation and use of digital health technologies in these settings. However, such factors have not been identified in a multidisciplinary, pediatric context. The objective of this study was to describe actual use and to identify the factors that promote or hinder the intention to use digital health technologies (mobile learning applications, virtual/augmented reality, serious games, robotic devices, telehealth applications, computerized assessment tools, and wearables) among pediatric healthcare professionals. Methods An online survey evaluating opinions, current use, and future intentions to use digital health technologies was completed by 108 professionals at one of Canada’s largest pediatric institutes. Mann-Whitney U tests were used to compare the attitudes of healthcare professionals who intend to increase their use of digital health technologies and those who do not. Linear regression analyses were used to determine predictors of usage success. Results Healthcare professionals reported mostly using mobile and tablet learning applications (n = 43, 38.1%), telehealth applications (n = 49, 43.4%), and computerized assessment tools (n = 33, 29.2%). Attitudes promoting the intention to increase the use of digital health technologies varied according to technology type. Healthcare professionals who wished to increase their use of digital health technologies reported a more positive attitude regarding benefits in clinical practice and patient care, but were also more critical of potential negative impacts on patient-professional relationships. Ease of use (β = 0.374; p = 0.020) was a significant predictor of more favorable usage success. The range of obstacles encountered was also a significant predictor (β = 0.342; p = 0.032) of less favorable evaluation of usage success. Specific factors that hinder successful usage are lack of training (β = 0.303; p = 0.033) and inadequate infrastructure (β = 0.342; p = 0.032). Conclusions When working with children, incorporating digital health technologies can be effective for motivation and adherence. However, it is crucial to ensure these tools are implemented properly. The findings of this study underscore the importance of addressing training and infrastructure needs when elaborating technology-specific strategies for multidisciplinary adoption of digital health technologies in pediatric settings.

Abstract Background National guidance recognises the key role of rehabilitation in improving outcomes for people living with chronic kidney disease. Implementation of this guidance is reliant upon an adequate and skilled rehabilitation workforce. Data relating to this is currently lacking within the UK. This survey aimed to identify variations and good practices in kidney physiotherapy (PT), occupational therapy (OT) and clinical exercise physiologist (CEP) provision; and to understand barriers to implementation. Methods An online survey was sent to all 87 UK kidney units between June 2022 and January 2023. Data was collected on the provision of therapy services, barriers to service provision and responses to the COVID-19 pandemic. The quantitative survey was analysed using descriptive statistics. Free-text responses were explored using reflexive thematic analysis. Results Forty-five units (52%) responded. Seventeen (38%) units reported having a PT and 15 (33%) an OT with a specialist kidney role; one unit (7%) had access to a CEP. Thirty units (67%) offered inpatient therapy services, ten (22%) outpatient therapy clinics, six (13%) intradialytic exercise, six (13%) symptom management and three (7%) outpatient rehabilitation. Qualitative data revealed lack of money/funding and time (both n = 35, 85% and n = 34, 83% respectively) were the main barriers to delivering kidney-specific therapy. Responders saw an increase in the complexity of their caseload, a reduction in staffing levels and consequently, service provision during the COVID-19 pandemic. Exemplars of innovative service delivery, including hybrid digital and remote services, were viewed as positive responses to the COVID-19 pandemic. Conclusion Despite clear evidence of the benefits of rehabilitation, across the UK, there remains limited and variable access to kidney-specific therapy services. Equitable access to kidney-specific rehabilitation services is urgently required to support people to ‘live well’ with kidney disease.

Abstract Background Understanding the patient perspective of frailty is critical to offering holistic patient-centred care. Rehabilitation strategies for patients with advanced chronic kidney disease (CKD) and frailty are limited in their ability to overcome patient-perceived barriers to participation, resulting in high rates of drop-out and non-adherence. The aim of this study was to explore patient perspectives and preferences regarding experiences with rehabilitation to inform a CKD/Frailty rehabilitation model. Methods This qualitative study involved two focus groups, six individual semi-structured interviews and three caregiver semi-structured interviews with lived experience of advanced kidney disease and frailty. Interviews were recorded, transcribed, and coded for meaningful concepts and analysed using inductive thematic analysis using constant comparative method of data analysis employing Social Cognitive Theory. Results Six major themes emerged including accommodating frailty is an act of resilience, exercise is endorsed for rehabilitation but existing programs have failed to meet end-users’ needs. Rehabilitation goals were framed around return to normative behaviours and rehabilitation should have a social dimension, offering understanding for “people like us”. Participants reported on barriers and disruptors to frailty rehabilitation in the CKD context. Participants valued peer-to-peer education, the camaraderie of socialisation and the benefit of feedback for maintaining motivation. Patients undertaking dialysis described the commodity of time and the burden of unresolved symptoms as barriers to participation. Participants reported difficulty envisioning strategies for frailty rehabilitation, maintaining a focus on the immediate and avoidance of future uncertainty. Conclusions Frailty rehabilitation efforts in CKD should leverage shared experiences, address comorbidity and symptom burden and focus on goals with normative value.

Abstract Health equity is a fast emerging priority for most healthcare systems around the world. Factors impacting health equity include education level, geographical location, age, gender, employment status and income. However, research examining the effect of these demographic variables on health service utilisation among mid-aged and older post-stroke adults is limited. Data was obtained from a sub-study of the Sax Institute’s 45 and Up Study, which is conducted in Australia. The sub-study survey collected demographic, health service utilisation and health status information from 576 participants who had a previous stroke diagnosis. Poisson regression was used to examine the association between demographic characteristics and number of consultations with a doctor and/or an allied health practitioner over a 12 month period. All demographic measures were significantly associated with the number of consultations with doctors and/or allied health practitioners. The number of doctor consultations increased for those who struggled to live on their available income (IRR = 1.41), but decreased for females (IRR = 0.81), those who reside in an inner regional area (IRR = 0.83), those who were separated, divorced or widowed (IRR = 0.61), and for those who completed a trade, apprenticeship or diploma (IRR = 0.83). The number of allied health practitioner consultations increased for those who completed a trade, apprenticeship or diploma (IRR = 1.27), and for those who struggled to live on their available income (IRR = 1.38), but decreased for increasing age (IRR = 0.87), females (IRR = 0.78), and for those who reside in an outer regional or remote area (IRR = 0.49). We identified several demographic factors associated with a lower frequency and type of health care services used by post-stroke adults. These possible barriers need to be explored further, as reduced use of healthcare services may lead to poorer stroke outcomes in these demographics. Specifically, researching strategies to best support individuals facing these additional challenges is necessary to ensure equitable healthcare for all Australians.

Abstract Background Family members are often affected by the long-term consequences of traumatic brain injury, but are rarely involved in rehabilitation programs in the chronic phase. We thus do not know what family members´ main concerns are in the chronic phase, what factors are associated with perceived caregiver burden, and whether family members´ health and functioning improves due to rehabilitation efforts received by the patients. This study explored family-members` functioning, predictors of caregiver burden and effect for family members of a goal-oriented intervention in the chronic phase of traumatic brain injury. Methods Family members self-reported data measuring their caregiver burden, depression, general health, loneliness, and their evaluation of patient competency in everyday life, patient awareness levels, main problem areas (target outcomes) for the patient related to the brain injury, and demographic data were collected. Regression models were used to explore predictors of caregiver burden, and mixed models analysis was used to explore treatment effects. Results In total, 73 family members were included, 39 in the intervention group and 34 in the control group. Moderate to high caregiver burden was reported by 40% of family members, and 16% experienced clinical levels of depression. Family member loneliness and their evaluation of the patient`s level of functional competency explained 57% of the variability in caregiver burden. There were no treatment-related changes in caregiver burden, family member depression or general health. At T2 there was however a significant reduction in how family members rated severity of target outcomes that the family members had nominated at baseline (-0.38, 95% CI, -0.75 to -0.02, p = 0.04), but not for the target outcomes the patients had nominated. Conclusions A significant proportion of family members to patients in the chronic phase of TBI continue to experience challenging caregiver burden and emotional symptoms. Both family member-related and patient factors contribute to caregiver burden. Interventions targeting patient complaints do not automatically alleviate family members´ burden. It is important to address social support for family members early after injury, and there is a need for more interventions specifically targeting family members´ needs. Trial registration The trial was registered at ClinicalTrials.gov, NCT03545594 on the 4th of June 2018.

