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Introduction: Cerebral palsy (CP) is a paediatric disorder with permanent impairment of movement and posture with a prevalence of about 2.11 in 1000 births in the world. Given the therapeutic effect of hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) in children with CP, a systematic review of the available literature on this topic is warranted. The objective of this study is to systematically review the effectiveness of HABIT-ILE on upper extremity, lower extremity and trunk outcomes within the domains of body functions and structures, activity and participation of the International Classification of Functioning, Disability and Health in children with CP., Methods and Analysis: This study will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches will be conducted in six databases: MEDLINE, PubMed, Cochrane Library, Scopus, OT seeker and Web of Science for available published literature. The grey literature sources will include WorldCat, National Technical Information Service, Agency for Healthcare Research and Quality, Open Grey, WHO and OpenDOAR. Manual searches of citations of included papers will be performed to collect all experimental studies of HABIT-ILE in children with CP. The level of evidence for included articles will be classified according to the level of evidence in the guidelines for systematic reviews on the American Occupational Therapy Association website. Based on the study design of the included articles, the risk of bias will be assessed using the revised Cochrane risk-of-bias tool, the Cochrane Risk Of Bias In Non-randomised Studies - of Interventions tool and the quality assessment tool recommended by the American Occupational Therapy Association. In order to synthesise the data, narrative synthesis will be used, along with meta-analysis, if available., Ethics and Dissemination: As this study only reviewed previously published articles, ethical approval was not required. The findings will be published in a peer-reviewed scientific journal., Prospero Registration Number: CRD42024518179., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Bone-anchored limbs (BALs) are a transformative alternative for patients with lower-limb amputation who suffer from debilitating socket problems by eliminating the need for skin-to-prosthetic contact. Despite its successes, some individuals continue to face challenges with BALs, experiencing a loss of implant integration resulting in prosthetic loosening. A thorough understanding of biomechanical behavior at the residual limb and bone-implant interface is necessary to fully understand mechanical failure mechanisms. In addition, a deeper understanding of BAL biomechanical behavior would allow clinicians and researchers to predict and test different implant geometries, inform patient eligibility, rehabilitation strategies, and implantation methods in a safe and low-cost way. Thus, this study designed an innovative simulation method to quantify the temporal mechanical behavior of the residual limb in transfemoral and transtibial BALs by using subject-specific kinematics, musculoskeletal loads, and bone geometry and health. Our novel method was applied to two patients (one transtibial, one transfemoral) with similar BMI and age during level ground walking. Our results demonstrated a pattern of higher residual limb stresses in the transtibial model (26.80 MPa vs. 23.69 MPa). This study not only furthers our understanding of BAL biomechanics but introduces a versatile subject-specific methodology with direct applications in clinical practice. As we navigate the complexities of BAL implantation, this modeling platform lays the groundwork for more informed decision-making., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: Recent evidence has utilized energetic absorption as an alternative method to evaluate biomechanical profiles associated with lower extremity injury risk. The aim of scoping review is to summarize the literatures that utilized energetic analysis in individuals with lower extremity injury history during functional tasks., Methods: A literature search, conducted in August 2023, involved four databases-PubMed, SPORTDiscus, Scopus, and Web of Science. A manual search was performed to identify additional articles., Findings: Among the 17 included studies, we identified 11 and 6 articles investigated lower extremity energetic absorption in individuals with anterior cruciate ligament reconstruction and chronic ankle instability history during jump-related tasks, receptively. Individuals with anterior cruciate ligament reconstruction displayed a reduction of energetic absorption in the involved knee, coupled with increased energetic absorption in the involved hip, as compared to the uninvolved limb or the reference group. The findings in those with chronic ankle instability were varied. Most studies suggested that individuals with chronic ankle instability displayed a compensatory movement pattern to off-load their ankle joint, while concurrently increasing energy absorbed at the knee joint compared to the reference group. Conversely, one study suggested that individuals with chronic ankle instability might rely more on their ankle joint for energy absorption., Interpretation: Our findings indicated that both individuals with anterior cruciate ligament reconstruction and chronic ankle instability displayed a distinctive compensatory strategy during landing. This