This study gives information about the role of occupational therapy in improving motor function and patient satisfaction in adults with Parkinson's disease. Parkinson's is a neurodegenerative disorder that severely impacts motor skills, and while pharmacological treatments provide temporary relief, non-pharmacological interventions, such as occupational therapy are critical for long-term management. The study involved 25 participants from North Macedonia, divided into two groups: 20 receiving occupational therapy and 5 not. Data were collected using a structured questionnaire to assess therapy types, motor function improvement and satisfaction levels. Statistical analysis using ANOVA and Chi-Square tests revealed significant differences in satisfaction and motor function improvement between participants receiving OT and those who did not. The results showed that those who go through occupational therapy reported higher satisfaction and became aware of the improvements in their motor skills, accenting the effectiveness of occupational therapy. Stretching and balance exercises were the most commonly performed and participants indicated a moderate to high perceived benefit of these interventions. This study focuses on the need for integrating occupational therapy into comprehensive Parkinson’s disease management programs and suggests expanding occupational therapy services for greater accessibility. While the results are promising, further research with larger sample sizes is necessary to validate these findings and explore the long-term impact of occupational therapy in Parkinson's management.

Abstract Peripheral nerve injury (PNI) occurs due to damage of peripheral nerves, with healthcare professionals playing significant roles in PNI rehabilitation. This study aimed to explore the knowledge, attitudes, and practices (KAP) towards PNI rehabilitation among healthcare professionals. This cross-sectional study was conducted on June 2023 in China and healthcare professionals were enrolled. A total of 611 valid questionnaires were collected, with 62.52% female respondents. Mean scores for KAP were 14.26 ± 2.044 (possible range: 0–19), 29.77 ± 3.622 (possible range: 7–35), and 41.55 ± 9.523 (possible range: 11–55), respectively. Multivariate logistic regression revealed positive associations of professional titles (OR = 1.743, 95% CI: 1.083–2.804), occupation (OR = 1.833, 95% CI: 1.151–2.919), and involvement in treatment or care of PNI patients (OR = 1.462, 95% CI: 1.024–2.088) with knowledge. Knowledge (OR = 1.155, 95% CI: 1.042–1.280), gender (OR = 2.140, 95% CI: 1.255–3.646), education (OR = 2.258, 95% CI: 1.131–4.507), and involvement in treatment or care of PNI patients (OR = 2.463, 95% CI: 1.460–4.155) were positively associated with attitude. Attitude (OR = 1.214, 95% CI: 1.148–1.283), bachelor's degree education (OR = 0.548, 95% CI: 0.326–0.919), master's degree or higher (OR = 0.545, 95% CI: 0.308–0.964), having rehabilitation training for PNI (OR = 2.485, 95% CI: 1.633–3.781), and involvement in treatment or care of PNI patients (OR = 2.093, 95% CI: 1.395–3.138) were independently associated with practice. Healthcare professionals exhibited moderate knowledge, positive attitudes, and moderate practices towards the PNI rehabilitation. Those involved in the treatment or care of PNI have significantly higher KAP. Targeted interventions were needed to enhance understanding and promote proactive engagement in clinical practice.

Abstract Background The progressive aging of the population has meant the increase in elderly patients requiring an urgent surgery. Older adults, especially those with frailty, have a higher risk for complications, functional and cognitive decline after urgent surgery. These patients have their functional and physiological reserve reduced which makes them more vulnerable to the effects of being bedridden. The consequences are at multiple levels emphasizing the functional loss or cognitive impairment, longer stays, mortality and institutionalization, delirium, poor quality of life and increased use of resources related to health. We aim to determine whether postoperative physical rehabilitation can prevent functional and cognitive decline and modify the posterior trajectory. Methods/design This study is a randomized clinical trial, simple blinded, conducted in the Department of Surgery of a tertiary public hospital in Navarra (Hospital Universitario de Navarra), Spain. Patients > = 70 years old undergoing urgent abdominal surgery who meet inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent physical training programme, which will include progressive and supervised endurance, resistance and balance training for 4 weeks, twice weekly sessions with a total of 8 sessions, and the group control will receive the usual care. The primary outcome measure is the change in functional (SPPB) and cognitive status (Mini-Mental State Examination) and the change of quality of life (EuroQol-5D-VAS) during the study period. The secondary outcomes are postoperative complications, length of stay, delirium, mortality, use of health resources, functional status (Barthel Index and handgrip strength tests), cost per quality-adjusted life year and mininutritional assessment. The data for both the intervention group and the control group will be obtained at four different times: the initial visit during hospital admission and at months 1, 3 and 6 months after hospital discharge. Discussion If our hypothesis is correct, this project could show that individualized and progressive exercise programme provides effective therapy for improving the functional capacity and achieve a better functional, cognitive and quality of life recovery. This measure, without entailing a significant expense for the administration, probably has an important repercussion both in the short- and long-term recovery, improving care and functional parameters and could determine a lower subsequent need for health resources. To verify this, we will carry out a cost-effectiveness study. The clinical impact of this trial can be significant if we help to modify the traditional management of the elderly patients from an illness model to a more person-centred and functionally oriented perspective. Moreover, the prescription of individualized exercise can be routinely included in the clinical practice of these patients. Trial registration ClinicalTrials.gov Identifier: NCT05290532. Version 1. Registered on March 13, 2022.

Abstract Background Mycoplasma pneumoniae pneumonia (MPP) is responsible for 20 to 40% of all cases of pneumonia acquired by children and shows an increasing incidence year by year. The aim of this study was to investigate the expression of miR-34a in children with MPP and its diagnostic value, and further explore the relationship between miR-34a and the rehabilitation effect of children with MPP. Methods The expression level of miR-34a was detected by RT-qPCR, and the clinical value of miR-34a was analyzed by ROC analysis. In addition, the levels of IL-6, IL-18 and TNF-α in serum of children with MPP were detected by ELISA kit, and the correlation with miR-34a was analyzed. Results Elevated levels of miR-34a were observed in the serum of children with MPP, and significantly higher expression levels were observed in children with severe symptoms and poor rehabilitation. The study suggested that miR-34a has potential as a diagnostic marker for MPP in children, helping to distinguish between mild and severe cases and predicting rehabilitation from MPP in children. In addition, miR-34a expression was positively correlated with IL-6, IL-8, and TNF-α levels. Conclusions miR-34a is closely related to MPP in children and miR-34a may be used as a clinical biomarker for MPP in children.

Objectives: This scoping review allows a better understanding of current evidence regarding mirror therapy (MT) among children to help the future development of MT intervention protocol on children. Methods: PubMed, Science-Direct, Web of Science and ProQuest databases were searched from January 2005 to January 2023 for interventions within the scope of MT for children. Google Scholar was also scanned for additional resources. The process of the present study was according to guidelines of the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. The main inclusion criteria were articles in English and Persian language and peer-reviewed empirical studies of MT for children. This study charted methodological information from articles according to participant characteristics, design, intervention, and outcome measures. Results: Of 18 studies that were included in this scoping review, 17 studies were conducted in children with hemiplegic cerebral palsy, and only two studies were in other conditions. A total of 16 articles were randomized controlled clinical trials, one case study and one single subject. Meanwhile, 33 outcomes were in the body structures (BS) and functions level, and 10 outcome measures were in the activities and participation levels of the International classification of functioning. Discussion: The review indicates that in future studies, it is necessary to pay more attention to other disorders beyond hemiplegic cerebral palsy; furthermore, levels of activity and participation as the outcome need to be used more.

The occurrence of an ischemic stroke arises from the unfortunate circumstance in which a blood vessel becomes impeded or obstructed, resulting from the presence of a clot, atherosclerosis, or the narrowing of arteries. The neurology department of a 300-bed, multi-specialty tertiary teaching hospital was the site of this six-month observational study. Prescriptions for both inpatients and outpatients in the neurology unit, totalling 90, are considered according to the inclusion criteria. Patient case sheets, questionnaires, interviews, biomedical and radiological reports, and drug regimen charts are the main data sources. Acute ischemic stroke (AIS) patients are more prevalent in the over-60 age group than in the 20–35 age group. The information obtained indicates that male patients have greater effects than female ones. Furthermore, our research indicates that AIS is more common in obese and overweight people. One of the main risk factors for developing AIS is alcohol drinking, tobacco chewing, and smoking, which affect most AIS patients. Treatment options for acute ischemic stroke (AIS) include intravenous thrombolytic therapy (IVT), anti-platelet therapy, anticoagulant therapy, and adjuvant therapies using statins and drugs based on the comorbidities of the patients. This research highlights that individuals with AIS have shown higher progress when physical rehabilitation is combined with intravenous thrombolytic treatment (IVT) for patients with comorbidities. We found that the individuals who continued taking their medicine and therapy after their discharge from the hospital had better motor strength than those who stopped. Our study concludes that the integration of pharmacotherapy with physical rehabilitation yielded significant enhancements in the functional capacity of individuals affected by stroke.

Objective To evaluate the efficacy of repetitive facilitative exercise combined with low-frequency acupoint electrical stimulation therapy in the recovery of patients with upper limb motor dysfunction after stroke. Methods Sixty-two patients with upper limb motor dysfunction after stroke were divided into the observation group （n =31） and control group （n =31）. Patients in the control group were treated with conventional rehabilitation training combined with low-frequency acupoint electrical stimulation in Department of Neurology， and those in the observation group were treated with repetitive facilitative exercise besides the interventions in the control group. The efficacy of the two groups was evaluated by Fugl-Meyer Motor Assessment （FMA） scale， Modified Ashworth scale （MAS） and Modified Barthel Index （MBI） scale before treatment and at 2 weeks after treatment， respectively. Results The FMA scores after treatment were significantly higher than pre-treatment scores in two groups， the FMA scores in the observation group were significantly higher than those in the control group， and the difference of the FMA scores between pre- and post-treatment in the observation group was significantly larger compared with that in the control group （all P <0.05）. After treatment， the MAS grade was decreased compared with that before treatment in two groups， and the degree of grade decrease in the observation group was greater than that in the control group （all P <0.05）. The MBI scores after treatment were higher than those before treatment in two groups， the MBI scores in the observation group were higher than those in the control group， and the difference of the MBI scores between pre- and post-treatment in the observation group was larger than that in the control group （all P <0.05）. Conclusion Repetitive facilitative exercise combined with low-frequency acupoint electrical stimulation therapy yields high efficacy in the recovery of upper limb motor function， mitigation of muscular spasm and improvement of daily living capability after stroke.

Stroke is a common neurological disease. Post-stroke sensory disorder is one of the common complications of stroke， which has severe negative impact on motor function and activity participation of patients. Transcranial direct current stimulation （tDCS）， a technique that uses 1 to 2 mA of direct current to modulate the cerebral cortex， is non-invasive， safe and well tolerated by patients. This study elaborates on the theoretical basis and mechanism of action of tDCS in treating post-stroke sensory disturbances， and analyzes and summarizes the application of tDCS in post-stroke sensory disturbances， confirming the effectiveness of tDCS， providing strong support for further clinical research of tDCS in the field of post-stroke rehabilitation.

Abstract Background Auditory reaction time (ART) and visual reaction time (VRT) are critical for patients with stroke, especially during balance training. According to the research, most patients with stroke are fatigued at sub-maximal levels during their stroke rehabilitation. Sub-maximal physical fatigue may affect ART and VRT and impede stroke rehabilitation. Hence, it is important to study the effect of submaximal physical fatigue on ART and VRT. A pilot study on healthy adults paves the way for further research on stroke rehabilitation. The purpose of this research is to find out if submaximal physical fatigue affects ART and VRT in healthy adults. In addition, this study also determines if ART and VRT recover to baseline after 15 min of rest post-fatigue session. Furthermore, the goal is to determine whether sub-maximal physical fatigue has a greater effect on ART or VRT. Methods A repeated measures within-subject design was used in the study. Eighteen healthy participants (median age 24 years) completed two sessions of a sub-maximal fatigue protocol on a cycle ergometer until they reached a rating of perceived exertion (RPE) of 15 on a scale of 6–20. Two different fatigue sessions were conducted (one to study the effects of fatigue on ART and the other for VRT). ART or VRT was measured on computer software before (PRE), immediately after (POST-0), and 15 min after (POST-15) the sub-maximal physical fatigue protocol. Results The value of median ART increased significantly from PRE to POST-0 (P = 0.002) and it decreased significantly at POST-15 (P = 0.010). Similarly, the value of mean VRT increased from PRE to POST-0 (P = 0.001) before decreasing significantly at POST-15 (P = 0.001). There was no significant difference between the effects of submaximal fatigue on ART and VRT (P = 0.156). Conclusion Due to submaximal physical fatigue, ART and VRT were slower, but they returned to baseline after 15 min of rest. Submaximal physical fatigue had an equal impact on ART and VRT. As balance training requires quicker ART and VRT for optimal outcomes, it may be better if the physiotherapists consider a 15-min rest period between the exercise and balance training in patients with stroke.

Abstract Background Eye tracking technology not only reveals the acquisition of visual information at fixation but also has the potential to unveil underlying cognitive processes involved in learning to use a multifunction prosthetic hand. It also reveals gaze behaviours observed during standardized tasks and self-chosen tasks. The aim of the study was to explore the use of eye tracking to track learning progress of multifunction hands at two different time points in prosthetic rehabilitation. Methods Three amputees received control training of a multifunction hand with new control strategy. Detailed description of control training was collected first. They wore Tobii Pro2 eye-tracking glasses and performed a set of standardized tasks (required to switch to different grips for each task) after one day of training and at one-year-follow-up (missing data for Subject 3 at the follow up due to socket problem). They also performed a self-chosen task (free to use any grip for any object) and were instructed to perform the task in a way how they would normally do at home. The gaze-overlaid videos were analysed using the Tobii Pro Lab and the following metrics were extracted: fixation duration, saccade amplitude, eye-hand latency, fixation count and time to first fixation. Results During control training, the subjects learned 3 to 4 grips. Some grips were easier, and others were more difficult because they forgot or were confused with the switching strategies. At the one-year-follow-up, a decrease in performance time, fixation duration, eye-hand latency, and fixation count was observed in Subject 1 and 2, indicating an improvement in the ability to control the multifunction hand and a reduction of cognitive load. An increase in saccade amplitude was observed in both subjects, suggesting a decrease in difficulty to control the prosthetic hand. During the standardized tasks, the first fixation of all three subjects were on the multifunction hand in all objects. During the self-chosen tasks, the first fixations were mostly on the objects first. Conclusion The qualitative data from control training and the quantitative eye tracking data from clinical standardized tasks provided a rich exploration of cognitive processing in learning to control a multifunction hand. Many prosthesis users prefer multifunction hands and with this study we have demonstrated that a targeted prosthetic training protocol with reliable assessment methods will help to lay the foundation for measuring functional benefits of multifunction hands.

Abstract Background This retrospective study characterizes clinical profiles and evolution of elderly stroke patients undergoing neurorehabilitation. Additionally, it identifies predictors of functional outcomes and hospital length of stay (LOS). For this purpose, patients aged ≥ 60 years admitted for neurorehabilitation within 6 months post-stroke, were recruited between January 2015 and August 2022. Rehabilitation profiles were identified using two-step clustering analysis, including the Modified Rankin Score (mRS), the National Institutes of Health Stroke Scale (NIHSS) and the motor and cognitive Functional Independence Measure (m-FIM and c-FIM) upon admission. FIM-effectiveness was calculated as (FIM-discharge−FIM-admission)/(maximum FIM−FIM-admission). Linear regression analyses were conducted to identify predictors of functional outcomes and LOS (days). Results The study enrolled 104 patients (68 male; mean age = 69.45 ± 6.5 years). Three clusters were identified: “Moderate” [NIHSS = 7.70 ± 3.21, motor-FIM = 59.42 ± 12.24, cognitive-FIM = 26.96 ± 4.69, mRS = 4 (4–4), aphasia = 41.7%, severe dysphagia = 4.2%, LOS = 45 (33.25–59) days]; “Moderate-severe” [NIHS = 10.40 ± 3.23, motor-FIM = 28.00 ± 7.74, cognitive-FIM = 25.92 ± 6.55, mRS = 4 (4–5), aphasia = 13%, severe dysphagia = 6.4%, LOS = 61 (45–92) days]; and “Severe” group [NIHS = 18.76 ± 4.19, motor-FIM = 16.12 ± 6.69, cognitive-FIM = 10.58 ± 4.14, mRS = 5 (5–5), aphasia = 60.6%, severe dysphagia = 42.4%, LOS = 71 (60.5–97.5) days]. The motor and cognitive FIM effectiveness significantly improved in the “Moderate” (m-FIM-effectiveness = 33.70 [12.16–53.54]; c-FIM-effectiveness = 33.3 [0–50.0]) and “Moderate-severe” cluster (m-FIM-effectiveness = 31.15 [10.34–46.55]; c-FIM-effectiveness = 33.3[0–63.16]) compared to the “Severe” cluster (m-FIM-effectiveness = 5.77 [0–18.77]; c-FIM-effectiveness = 4.65 [0–22.30]) (p = 0.001 and p = 0.025), whereas aphasia and dysphagia improved in all groups (p > 0.1). Severe stroke (NIHSS) (β = 0.33, p

Abstract Background This study aimed to further complete normative data sets for the strength profile of the thigh in soccer players by performing isometric and isokinetic measurements in a large sample per player position. Methods In total, 364 soccer players were divided into subgroups according to their pitch position. All players performed isometric and isokinetic strength measurements during active competition period using an isokinetic dynamometer (System 3, Biodex®, ENRAF-NONIUS, New York, USA). Results Isokinetic strength of m. Quadriceps was significantly (p = 0.023) higher in strikers compared to central midfielders in both the dominant (+ 9%) and the non-dominant (+ 4%) leg. No further differences were found in isometric or isokinetic strength per playing positions. Conclusions We have shown that strength profiles do not differ between playing positions on the field. This is valuable information for elite soccer high performance coaches and medical staffs aiming to improve daily training efficiency and rehabilitation of their players.