strategy is characterized by increasing energy dissipation on the proximal joints, compensating for a reduction on the distal joint to dissipate less energy., Competing Interests: Declaration of competing interest Tsung-Yeh Chou reports was provided by University of Delaware. Yu-Lun Huang reports financial support was provided by National Taiwan Normal University. Colin Mulligan reports was provided by Oregon State University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: People with patellofemoral pain (PFP) may have bilateral deficits in hop for distance test (SLHD) performance, whereas the worsening performance of the pain-free or less painful limbs suggests that bilateral movement differences may occur. While clinicians may not be aware of bilateral movement differences that may be employed during the clinical assessment of SLHD performance (e.g., excessive trunk flexion, lower knee, hip and ankle angles), their suboptimal investigation may overestimate function and favor long-term sequelae., Research Question: Do people with PFP exhibit bilateral differences in trunk and lower limb movements as well as bilateral deficits in SLHD performance compared to pain-free controls?, Methods: We captured three-dimensional motion of 26 adults with PFP and 22 controls during testing and calculated trunk and lower limb sagittal plane kinematics, total concentric and eccentric work, and hip, knee, and ankle work contributions during the jumping and landing phases of the SLHD. We also calculated vertical ground reaction forces during the landing phase and compared between-group and -limb differences using independent and paired t-tests., Results: People with PFP demonstrated bilateral deficits in SLHD performance (medium effects; p = .028-.050) and lower peak vertical ground reaction force values (medium-to-large effects; p = .006-.012) as compared to controls. No other between-group or -limb differences were identified., Significance: Bilateral deficits in SLHD performance seem to occur independently of movement differences in people with PFP, as they presented shorter distance but no differences in sagittal plane biomechanical patterns., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

OpenCap, a smartphone-based markerless system, offers a cost-effective alternative to traditional marker-based systems for gait analysis. However, its kinematic measurement accuracy must be evaluated before widespread use in clinical practice. This study aimed to evaluate OpenCap for lower-limb joint angle measurements during walking in patients with knee osteoarthritis (OA) and to compare error metrics between patients and healthy controls. Lower-limb kinematic data were simultaneously collected from 53 patients with knee OA and 30 healthy individuals using OpenCap and a marker-based motion capture system while walking at a self-selected speed. Evaluation was assessed through root mean square error (RMSE) and intraclass correlation coefficient (ICC). Two-way repeated measures analyses of variance were employed to evaluate the main effects of and interactions between group (knee OA patients vs. healthy controls) and walking direction (toward vs. away from the camera). The results demonstrated a grand mean RMSE of 6.1° and an ICC of 0.67 for knee OA patients when walking toward the camera. Patients with knee OA exhibited significantly higher RMSE and lower ICC values compared to healthy controls. Additionally, walking toward the camera was associated with significantly lower RMSE and higher ICC values than walking away from the camera. OpenCap's minimal hardware costs, free software, and user-friendly interface suggest its potential for widespread clinical implementation. The sagittal hip and knee angles demonstrate strong agreement with the marker-based system; however, caution is warranted in clinical decision-making for this population, as errors in most joint angles slightly surpass acceptable thresholds., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Introduction: Parkinson's disease can contribute to the loss of muscle strength, and physical exercise such as Mat Pilates can be effective in improving this, core stability, flexibility, and muscle control., Objective: To analyze the effects of a 12-week intervention with Mat Pilates in the short and long term, on lower limb and hand grip strength in people with Parkinson's., Methods: The study included 23 people (61.7 ± 7.5 years) of both sexes, diagnosed with Parkinson's disease who were selected according to inclusion criteria and divided into intervention and control groups., Results: The hand grip variable showed improvement in the intervention group intragroup only in the right hand (p = 0.003) in the post-intervention period. In the lower limb strength variable, there was significance in the extension of the left leg both in the intervention intragroup (p = 0.042), and in the control group (p = 0.001) the result in the flexion of the left leg in the intervention group (p = 0.032). The follow-up data showed significance in the strength of extension of the right leg in the intervention group (p = 0.049) and in the control group (p = 0.024) and in the extension of the left leg in the intervention group (p = 0.021)., Conclusion: Mat Pilates classes for people with Parkinson's with mild and moderate degrees proved to be effective in the short term in the hand grip strength of the right hand, and in the extension and flexion of the left