Xueen Liu,1 Fang Pan,1 Qingmei Wang,1 Shuai Wang,1 Jiale Zhang2 1Department of Nursing, Beijing Hepingli Hospital, Beijing, People’s Republic of China; 2Institute of Basic Theory for Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, People’s Republic of ChinaCorrespondence: Jiale Zhang, Email zhang_tcm@163.comAbstract: Myofascial as a holistic structure emphasizes a holistic approach to intervention and treatment of fascial-related disorders such as neck pain (NP), low back pain (LBP), and knee pain. There are currently adverse effects of medication for diseases related to myofascial. Traditional Chinese rehabilitation exercise (TCRE) is a practical approach to traditional Chinese medicine and is a valuable option for intervening in myofascial-related pain. This article found some research evidence for Baduanjin, Wuqinxi, and Yijinjing in clinical studies of myofascial chain-related pain. The article summarizes the current evidence and finds that TCRE can enhance limb movement function through breathing and slow movements, increase joint movement and flexibility, and reduce joint pathology and stress-induced pain. As for future directions, focus on TCRE in improving the health of older adults and treating long-COVID syndrome, and integrate robotic and TCRE training to frame safe and effective exercise models. Relevant studies have already been registered in the Clinical Trials Registry, and some clinical study protocols have been published. TCRE can be an alternative nonpharmacological rehabilitation therapy to alleviate chronic rheumatic pain symptoms and augment public health management.Keywords: traditional Chinese rehabilitation exercise, pain, myofascial chain, rehabilitation

Objective To distinguish infarct location and type with the utmost precision using the advantages of the Swin UNEt TRansformers (Swin UNETR) architecture. Methods The research employed a two-phase training approach. In the first phase, the Swin UNETR model was trained using the Ischemic Stroke Lesion Segmentation Challenge (ISLES) 2022 dataset, which included cases of acute and subacute infarcts. The second phase involved training with data from 309 patients. The 110 categories result from classifying infarcts based on 22 specific brain regions. Each region is divided into right and left sides, and each side includes four types of infarcts (acute, acute lacunar, subacute, subacute lacunar). The unique architecture of Swin UNETR, integrating elements of both the transformer and u-net designs with a hierarchical transformer computed with shifted windows, played a crucial role in the study. Results During Swin UNETR training with the ISLES 2022 dataset, batch loss decreased to 0.8885±0.1897, with training and validation dice scores reaching 0.4224±0.0710 and 0.4827±0.0607, respectively. The optimal model weight had a validation dice score of 0.5747. In the patient data model, batch loss decreased to 0.0565±0.0427, with final training and validation accuracies of 0.9842±0.0005 and 0.9837±0.0010. Conclusion The results of this study surpass the accuracy of similar studies, but they involve the issue of overfitting, highlighting the need for future efforts to improve generalizability. Such detailed classifications could significantly aid physicians in diagnosing infarcts in clinical settings.

Introduction: Inspiratory Muscle Training (IMT) is an integral part of pulmonary rehabilitation. It is a therapeutic modality that has demonstrated considerable promise in augmenting respiratory muscle function and overall pulmonary well-being in a range of clinical cohorts. While IMT has been extensively scrutinised in the adult demographic, its efficacy in paediatric populations has remained a relatively underexplored realm. Aim: This systematic review seeks to undertake a meticulous assessment of the existing literature to gauge the potential of IMT in ameliorating respiratory function in children and adolescents. Materials and Methods: The present systematic review includes seven pertinent studies, comprising randomised controlled trials, cohort investigations, and pilot studies published in English from 2018-2023 from the Cochrane Library, PubMed, Google Scholar, and ScienceDirect. The keywords used were paediatric, restrictive lung diseases, obstructive lung diseases, IMT, obesity, neuromuscular disorders, thoracic surgeries, and advanced physiotherapy. Risk of bias assessment was done using the Cochrane risk-of-bias assessment tool. Results: These studies have investigated the impact of IMT on various paediatric cohorts, from athletic populations to those afflicted with neuromuscular disorders, cystic fibrosis, and other respiratory pathologies. Collectively, the findings offer compelling evidence that IMT has the potential to enhance inspiratory muscle strength, endurance, and overall respiratory function in paediatric populations. Conclusion: In light of the findings gleaned from this systematic review, it is evident that IMT possesses the potential to be an efficacious intervention for enhancing respiratory function in the paediatric population and offering the prospect of improved clinical outcomes and an enhanced quality of life for this vulnerable cohort.

Abstract Background Healing Right Way (HRW) aimed to improve health outcomes for Aboriginal Australians with stroke or traumatic brain injury by facilitating system-level access to culturally secure rehabilitation services. Using a stepped-wedge randomised controlled trial (RCT) design (ACTRN12618000139279, 30/01/2018), a two-pronged intervention was introduced in four rural and four urban hospitals, comprising 1.Cultural security training (CST) for staff and 2.Training/employment of Aboriginal Brain Injury Coordinators (ABIC) to support Aboriginal patients for 6-months post-injury. Three-quarters of recruited patients lived rurally. The main outcome measure was quality-of-life, with secondary outcomes including functional measures, minimum processes of care (MPC); number rehabilitation occasions of service received, and improved hospital experience. Assessments were undertaken at baseline, 12- and 26-weeks post-injury. Only MPCs and hospital experience were found to improve among intervention patients. We report on the process evaluation aiming to support interpretation and translation of results. Methods Using mixed methods, the evaluation design was informed by the Consolidated Framework for Implementation Research. Data sources included minutes, project logs, surveys, semi-structured interviews, and observations. Four evaluation questions provided a basis for systematic determination of the quality of the trial. Findings from separate sources were combined to synthesise the emerging themes that addressed the evaluation questions. Three components were considered separately: the trial process, CST and ABIC. Results The complex HRW trial was implemented to a satisfactory level despite challenging setting factors, particularly rural–urban system dynamics. Patient recruitment constraints could not be overcome. The vulnerability of stepped-wedge designs to time effects influenced recruitment and trial results, due to COVID. Despite relatively high follow-up, including to rural/remote areas, data points were reduced. The lack of culturally appropriate assessment tools influenced the quality/completeness of assessment data. The ABIC role was deemed feasible and well-received. The CST involved complex logistics, but rated highly although online components were often incomplete. Project management was responsive to staff, patients and setting factors. Conclusions Despite mostly equivocal results, the ABIC role was feasible within mainstream hospitals and the CST was highly valued. Learnings will help build robust state-wide models of culturally secure rehabilitation for Aboriginal people after brain injury, including MPC, workforce, training and follow-up.

Abstract Approximately 75% of stroke survivors have movement dysfunction. Rehabilitation exercises are capable of improving physical coordination. They are mostly conducted in the home environment without guidance from therapists. It is impossible to provide timely feedback on exercises without suitable devices or therapists. Human action quality assessment in the home setting is a challenging topic for current research. In this paper, a low-cost HREA system in which wearable sensors are used to collect upper limb exercise data and a multichannel 1D-CNN framework is used to automatically assess action quality. The proposed 1D-CNN model is first pretrained on the UCI-HAR dataset, and it achieves a performance of 91.96%. Then, five typical actions were selected from the Fugl-Meyer Assessment Scale for the experiment, wearable sensors were used to collect the participants’ exercise data, and experienced therapists were employed to assess participants’ exercise at the same time. Following the above process, a dataset was built based on the Fugl-Meyer scale. Based on the 1D-CNN model, a multichannel 1D-CNN model was built, and the model using the Naive Bayes fusion had the best performance (precision: 97.26%, recall: 97.22%, F1-score: 97.23%) on the dataset. This shows that the HREA system provides accurate and timely assessment, which can provide real-time feedback for stroke survivors’ home rehabilitation.

Abstract Objectives Chronic pain in children and adolescents is often associated with functional, physical, and psychosocial challenges. Intensive interdisciplinary pain treatment (IIPT) programs are effective at helping these youth regain functioning, but little is known about their perspectives prior to and during IIPT participation. This study sought to better understand how children and adolescents experience the process from evaluation to completion of the IIPT program. Methods Individual interviews (n = 7) were conducted at three time-points; (1) prior to initial evaluation in a pain clinic, (2) after pain clinic evaluation while considering IIPT, and (3) after completion of an IIPT program. Results Participants ranged in age from 13–17 years. Across these time points, participants demonstrated changes in thoughts and perspectives. While Time 1 was associated with ambivalence, skepticism, and some hope, Time 2 was characterized by processing information about the program and resolution of some of their ambivalence. At Time 3, participants described their experience as “challenging” and “intense” and reported recognition that they had benefited from the program. Participants also wished to pass along lessons learned to future potential patients. Discussion This study provides information to help clinicians better approach adolescents with chronic pain who may be considering IIPT.

Abstract Background Inactivity and bedrest during hospitalisation have numerous adverse consequences, and it is especially important that older patients are mobile during hospitalisation. This study aimed to identify whether the introduction of formal education of clinical staff and a Mobilisation Initiative (MI) could increase mobilisation of patients in a geriatric and a medical ward. Furthermore, to explore patients’ and health care staffs’ view on facilitators and barriers for mobilisation during hospitalisation. Methods The study was a pragmatic clinical study. Both qualitative and quantitative methods were used. The patients’ level of mobilisation was obtained through short interview-based surveys and observations. Focus group interviews and formal education of clinical staff was initiated to increase awareness of mobilisation along with the implementation of a MI. Results 596 patient surveys were included. Of all patients, 50% in the geriatric ward and 70% in the medical ward were able to independently mobilise. The highest percentage of patients sitting in a chair for breakfast and lunch in the geriatric ward was 57% and 65%, and in the medical ward 23% and 26%, respectively. A facilitator for mobilisation was interdisciplinary collaboration, and barriers were lack of chairs and time, and the patients’ lack of help transferring. Conclusions This study adds new knowledge regarding the lack of in-hospital mobilisation in geriatric and medical departments. Mealtimes are obvious mobilisation opportunities, but most patients consume their meals in bed. A potential for a MI is present, however, it must be interdisciplinarily and organisationally anchored for further investigation of effectiveness. Trial registration Retrospectively registered at ClinicalTrials.gov with the trial number NCT05926908.

Allison Maher,1 Michelle Bennett,1 Hsin-Chia Carol Huang,1,2 Philip Gaughwin,1,3 Mary Johnson,1 Madeleine Brady,1 Kacie Patterson,1,3 Tanya Buettikofer,1,3 Jo Morris,1 Veronica Mary Rainbird,3 Imogen Mitchell,1,2 Bernie Bissett1,3 1Rehabilitation and Community Services / Respiratory Medicine, Canberra Health Services, Canberra ACT, Australia; 2College of Health and Medicine, Australian National University, Canberra ACT, Australia; 3Faculty of Health, University of Canberra, Canberra ACT, Bruce, AustraliaCorrespondence: Bernie Bissett, Email Bernie.Bissett@canberra.edu.auObjective: To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature.Background: There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia’s few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation.Methods: Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer’s presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4– 6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual’s progress, at an intensity 4– 6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥ 50% of their maximum inspiratory pressure).Discussion: We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts.Conclusion: In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual’s symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.Plain Language Summary: Long COVID affects 5-10% of people following COVID infection. There is little specific guidance on how exercise can be safely prescribed in Long COVID. This paper is the first to provide a detailed description of an Australian multidisciplinary Long COVID clinic, including specific tools and guidance about how exercise can be prescribed while minimising post-exertional symptom exacerbation. The tools described could be valuable to other health facilities striving to optimise multidisciplinary care for people with Long COVID, incorporating safe exercise prescription.Keywords: COVID, rehabilitation, multidisciplinary care, physiotherapy, respiratory muscle training

Urban infrastructure, important for societal functioning, faces challenges from aging assets and increasing service demands. Traditional asset management practices, often conducted in silos, fail to address the interconnected nature of these systems, leading to inefficiencies and heightened system failure risks. This article combines the spatial and temporal aspects of sewer, water, and road networks to facilitate integrated interventions and enable informed decision-making among diverse stakeholders. The outcome of this research is the creation of interactive hotspot maps on a unified platform, highlighting potential areas for integrated intervention across different infrastructures. To enhance the potential for collaboration in integrated interventions, flexibility in intervention planning was incorporated. With increased flexibility in intervention decisions, the potential for collaboration also increased. For the case study, introducing a 5-year intervention flexibility increased the number of collaborative projects between sewer, water, and roads from 0 to 18. The maps can also indicate areas where the application of trenchless technologies are justifiable. Other important information on asset characteristics for the decision-makers, including age, inspection, deterioration, and other relevant spatial and temporal details can also be obtained from the maps. The presented methodology and findings provide practical solution for utilities to manage urban infrastructure networks more efficiently. HIGHLIGHTS Spatial and temporal integration of infrastructure networks for collaborative asset management.; Demonstration of a unified platform to streamline integrated interventions of sewer, water, and roads.; Collaboration potential increased from 0 to 18 projects with a 5-year intervention flexibility.; Hotspot maps and project level description of a case study is shown to illustrate the usefulness of the framework.;

Abstract A whiplash injury can alter neck muscle function, which remains years after the injury and may explain why symptoms such as persistent pain and disability occur. There is currently limited knowledge about dynamic neck muscle function in chronic whiplash-associated disorders (WAD), and about the extent to which altered muscle function can improve after rehabilitation. Ultrasound can detect mechanical neck muscle function by measuring real-time deformation and deformation rate in the muscles. This method was used for five dorsal neck muscles in participants with chronic WAD versus matched controls in resistant neck rotation. We obtained real-time, non-invasive ultrasound measurements using speckle tracking, multivariate analyses, and mixed-design ANOVA analyses. The results showed altered deformation in the three deepest neck muscle layers, with less deformation area in the WAD group compared to controls in rotation to the most painful side at baseline. Participants in the WAD group performed three months of neck-specific exercises, resulting in improved deformation in the deep neck muscles in WAD and with a similar deformation pattern to controls, and the significant group differences ceased. We reveal new and important insights into the capability of ultrasound to diagnose altered neck muscle function and evaluate an exercise intervention.

Abstract Background The effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders. Methods Randomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger’s test. Results Ten studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period. Conclusion Telemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings.

Abstract Background Both individuals and society bear a considerable burden from ischemic stroke (IS), not only do patients continue suffering from motor dysfunction after discharge from hospital, but their caregivers also undertake the principal responsibility of assisting them in reintegrating into the family and society. To better improve the IS patients’ limb function and daily life activities, their caregivers should also be involved in the training of the motor function rehabilitation during the period transitioning from hospital back home. This study mainly aims to investigate the effects of a nurse-led training for IS patients and their family caregivers on the improvement of the patients’ physical function and the burden of caregivers. Methods/design A randomized controlled trial with blind assessment will be conducted in hospitals and during the follow-ups at home. Fifty-eight pairs of adults diagnosed with ischemic stroke and their primary caregivers will be included. Participants will be randomly given with (1) a nurse-led, home-based motor rehabilitation training participated by caregivers (intervention group) or (2) routine self-care (control group). Both groups will receive assessment and health guidance on the day of discharge, and the intervention group will receive an additional home-based training program and supervision. These two groups will be followed up every week after discharge. The primary results are drawn from the evaluation of physical function and caregiver-related burden, and the secondary results derived from statistics of the modified Barthel index, stroke-specific quality of life, and National Institutes of Health Stroke Scale. Differences between the two groups will be measured by two-way repeated measures ANOVA, considering the data at baseline and at 1-week and 4-week follow-up after training. Discussion Results may provide novel and valuable information on the effects of this culturally appropriate, caregiver-involved, and home-based rehabilitation training on the physical function of IS patients and caregiver-related burden. Trial registration Chinese Clinical Trial Registry (chictr.org.cn) ChiCTR2300078798. Registered on December 19, 2023.