legs, and positive effects in the long term in the strength of extension of the right also left legs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: The Ten Meter Walk Test (10MWT) is a vital diagnostic tool for identifying neuromuscular and neurodegenerative conditions. This systematic review explores the potential of wearables, mobile devices, and sensors to enhance the 10MWT's use in medical gait analysis based on lower limb movements., Methods: This systematic review explores the use of wearables, mobile devices, and sensors to improve the 10MWT in medical gait analysis based on lower limb movements. The study uses the PRISMA approach to assess literature from January 2010 to October 2023, highlighting the importance of new technologies like machine learning and artificial intelligence in improving the accuracy and efficiency of the 10MWT., Results: The findings demonstrate how technology-enabled 10MWT can help develop specialized treatment strategies and provide a more accurate understanding of disease pathophysiology., Conclusions: The paper reviews 17 studies on lower limb movements during the 10MWT, highlighting their importance in assessing medical diseases and gait analysis as a diagnostic tool. It emphasizes the role of technology in rehabilitation and physical therapy, where some studies combine Transcranial Direct Current Stimulation with robotic or wearable technologies., Significance: The review comprehensively explains these technologies' advantages and current use in therapeutic contexts., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To evaluate the motor function of the lower extremity (LE), we used direct cortical stimulation motor-evoked potential (D-MEP) monitoring with a single six-contact subdural strip electrode placed in the interhemispheric fissure., Methods: Intraoperative neuromonitoring using D-MEPs in the LE was performed in 18 cases (16 patients) for brain tumor surgery from December 2018 to April 2023 with a follow-up period of at least 3 months. After dural opening, a single six-contact subdural strip electrode was placed inside the interhemispheric fissure. To identify the central sulcus, phase reversal was recorded using somatosensory evoked potentials. Next, direct cortical stimulation was applied to the primary motor cortex. The baseline waveform was defined as a reproducible waveform of 30 µV or higher, and a significant decrease of ≥50% in the amplitude resulted in a warning during surgery., Results: The success rate of central sulcus identification in the LE was 66.7% (12/18 cases). Direct cortical stimulation motor-evoked potential monitoring could record stable contralateral motor-evoked potentials of the tibialis anterior, gastrocnemius, and abductor hallucis in 16 of 18 cases (88.9%). The mean intensity of stimulation for D-MEPs was 20.5 ± 9.9 mA, and the 16 cases showed no significant reduction in amplitude. Seventeen cases showed no deterioration of motor function of the LE at 1 and 3 months postoperatively. In the remaining case with unsuccessful D-MEP, paralysis of the LE worsened at 1 and 3 months postoperatively., Conclusions: The placement of electrodes in the interhemispheric fissure on the primary motor cortex of the LE enabled motor-function monitoring in the LE with D-MEPs, suggesting that D-MEP-based monitoring may be a reliable approach., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 by the American Clinical Neurophysiology Society.)

Objective: This study aimed to evaluate the effectiveness of robot-assisted gait training (RAGT) and explore the optimal exercise prescription using a network meta-analysis approach., Data Sources: A comprehensive search was conducted on randomized controlled trials comparing robotic and conventional rehabilitation published up to January 2024 in PubMed, Web of Science, Cochrane Library, Embase, CNKI, VIP, Wanfang, and SinoMed databases., Review Methods: The evaluation parameters included Fugl-Meyer Assessment of Lower Extremity (FMA-LE), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), and 6-Minute Walk Test (6MWT). Two investigators independently performed study screening, data extraction, and bias evaluation. Data were merged, analyzed, and plotted using Review Manager 5.4.1 and Stata 18.0 software., Results: A total of 21 articles involving 822 subjects were included in the analysis. RAGT positively influenced FMA-LE score (MD = 3.74, 95%CI 3.02-4.46, P < 0.05), FAC score (MD = 0.31, 95%CI 0.1-0.53, P < 0.05), BBS score (MD = 3.63, 95%CI 2.46-4.80, P < 0.05), and 6MWT score (MD = 23.73, 95%CI 15.31-32.14, P < 0.05). Surface under the cumulative ranking curve (SUCRA) values indicated that an exercise time of 40-60 min/training (97.4%), exercise frequency of 2-5 times/week (87.6%), and exercise duration of 8-12 weeks (78.1%) were most effective in improving the FMA-LE score., Conclusions: RAGT can effectively improve lower limb motor function, walking function, balance function, and walking endurance in stroke patients. For optimal improvement in FMA-LE score, an exercise time of 40-60 min/training, exercise frequency of 2-5 times/week, and exercise duration of 8-12 weeks are recommended., Competing Interests: Declarations. Ethical approval: None. Informed consent: None. Conflict of interest: The authors declare no conflicts of interest with others or organizations, and no financial or personal relationships to disclose., (© 2024. Fondazione Società Italiana di Neurologia.)