Abstract Background Dysmetria, the inability to accurately estimate distance in motor tasks, is a characteristic clinical feature of cerebellar injury. Even though subjective dysmetria can be quickly detected during the neurological examination with the finger-to-nose test, objective quantification of reaching accuracy for clinical assessment is still lacking. Emerging VR technology allows for the delivery of rich multisensory environmental stimuli with a high degree of control. Furthermore, recent improvements in the hand-tracking feature offer an opportunity to closely examine the speed, accuracy, and consistency of fine hand movements and proprioceptive function. This study aims to investigate the application of virtual reality (VR) with hand tracking in the rapid quantification of reaching accuracy at the bedside for patients with cerebellar stroke (CS). Methods and results Thirty individuals (10 CS patients and 20 age-matched neurologically healthy controls) performed a simple task that allowed us to measure reaching accuracy using a VR headset (Oculus Quest 2). During this task, the participant was asked to reach for a target placed along a horizontal sixty-degree arc. Once the fingertip passed through the arc, the target immediately extinguished. 50% of the trials displayed a visible, real-time rendering of the hand as the participant reached for the target (visible hand condition), while the remaining 50% only showed the target being extinguished (invisible hand condition). The invisible hand condition isolates proprioception-guided movements by removing the visibility of the participant’s hand. Reaching error was calculated as the difference in degrees between the location of the target, and where the fingertip contacted the arc. Both CS patients and age-matched controls displayed higher average reaching error and took longer to perform a reaching motion in the invisible hand condition than in the visible hand condition. Reaching error was higher in CS than in controls in the invisible hand condition but not in the visible hand condition. Average time taken to perform each trial was higher in CS than in controls in the invisible hand conditions but not in the visible hand condition. Conclusions Reaching accuracy assessed by VR offers a non-invasive and rapid approach to quantifying fine motor functions in clinical settings. Furthermore, this technology enhances our understanding of proprioceptive function in patients with visuomotor disabilities by allowing the isolation of proprioception from vision. Future studies with larger cohorts and longitudinal designs will examine the quantitative changes in reaching accuracy after stroke and explore the long-term benefits of VR in functional recovery.

Abstract Background EU workers exposed to hand-arm vibration should be offered health surveillance to detect early symptoms, and findings, of Hand-Arm Vibration Syndrome (HAVS). To execute the mandatory vocational rehabilitation, the employer needs to be aware of injuries found in the medical check-up. We aimed to analyse: 1) How physicians graded the neurosensory component of HAVS on the Stockholm Workshop Scale (SWS), compared to semi-objective findings. 2) What vocational rehabilitative decisions (VRD) were taken by physicians after examinations. 3) Whether the VRDs differed in relation to the SWS-grading. Methods Data came from 660 medical records - all examinations performed during twelve consecutive months in one large Swedish occupational healthcare company. 572 individuals had data on the SWS from the physician. For the qualitative analysis, we used the inductive-iterative immersion-crystallization method. Results 60% of the examined workers had symptoms and 32% had semi-objective findings consistent with HAVS. The physicians’ SWS gradings were underestimated in 59% of the cases with semi-objective findings. The VRDs were classified, relative to communication with the employer, as: “Adequate” (57%), when no injury was present, communication had already taken place, was planned, or was no longer needed in the absence of further exposure, “Semi-adequate” (18%), if no plan for communication was yet established or only communicated through a document with a shorter time until next check-up, and “Inadequate”(25%), when patients refused (20%), or physicians failed to communicate with the employer, despite findings (80%). Underestimated SWS-gradings of HAVS were significantly associated with more “Inadequate” VRDs in the group with semi-objective findings. Conclusions Occupational physicians underestimate the number of individuals with SWS 2–3 compared with semi-objective findings and regularly fail to communicate to the employer despite findings of HAVS. The underestimation of SWS-grading, followed by inadequate VRDs, excludes many workers from the employer’s mandatory protective measures which may lead to aggravation of an untreatable injury in the affected individual and development of HAVS in their similarly exposed colleagues.

Abstract Background Patient access to body-powered and myoelectric upper limb prostheses in the United States is often restricted by a healthcare system that prioritizes prosthesis prescription based on cost and perceived value. Although this system operates on an underlying assumption that design differences between these prostheses leads to relative advantages and disadvantages of each device, there is limited empirical evidence to support this view. Main text This commentary article will review a series of studies conducted by our research team with the goal of differentiating how prosthesis design might impact user performance on a variety of interrelated domains. Our central hypothesis is that the design and actuation method of body-powered and myoelectric prostheses might affect users’ ability to access sensory feedback and account for device properties when planning movements. Accordingly, other domains that depend on these abilities may also be affected. While our work demonstrated some differences in availability of sensory feedback based on prosthesis design, this did not result in consistent differences in prosthesis embodiment, movement accuracy, movement quality, and overall kinematic patterns. Conclusion Collectively, our findings suggest that performance may not necessarily depend on prosthesis design, allowing users to be successful with either device type depending on the circumstances. Prescription practices should rely more on individual needs and preferences than cost or prosthesis design. However, we acknowledge that there remains a dearth of evidence to inform decision-making and that an expanded research focus in this area will be beneficial.

Abstract Urinary incontinence is a common complication in stroke survivors for whom new interventions are needed. This study investigated the therapeutic effect of low-frequency (LF) repeated transcranial magnetic stimulation (rTMS) on the contralesional primary motor cortex (M1) in patients with poststroke urinary incontinence (PSI). A total of 100 patients were randomly assigned to the rTMS group or sham-rTMS group on basis of the intervention they received. Both groups underwent five treatment sessions per week for 4 weeks. Data from the urodynamic examination were used as the primary outcome. The secondary outcome measures were questionnaires and pelvic floor surface electromyography. After 4 weeks of intervention, the maximum cystometric capacity (MCC), maximum detrusor pressure (Pdet.max), residual urine output, overactive bladder score (OABSS) (including frequency, urgency, and urgency urinary incontinence), and the ICIQ-UI SF improved significantly in the rTMS group compared with those in the sham-rTMS group (P 0.05). Our data confirmed that 4 weeks of LF-rTMS stimulation on the contralateral M1 positively affects poststroke urinary incontinence in several aspects, such as frequency, urgency urinary incontinence, MCC, end-filling Pdet, OABSS, and ICIQ-UI SF scores.

Abstract Enhanced recovery after surgery (ERAS) has been successfully integrated into a diverse array of surgical fields to improve the quality and efficacy of treatment intervention. Nonetheless, the application of the ERAS protocol for patients with diabetic foot ulcer (DFU) subsequent to undergoing surgical procedures has not been previously explored. Therefore, this study aimed to investigate the effect of an enhanced recovery protocol on perioperative outcomes in patients with DFU following surgical procedures. A retrospective analysis was conducted on 112 patients with DFU who underwent surgery between January 2020 and December 2021 at a tertiary referral care center. In total, 57 patients received standard perioperative care (the non-ERAS group), and 55 patients received ERAS care (the ERAS group). The primary outcomes included the length of stay (LOS), wound healing time, patient satisfaction, and costs, serving as the basis for assessing the effectiveness of the two approaches. Secondary outcomes included preoperative anxiety (APAIS score), nutritional status (PG-SGA), pain (NRS score), the incidence of lower-extremity deep vein thrombosis (DVT), the reduction in lower-limb circumference, and the activity of daily living scale (Barthel Index). The ERAS group exhibited significantly shorter LOS (11.36 vs. 26.74 days; P 0.05). By reducing the LOS and hospital costs, and by minimizing perioperative complications, the ERAS protocol improves the quality and efficacy of treatment intervention in patients with DFU who underwent surgical procedures. Trial registration number: ChiCTR 2200064223 (Registration Date: 30/09/2022).

Abstract Dual-task performance holds significant relevance in real-world scenarios. Implicit learning is a possible approach for improving dual-task performance. Analogy learning, utilizing a single metaphor to convey essential information about motor skills, has emerged as a practical method for fostering implicit learning. However, evidence supporting the effect of implicit learning on gait-cognitive dual-task performance is insufficient. This exploratory study aimed to examine the effects of implicit and explicit learning on dual-task performance in both gait and cognitive tasks. Tandem gait was employed on a treadmill to assess motor function, whereas serial seven subtraction tasks were used to gauge cognitive performance. Thirty healthy community-dwelling older individuals were randomly assigned to implicit or explicit learning groups. Each group learned the tandem gait task according to their individual learning styles. The implicit learning group showed a significant improvement in gait performance under the dual-task condition compared with the explicit learning group. Furthermore, the implicit learning group exhibited improved dual-task interference for both tasks. Our findings suggest that implicit learning may offer greater advantages than explicit learning in acquiring autonomous motor skills. Future research is needed to uncover the mechanisms underlying implicit learning and to harness its potential for gait-cognitive dual-task performance in clinical settings.

Abstract Background Hereditary Angioedema (HAE) due to C1-inhibitor deficiency (C1INH) is a rare condition, clinically characterised by recurrent swelling. The unpredictability of attacks affects the patients’ quality of life (QoL). HAE patients and their families have vast unmet physical, psychological, and social needs. A human-centred design (HCD) approach to describing the needs of different user types is to utilise personas, a data-driven narrative tool for communicating user archetypes that capture the individuals’ attitudes, goals, and behaviours. The aim of this study was to create and analyse personas based on HAE patients’ and their caregivers’ interviews. Semi-structured interviews were conducted through anthropological conversations with patients, patient-caregivers (double role of patient and caregiver), and non-affected caregivers. Qualitative and quantitative insights from analyses formed the basis to create personas. Results We enrolled 17 subjects: 15 patients (6 of them were patient-caregivers) and 2 non-affected caregivers. The mean age of participants was 50.3 ± 14.4 years. Eight patients were on treatment with prophylactic therapy. The mean percentage score of Angioedema Quality of Life (AE-QoL) for HAE patients was 19.8 ± 12.0. Six personas were identified describing the participants’ personal history, disease management, and needs: four personas referred to patients, one to patient-caregivers, and one non-affected caregiver personas were identified. Across patient personas, the most expressed needs were psychological support and better awareness amongst healthcare professionals. Caregivers, on their side, desired better information about the disease, including the latest therapies, and higher awareness within the community. Conclusion A Human Centred Innovative Approach Based on Persona extends beyond the physical symptoms to encompass the psychological and social aspects of the individual's well-being also including the family in the evaluation.

Abstract Trial design This study is a pilot randomized clinical trial aimed to investigate the effect of using Hip Exoskeleton Assistive (HEXA) robot compared to conventional physiotherapy on the quality of walking, disability, and quality of life of stroke patients with hemiplegia. Methods In this study, 24 patients were randomly assigned to the intervention group (robotic physiotherapy with HEXA robot), or control group (conventional physiotherapy). In each session, both groups received 30 min of conventional physiotherapy including electrotherapy and conventional exercises, and then the intervention group did gait training for 30 min with the HEXA robot and the control group for 30 min without the HEXA robot. The treatment program was 12 sessions, 3 times a week. Before the 1st and after the 12th sessions, both groups were evaluated for walking quality, disability, and quality of life. Results The results showed that the main effect of time was significant (P

Abstract Background The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. Methods An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. Results Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. Conclusion Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

Abstract Background Fall prevention and balance control constitute critical components of rehabilitation for stroke survivors. Kneeling training, characterized by its low center of gravity focus, has been incorporated into rehabilitation regimens to enhance postural control across various pathological conditions. Despite its widespread use, empirical evidence substantiating the efficacy of kneeling training is limited, particularly in the context of mobility and balance improvement for patients who have had a stroke. This study aims to substantiate the safety and effectiveness of kneeling training in individuals recovering from stroke. Methods A randomized controlled trial comparing kneeling training and conventional rehabilitation training was conducted, involving sixty-seven participants allocated to the Kneeling Training Group (KNT) and the Conventional Rehabilitation Group (CVR). The KNT group underwent 30-minute sessions of kneeling training, while the CVR group received conventional treadmill walking training, both administered six times per week over four weeks. Evaluation encompassed the Fugl-Meyer Assessment for Lower Extremity (FMA-LE), the Berg Balance Scale (BBS), and gait analysis was conducted at baseline, as well as at the 2 and 4-week intervals. Results Our study established the safety of a 4-week kneeling training program. Notably, the KNT group exhibited more pronounced improvements in BBS scores at weeks 2 and 4 compared to the CVR group. However, no significant disparities emerged in FMA-LE and gait analysis between the two groups. Our findings suggest that kneeling training may serve as a viable option for enhancing lower limb balance in survivors who have had a stroke. Conclusions We conclude that kneeling training, characterized by its safety, simplicity, and no restrictions on location or equipment, represents a valuable therapeutic approach for enhancing walking balance in individuals recovering from stroke. Trial registration Clinical trials ChiCTR1900028385, December 20, 2019.

Kun Li,1 Ahmad Alhaskawi,2 Haiyin Zhou,2 Yanzhao Dong,2 QingFang Zhao,3 Chenxi Wang,4 Hui Lu2 1Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 2Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 3Department of Plastic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of China; 4Medical Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People’s Republic of ChinaCorrespondence: Kun Li, Department of Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang, People’s Republic of China, Email Likicu@zju.edu.cn Hui Lu, Department of Orthopaedics, The First Affiliated Hospital, Zhejiang University School of Medicine, No.79, Qingchun Road, Shangcheng District, Hangzhou, Zhejiang Province, People’s Republic of China, Email HuiLu@zju.edu.cnObjective: This retrospective study examines risk factors and electromyographic (EMG) characteristics associated with acquired weakness in critically ill patients and assesses their impact on patient prognosis.Methods: Ninety-seven critically ill patients, ventilated for over 48 hours, were included. Patient data, encompassing general condition, medical history, Medical Research Council (MRC) scores, serum markers (c-reactive protein, calcitonin gene, albumin, brain natriuretic peptide, urea nitrogen, creatinine), EMG characteristics, respiratory treatment modalities, and parameters, were recorded. Mechanical ventilation duration, ICU stay duration, hospitalization duration, and patient prognosis were documented. Based on MRC scores, patients were categorized into the ICU-acquired weakness (ICU-AW) group (MRC < 48 points) and the non-ICU-AW group (MRC ≥ 48 points).Results: The study comprised 47 ICU-AW and 50 non-ICU-AW patients. Significant differences (p < 0.05) were observed in age, MRC scores, albumin levels, c-reactive protein, calcitonin gene, brain natriuretic peptide, urea nitrogen, creatinine, mechanical ventilation duration, ICU stay duration, and hospitalization duration between groups. In the ICU-AW group, nerve conduction examinations revealed slow conduction velocity, reduced wave amplitude, and in severe cases, a complete loss of motor and sensory potentials. Multivariate logistic analysis identified low serum albumin levels and MRC scores as potential ICU-AW risk factors.Conclusion: This study suggests that low serum albumin levels and MRC scores may contribute to ICU-AW risk. The ICU-AW group exhibited varied peripheral nerve damage and slow conduction velocities on EMG. Additionally, severe systemic inflammatory responses, renal function, brain natriuretic peptide levels, prolonged mechanical ventilation, and peripheral nerve damage may be associated with ICU-AW. Follow-up studies are essential for further understanding these complex interactions.Keywords: ICU-acquired weakness, risk factor, critical care, therapy, respiratory failure, electromyography

Stroke, a leading cause of disability and death, results in impairments affecting daily activities and quality of life. Traditional rehabilitation often includes physical, occupational, and speech therapies. However, complementary therapies such as music therapy are gaining attention for their additional benefits. This systematic literature review investigates the effects of music therapy on motor recovery, cognitive rehabilitation, and emotional well-being in stroke survivors. The review includes randomized controlled trials, cohort studies, and case studies sourced from databases like PubMed and ResearchGate. Findings show that Rhythmic Auditory Stimulation (RAS) significantly improves motor functions, particularly gait and upper limb movements, by improving motor control and coordination and promoting neuroplasticity. Also, music therapy benefits cognitive functions such as memory and attention, and improves emotional well-being by reducing anxiety and depression. Implementing RAS in rehabilitation requires customization to individual patient needs, and it can be integrated into home-based programs for continuous improvement. Beyond physical benefits, music therapy supports cognitive and emotional recovery, offering a holistic approach to stroke rehabilitation. Integrating music therapy into rehabilitation programs can significantly improve recovery and quality of life for stroke survivors.