Objective: Osteoarthritis is a major cause of impairment. Research has shown that individuals with unilateral lower limb amputation are 17 times more likely to develop osteoarthritis on their sound side limb. Therefore, this review aimed to describe similarities and differences in the biomechanical loading variables of individuals with osteoarthritis and those with unilateral lower limb amputation., Design: Researchers systematically searched PubMed-Medline, EBSCOhost, and Web of Science for articles published between January 1990 and February 2022. Included studies investigated the biomechanical profiles (peak external knee adduction moment; peak external knee flexion moment; ground reaction force; external knee adduction moment loading rate; external knee adduction moment impulse) of both population groups., Results: A total of 31 articles were included in this review. Only knee adduction moment and knee flexion moment presented similar profiles in both groups, while all other variables were dissimilar. The use of advanced prostheses reduced the loading on the sound side of individuals with unilateral lower limb amputation., Conclusions: As both knee adduction moment and knee flexion moment are surrogate measures for knee contact forces, interventions need to target these variables to help manage and prevent the development of osteoarthritis. Interventions, particularly for addressing these variables in individuals with unilateral lower limb amputation, should be further investigated in future research., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Posterior tibialis tendon dysfunction (PTTD) is a debilitating condition that leads to biomechanical changes, for which foot orthoses are often prescribed to attenuate. There is a need to improve the ability to predict these biomechanical alterations, determine the biomechanical effectiveness of foot orthoses, and anticipate their effects on individuals with PTTD during gait., Research Question: Is the supination resistance test (SRT) reliable, and capable of predicting foot and ankle biomechanics, as well as the biomechanical effects of foot orthoses in individuals with PTTD during gait?, Methods: Twenty-one individuals with PTTD participated with supination resistance measured over two sessions. Midfoot and ankle angles, and moments, were analyzed during gait. SRT test-retest reliability was evaluated, and the biomechanical effects of foot orthoses were assessed using statistical parametric mapping. SRT correlations with foot and ankle biomechanics and foot orthoses effects were examined., Results: The SRT demonstrated excellent intrarater reliability. Positive correlations were noted between the SRT and midfoot sagittal and frontal angles, while a negative correlation was observed with ankle sagittal and frontal angles. In the foot orthoses condition, midfoot dorsiflexion, external rotation, ankle eversion angles, and inversion moments were reduced. A negative correlation was identified between SRT and foot orthoses effects on the ankle frontal angle., Significance: The SRT is useful for predicting foot and ankle biomechanics, as well as the effects of foot orthoses on ankle frontal angles during gait in individuals with PTTD. These findings emphasize the clinical and research relevance of assessing supination resistance in PTTD management., Competing Interests: Declaration of Competing Interest We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author and which has been configured to accept email from gabriel.moisan@uqtr.ca., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Purpose: To analyze immediate effects of TECAR therapy (TT) to reduce lower limb hypertonia and improve functionality in chronic post-stroke., Materials and Methods: It is a single-blind randomized controlled clinical trial. A total of 36 chronic stroke survivors were divided into two groups. The experimental group received a single 30-minute session of TT with functional massage (FM) on lower limb. The control group received a single 30-minute session sham treatment of TT plus FM. The primary outcome measure was hypertonia (Modified Ashworth Scale, MAS). Secondary outcomes were gait speed (4-Meter Walk-Test), standing knee-flexion (Fugl-Meyer Assessment Scale IV-item), change in weight bearing ankle dorsiflexion (Ankle Lunge Test, ALT), and functional lower limb strength (5-Times Sit-to-Stand Test). All measurements were performed at baseline, immediately and 30-minutes after treatment., Results: There was a group-time interaction in MAS-knee ( p  = 0.044), MAS-ankle ( p  = 0.018) and ALT ( p  = 0.016) between T 1 and T 0 ( p <.0001) and T 2 and T 0 ( p <.0001) for the experimental group. There was a significant increase in ALT between T 1 and T 0 ( p  = 0.003) in the control group., Conclusions: A single session of TT performed at the same time as FM immediately reduces plantar-flexors and knee-extensor muscle hypertonia and increases change in weight bearing ankle dorsiflexion in chronic stroke survivors.