Background Post-stroke cognitive impairment (PSCI) can significantly limit the recovery of stroke patients at all stages and lead to a decline in activity participation and quality of life. Objective Based on the concept of full-cycle rehabilitation in stroke, by investigating the incidence of PSCI, to analyzed the differences of PSCI in different age and disease period and its potential influencing factors. Methods Stroke patients were hospitalized in the rehabilitation departments of 27 hospitals in different regions of China from October 2022 to July 2023 using simple random sampling method for cross-sectional analysis. A total of 402 patients were finally included according to the study criteria, and categorized into the young and middle-aged group (18-64 years old, n=234) and the elderly group (≥65 years old, n=168) according to the criteria of the National Bureau of Statistics of China, and the patients were also categorized into the acute-phase group (1-7 d, n=25), subacute-phase group (8-180 d, n=338), and the chronic-phase group (>180 d, n=39) according to the International Stroke Rehabilitation Alliance. Baseline information on patients was collected through interviews, assessments, and an electronic case system. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), and subscores and total scores were calculated for each cognitive domain. Using the National Institute of Health Stroke Scale (NIHSS), Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Fugl-Meyer Assessment-Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), Hospital Anxiety Scale (HADS-A), and the Hospital Depression Scale (HADS-D) were used to assess the disease conditions and physical functioning of the patients. Spearman's rank correlation analysis was used to investigate the correlation between cognitive function levels and other clinical indicators at different ages and different stages of disease. Results The prevalence of PSCI in stroke patients was 76.4% (307/402), including 81.0% (136/168) in elderly patients and 73.1% (171/234) in young and middle-aged patients; the prevalence of PSCI in stroke patients was 56.0% (14/25) in the acute phase, 78.4% (265/338) in the subacute phase, and 71.8% (28/39) in the chronic phase. The results of grouping by age and disease period showed that the elderly group had lower visuospatial and executive function, attention, numeracy, delayed recall scores and total MoCA scores than those in the young and middle-aged group (P

Background and Objective: Spinal pathology frequently presents in physiotherapy caseloads, making a thorough understanding of Cauda Equina Syndrome (CES) essential. Although the treatment of CES with physical therapy and rehabilitation is uncommon, this case study aims to identify optimal treatment strategies and early rehabilitation following a traumatic event.Case Presentation: We present a case of a 56-year-old Chinese male who visited Tongji Hospital in 2023 after experiencing a fall. Imaging revealed a burst fracture at the L1 vertebral body, resulting in compression of the corresponding spinal cord. The patient was diagnosed with T12-L1 epiconus syndrome accompanied by L2 CES. Following a comprehensive evaluation, including MRI and motor-sensory function assessments, he underwent a structured rehabilitation protocol and therapeutic management. At the final follow-up, the patient achieved ASIA grade D.Discussion: This case study highlights the effectiveness of comprehensive physical rehabilitation and multidisciplinary collaboration in treating traumatic events that lead to epiconus syndrome with CES. It offers valuable insights for clinical decision-making and highlights the importance of early rehabilitation in enhancing patient outcomes.

During the years of widespread use of radiotherapy in cancer patients, the incidence of local radiation damage to soft tissues (of varying severity) reached 30–40% or more. The experience of the radiation injury treatment department in the 70s and 80s indicates that every 2–3 beds were occupied by patients with this pathology. With the development of radiology, the introduction of new sources and techniques, the frequency of formation of such changes in the zone of irradiation fields has significantly decreased and currently stands at about 2%. The purpose of the proposed study is to demonstrate the possibilities of skin plastic surgery in this contingent of people who, as a rule, do not receive qualified care for a long time. As part of the work carried out, the time elapsed from the moment of formation of pathological changes to hospitalization in the department, on average, was 3–5 years, and was filled with ineffective conservative measures. Over the past 4 years, 60 reconstructive plastic surgeries have been performed in the radiation injury treatment department using musculoskeletal (21), skin fascial (21), skin (10) flaps, as well as plasty with local tissues (8). In the early postoperative period, the most common complication was marginal necrosis of the flap (13) which in 11 patients caused repeated operations in the form of secondary sutures or, in the case when it was not possible to perform this, plastic surgery of the defect with insular skin flaps was applied to the granulating wound. Subsequently, complete healing of the postoperative wound was noted in such patients. Thus, the proposed options for the reconstruction of radiation ulcers that developed after combined and radiation treatment of malignant neoplasms are highly effective methods that can get rid of disfiguring defects, improve the quality of life and restore social activity in almost 100% of patients.

Introduction. The development of a comfortable living environment for persons with disabilities is one of the most important tasks in the modern world. To a large extent, its implementation depends on housing conditions of wheelchair users, as well as principles of their settlement in multi-apartment residential buildings in cities. Physical barriers in the architectural environment are the most pressing problem hindering rehabilitation and socialization of disabled persons. Uncomfortable housing conditions can hinder therapeutic and preventive care aimed at health improvement, and physical barriers in housing and yard spaces can hamper the socialization of disabled residents. The problem is more relevant than ever, because due to the ongoing Special Military Operation, the number of physically challenged persons is growing fast. With this in mind, it is important to continue adapting residential buildings for limited mobility population groups and creating a more comfortable environment for all urban residents.Materials and methods. The article analyzes (1) the way wheelchair users take up residence in large-scale development areas in the post-war Krasnodar, (2) the settlement of wheelchair users in urban districts, (3) the residence of wheelchair users in buildings with a different number of storeys. Contradictions are identified between current urban development conditions and surrounding architecture, on the one hand, and the needs of limited mobility residents, including their socialization, on the other hand. Criteria for selecting design solutions are developed; recommendations are provided for the reconstruction of existing residential buildings, equipping and modernizing the urban environment, raising awareness of problems to be tackled by disabled persons.Results. A list of steps is proposed to solve problems of housing conditions and principles of resettlement of disabled persons. In particular, factors impeding the treatment, preventive care and socialization of wheelchair users are considered, and their elimination plan is proposed. The article provides a theoretical justification for techniques and principles of architectural design of buildings, taking into account the accessibility of standard residential buildings to limited mobility persons.Conclusions. The article describes methods and techniques for solving several most important problems of wheelchair users in Krasnodar, in particular, their accessible living environment. The appropriateness of the settlement of disabled persons in the existing urban development and reconstruction of this architectural environment were analyzed; methods for designing buildings that meet the housing requirements of limited mobility persons were presented. Also, a social approach to developing a comfortable living environment for such members of society was formulated and analyzed to ensure their integration into the life of society, equal access to infrastructure, work and education.

Malignant pleural mesothelioma (MPM) represents a significant clinical challenge due to limited therapeutic options and poor prognosis. Beyond mere survivorship, setting up an effective framework to improve functioning and quality of life is an urgent need in the comprehensive management of MPM patients. Therefore, this study aims to review the current understanding of MPM sequelae and the effectiveness of rehabilitative interventions in the holistic approach to MPM. A narrative review was conducted to summarize MPM sequelae and their impact on functioning, disability, and quality of life, focusing on rehabilitation interventions in MPM management and highlighting gaps in knowledge and areas for further investigation. Our findings showed that MPM patients experience debilitating symptoms, including fatigue, dyspnea, pain, and reduced exercise tolerance, decreasing quality of life. Supportive and rehabilitative interventions, including pulmonary rehabilitation, physical exercise improvement, psychological support, pain management, and nutritional supplementation, seem promising approaches in relieving symptoms and improving quality of life but require further research. These programs emphasize the pivotal synergy among patient-tailored plans, multidisciplinary team involvement, and disease-specific focus. Despite advancements in therapeutic management, MPM remains a challenging disease with limited effective interventions that should be adapted to disease progressions. Rehabilitative strategies are essential to mitigate symptoms and improve the quality of life in MPM patients. Further research is needed to establish evidence-based guidelines for rehabilitative interventions tailored to the unique needs of MPM patients.

People with disabilities often experience worse health outcomes than ordinary people because of multiple barriers to accessing healthcare. These inequalities are particularly exposed during the pandemic, indicating an urgent need to strengthen health systems, so that they are inclusive and responsive to the needs of these people during crises. These people are particularly affected by changes in routine services because of diversion of healthcare staff and facilities to respond to the pandemic, e.g., rehabilitation and medications. The combination of these factors substantially imparts negative impacts on their functioning and well-being. Health services research can help address the challenges of maintaining continuity of care during crises as well as addressing systematic inequalities in the health sector that marginalize people with disabilities even during noncrisis times. Therefore, research is needed to understand the health service design and to identify strategies to maximize active participation from this population.