Objective: Patellofemoral pain syndrome (PFPS) is a common knee issue, and hip joint function significantly affects knee health. Gluteus activation exercises are a promising treatment for PFPS. This study aims to investigate the impact of gluteal muscle activation exercises on the muscle involvement and movement patterns of young male patients with PFPS., Methods: Our study was a randomized controlled clinical trial study from June 2020 to December 2021, included 18 young male patients with PFPS, randomly divided into two groups: the gluteus activation group (GAG) and control group (CON), with nine cases in each group. The GAG underwent gluteal muscle activation exercises for 40 min per session, three times per week, for 6 weeks; the CON received no intervention. At baseline and after 6 weeks, the integrated electromyography (IEMG), contribution rates (CRs), and activation times (ATs) of the gluteus maximus (GM), vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), biceps femoris (BF), and semitendinosus (ST) muscles of the affected lower limb during stair-climbing exercise were assessed. Additionally, the explosive power (EP) of the lower limbs and the visual analog scale (VAS) pain value of the knee joint were evaluated. Paired sample t-tests and independent sample t-tests were used to compare the differences within and between groups., Results: After 6 weeks, the GAG showed a significant increase in the IEMG of GM by 118 ± 67.09 μVs compared to CON (p < 0.05), and an increase in the CR of the GM by 6.75% (p < 0.05). Additionally, the AT of the GM and BF was significantly reduced (p < 0.05), and the lower limb EP increased by 14.66% compared to the CON (p < 0.05). Concurrently, there was a very significant reduction in the knee VAS pain score (p < 0.01). The CON exhibited no significant changes in the EMG indices of the lower limbs, EP, and VAS before and after the 6 weeks (p > 0.05)., Conclusion: A 6-week gluteal muscle activation training program for patients with PFPS can adjust and optimize the IEMG, CR, and firing order of the lower limb muscle groups, enhance EP, and alleviate pain., (© 2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

To explore the additional value of shear wave elastography (SWE) in chronic obstructive pulmonary disease (COPD) patients. Ultrasound elastography of the rectus femoris and patellar tendon was performed to determine the mean elasticity index (SWE mean ) of the rectus femoris (SWE RF ) and patellar tendon (SWE PT ) in 56 patients with COPD and 53 healthy controls. Clinical tests included the COPD Assessment Test (CAT), the dyspnea index score (modified British Medical Research Council (mMRC)score), the Five-Repetition Sit-to-Stand Test(5STS) and the Six-Minute Walk Test (6MWT). We compared differences in SWEmean between healthy controls and COPD patients while describing the correlation between SWEmean and clinical tests in COPD patients. Both the intra-observer and inter-observer repeatability of SWE performance were excellent (all correlation coefficients > 0.75; p < 0.05). There was a statistically significant difference between healthy controls and COPD patients in the SWE RF and SWE PT between healthy controls and COPD patients (p < 0.001). The COPD patients had smaller SWE RF and larger SWE PT than healthy controls. The SWE RF was positively correlated with the 6MWT (r = 0.591, p < 0.001), and negatively related to the mMRC (r = - 0.794, p < 0.001), CAT (r = - 0.894, p < 0.001) and 5STS (r = - 0.928, p < 0.001). But the SWE PT was positively related to the 6MWT (r = 0.269, p < 0.05), mMRC (r = 0.398, p < 0.05), CAT (r = 0.377, p < 0.05) and 5STS (r = 0.332, p < 0.05). SWEmean of COPD patients was statisticant, different from that of healthy controls, and associated with clinical tests. SWE was a simple and feasible tool for reflecting the lower limb dysfunction in patients with COPD., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Informed consent: Informed consent was obtained from all subjects and/or their legal guardian(s)., (© 2025. The Author(s).)

Motor dysfunction is one of the most significant sequelae of stroke, with lower limb impairment being a major concern for stroke patients. Motor imagery (MI) technology based on brain-computer interface (BCI) offers promising rehabilitation potential for stroke patients by activating motor-related brain areas. However, developing a robust BCI-MI system and uncovering the underlying mechanisms of neural plasticity during stroke recovery through such systems requires large-scale datasets. These datasets are particularly needed for accurate lower limb MI in stroke patients and for longitudinal data reflecting the rehabilitation process. This study addresses this gap by collecting EEG data from 27 stroke patients, covering two enhanced paradigms and three different time points. The dataset includes raw EEG signals, preprocessed data, and patient information. An initial analysis using CSP-SVM on the dataset yielded an average classification accuracy of 80.50%. We anticipate that this dataset will facilitate research into brain neuroplasticity in stroke patients, aid in the development of decoding algorithms for lower limb stroke, and contribute to the establishment of comprehensive stroke rehabilitation systems., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: We aimed to examine associations between various sarcopenia indices-including skeletal muscle index (SMI), handgrip strength, lower-extremity muscle strength, a combined measure of handgrip and lower-extremity muscle strength, sarcopenia (defined as a combination of SMI and muscle strength), and the SARC-F questionnaire-and all-cause mortality in patients with advanced or recurrent lung cancer. Moreover, we aimed to identify factors influencing sarcopenia indices that demonstrate strong correlations with prognosis, aiming to inform the development of targeted interventional strategies., Methods: This retrospective observational study enrolled outpatients with lung cancer who underwent chemotherapy. Patients were evaluated for sarcopenia indices, including SMI, handgrip strength, five-repetition sit-to-stand test (5STS), and SARC-F. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). The log-rank test and Cox proportional hazards model, adjusted for confounders, were used to examine the association between the sarcopenia index and prognosis. Harrell's concordance index (C-index) was used to quantify the predictive power of the resultant model. To examine the significant factors associated with sarcopenia indices, which are associated with prognosis, multivariate logistic regression analysis was performed., Results: There was a significant association between low handgrip strength (hazard ratio [HR], 2.73; 95% confidence interval [CI], 1.20-6.25; P = 0.017), 5STS ≥ 12 s (low lower-extremity muscle strength) (HR, 2.32; 95% CI, 1.23-4.36; P < 0.01), the combination of low handgrip strength and 5STS ≥ 12 s (HR, 2.37; 95% CI, 1.23-4.57; P = 0.010), and sarcopenia (defined as a combination of SMI and muscle strength) (HR, 2.07; 95% CI, 1.02-4.21; P = 0.044) and survival, whereas there was no significant association between SMI (HR, 1.62; 95% CI, 0.74-3.53; P = 0.20) and SARC-F (HR, 2.07; 95% CI, 0.97-4.43; P = 0.061) and survival. The C-index for handgrip strength and 5STS was 0.625 (95% CI: 0.624-0.627) and 0.635 (95% CI: 0.634-0.636), respectively. Multivariate logistic analysis adjusted for age, sex, clinical stage, and treatment line showed that IPAQ-SF was an independent significant factor associated with 5STS ≥ 12 s (odds ratio [OR], 9.31; 95% CI, 2.93-29.58; P < 0.001), the combination of low handgrip strength and 5STS ≥ 12 s (OR, 6.45; 95% CI, 2.10-19.81; P = 0.001), and sarcopenia (OR, 4.90; 95% CI, 1.52-15.84; P = 0.008)., Conclusions: Handgrip strength and lower-extremity muscle strength were stronger predictors of prognosis compared to the SMI. Furthermore, physical inactivity was significantly associated with lower-extremity muscle strength. From a clinical perspective, evaluating lower-extremity strength and physical activity is essential, and implementing exercise interventions, including strategies to enhance physical activity levels, should be considered., Competing Interests: Declarations. Ethics approval and consent to participate: Ethical approval was obtained from the institutional review board of Kansai Medical University (approval number: 2023264). Consent for publication: An opt-out consent procedure was used due to the retrospective nature of the study. All procedures were performed in accordance with the ethical standards of the responsible committees for human experimentation (institutional and national) and the Helsinki Declaration of 1964 and its later versions. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: This study aimed to systematically evaluate the effect of Tai Chi on the balance function, mobility function, and gait function (including gait endurance, gait amplitude, and gait speed) of the lower limbs in patients with Parkinson's disease., Methods: The "PICOS" principle was used to search seven English and six Chinese databases. Search for relevant studies published up to September 11, 2023, from the date of database creation. Two authors independently screened all eligible studies. The included studies were assessed for risk of bias based on the criteria outlined in Cochrane Handbook 5.1.0. Quantitative statistics and meta-analyses were conducted using Review Manager 5.4 software., Results: Th 18 studies that met the inclusion criteria, 16 of which were included in the meta-analysis, included a sample of 963 cases from four countries. The meta-analysis revealed that Tai Chi was effective compared with conventional medication in improving balance function (MD = 2.06, 95% CI [1.35, 2.78], P < 0.00001, I 2  =0%), mobility function (MD = - 1.59, 95% CI [- 2.28, - 0.91], P < 0.00001, I 2  =14%), and gait speed (SMD =0.59, 95% [0.28, 0.91], P = 0.0002, I 2  =29%). However, there was no significant improvement in gait endurance (SMD = 0.14, 95% CI [-0.41, 0.68], P =0.62, I 2  = 0%) or gait amplitude (SMD =0.30 , 95% CI [- 0.00, 0.61], P = 0.05, I 2  =0%). Compared with other exercise therapies, Tai Chi was significantly superior in improving balance function (MD = 3.05, 95% CI [1.94, 4.16], P <0.00001, I 2  = 38%), mobility function (MD =-0.70, 95%CI [- 1.23, - 0.17], P = 0.01, I 2  = 0%), and gait range (SMD = 0.36, 95% CI [0.14, 0.58], P = 0.002, I 2  = 45%). However, the advantage of improving gait speed (SMD =0.00, 95% CI [- 0.28, 0.29], P = 0.98, I 2  =0%) was uncertain., Conclusion: Tai chi is a safe and effective rehabilitation intervention that can enhance the balance and mobility functions of the lower limbs in patients with Parkinson's disease., Competing Interests: Declarations. Ethics approval consent to participate: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Disorders in the recovery of gait strategies in individuals with incomplete spinal cord injury (SCI) suggest difficulties in controlling lower limb intersegmental dynamics, which could relate to proprioceptive impairments. To probe discrete aspects of lower limb interjoint coordination, we present here a novel protocol to assess lower limb motor strategies and evaluate the influence of proprioceptive impairments following SCI., Methods: Twelve able-bodied controls and 16 participants with SCI performed lower limb pointing to three targets that involved combined hip and knee flexion, or hip or knee flexion only while standing, with either full or obstructed visual feedback. We quantified lower limb proprioceptive sense in individuals with SCI using a robotic gait device. We used motion analysis to determine lower limb joint angles and foot trajectory, computed inverse dynamics to quantify joint and intersegmental dynamics, and derived muscle torque as an indicator of the motor strategies produced to control the motion to each target. We used linear mixed-effects models to assess differences between the control and SCI groups on end-point performance and muscle torque, and to assess the relationship of muscle torque with end-point performance and proprioceptive sense., Results: Groups differed in motor strategies, but not end-point performance, when pointing to all three targets. Compared to controls, the SCI group had difficulty controlling knee muscle torque when performing the hip-flexion-only target (p = 0.008) or when flexing the hip and knee simultaneously (p = 0.0004). To complete the knee-flexion-only target, the SCI group had difficulties generating the required hip extensor muscle torque to maintain the thigh in neutral (p = 0.0001). These altered motor strategies in individuals with SCI were associated with proprioceptive impairments and end-point performance., Conclusion: This novel lower limb pointing task can identify disordered motor strategies in individuals with SCI, especially at the knee, and are associated with proprioceptive impairment. Variations of this paradigm can be employed to further understand differences in motor strategies between controls and individuals with SCI, and the impact of proprioceptive deficits., Competing Interests: Declarations. Ethics approval and consent to participate: All procedures were approved by the University of British Columbia Clinical Research Ethics Board, and all participants provided written informed consent. Consent for publication: All participants provided written informed consent for the data to be published. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: To observe the effects of antagonistic needling therapy on lower limb spasticity and the muscle morphology of the tibialis anterior and gastrocnemius in patients with stroke., Methods: A total of 100 patients with post-stroke lower limb spasticity were randomly divided into an antagonistic needling group (50 cases, 1 case dropped out) and a routine acupuncture group (50 cases, 1 case dropped out). Both groups received basic treatment and rehabilitation training. The routine acupuncture group was treated with scalp acupuncture at anterior oblique line of vertex-temporal and vertex lateral line 1, combined with body acupuncture at Jianyu (LI15), Hegu (LI4), Zusanli (ST36), Taichong (LR3), etc. on the affected side, with Quchi (LI11) and Hegu (LI4), Zusanli (ST36) and Fenglong (ST40), Yanglingquan (GB34) and Taichong (LR3) connected to an electroacupuncture device, using disperse wave at 2 Hz of frequency. The antagonistic needling group used the same scalp and upper limb acupoints as the routine acupuncture group, with additional antagonistic needling on the lower limb at Yanglingquan (GB34), Qiuxu (GB40), Jiexi (ST41), and Xuanzhong (GB39) on the affected side, with Quchi (LI11) and Hegu (LI4), Yanglingquan (GB34) and Qiuxu (GB40), Jiexi (ST41), and Xuanzhong (GB39) connected to an electroacupuncture device, using disperse wave at 2 Hz of frequency. Both groups received treatment once daily for 6 consecutive days per course, with a total of 4 courses. The modified Ashworth scale (MAS), Holden functional ambulation classification (FAC), lower limb Fugl-Meyer assessment (FMA), composite spasticity scale (CSS), and musculoskeletal ultrasound parameters (thickness and fiber length of the tibialis anterior and gastrocnemius, and pennation angle of the gastrocnemius on both sides) were evaluated before and after treatment. Clinical efficacy was compared between the two groups., Results: Compared before treatment, the MAS grades and CSS scores were decreased in both groups after treatment ( P <0.01), with greater reductions in the antagonistic needling group ( P <0.05, P <0.01). FAC grades and FMA scores were increased in both groups after treatment ( P <0.01, P <0.05), with greater improvements in the antagonistic needling group ( P <0.05). The muscle thickness, fiber length of the tibialis anterior, the muscle thickness, fiber length and pennation angle of the gastrocnemius on the affected side were improved in both groups after treatment ( P <0.01), with greater improvements in the antagonistic needling group ( P <0.01, P <0.05). On the unaffected side, these parameters were also increased after treatment in both groups ( P <0.01, P <0.05), but the antagonistic needling group showed smaller increases than the routine acupuncture group ( P <0.01, P <0.05). The total effective rate in the antagonistic needling group was 91.8% (45/49), higher than 81.6% (40/49) in the routine acupuncture group ( P <0.05)., Conclusion: Antagonistic needling could effectively reduce spasticity, improve motor function, and enhance muscle structure in patients with post-stroke lower limb spasticity.

(1) Background: Hemiparetic patients after stroke have deficits on the side of the body opposite to the brain lesion. The aim of this study is to assess the occurrence of deficits in the ipsilesional lower limb. (2) Methods: Twenty-nine stroke patients (SG) and 29 healthy volunteers (CG) were recruited for this study. Passive (PROM), active (AROM), fast range of motion (FROM), and joint position sense (JPS) in the knee joint were measured using a wireless motion system. Participants were also assessed using the step test, balance platform, and the isometric protocol of measuring the strength of the extensor and flexor muscles of the knee. We compared non-paretic lower limb outcomes to the paretic side and a control group. (3) Results: The results showed a difference between the results of the ipsilesional side of the body of stroke patients and the control group. In the non-paretic limb, we observed deficits in PROM ( p = 0.018) and AROM ( p = 0.048), a lower average ( p < 0.001) and maximum speed ( p < 0.001) in FROM, worse proprioception (JPS, p < 0.001), and a lower number of repetitions in the step test ( p < 0.001) compared to the control group. We also observed a decrease in the average isometric strength of the extensor ( p < 0.001) and flexor ( p = 0.040) muscles of the non-paretic knee joint compared to the CG. The balance assessment on a balance platform showed worse postural control in people after stroke in all tested conditions (eyes open and closed on a firm and foam surface; p < 0.001). (4) Conclusions: The non-paretic lower limb in stroke patients is characterized by limited ROM at the knee joint, reduced movement speed, decreased proprioception, weakness of the knee flexors and extensors, and resulting impaired balance. The deficits identified require improvement and should be considered when planning rehabilitation.

Functional near-infrared spectroscopy (fNIRS) holds potential utility as a measure of neural correlates of pain. However, most studies have focused on upper limb stimulation, with limited investigation into lower limbs. In this study, we utilized fNIRS to observe brain changes in oxyhemoglobin levels during painful and non-painful electrical stimulation of various lower limb sites (bilateral groins and knees) in 16 healthy participants. Additionally, we explored perceptual responses to painful and non-painful electrical stimulation across these lower limb sites. Our findings showed no significant main effect of stimulation across different body sites on oxyhemoglobin activity. However, the interaction between body sites, stimulation modalities, and brain regions significantly influenced oxyhemoglobin activity. Specifically, we found a decrease of neuro-metabolic activity in prefrontal and bilateral primary somatosensory cortices during painful stimulation of the left groin compared to non-painful stimulation, whereas an increase of neuro-metabolic activity was observed during painful stimulation of the right knee. Our findings also revealed that stimulation intensity was notably lower for bilateral knees compared to the left groin. These findings underscore the potential and feasibility of utilizing fNIRS to investigate pain mechanisms related to stimulation across distinct lower limb regions., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The objective of this study was to conduct a comprehensive comparison of the effects of hip and knee strengthening training in patients with patellofemoral pain (PFP). A meta-analysis was conducted to investigate the effects of these two types of strengthening training on patients' lower limb biomechanics, knee pain and function. The aim was to evaluate the effectiveness of the two training modalities and provide evidence-based recommendations for the rehabilitation of patients with PFP. A total of 12 studies were identified through a search of the Web of Science, EBSCO, and PubMed databases. The selected studies comprised nine randomized controlled trials (RCTs), one comparative controlled trial (CCTs) and two cohort studies (CSs), with a total of 1,066 patients. The quality of the included studies was evaluated via the PEDro scale, and a meta-analysis was conducted via Stata18 software. The results show that both types of strengthening training positively impact pain reduction and improved knee function in PFP patients. Moderate evidence from meta-analyses indicated that hip strengthening training (SMD = -1.740, 95%; CI -2.212 to -1.267, P < 0.001) was more effective than knee strengthening training (SMD = -1.302, 95%; CI -1.75 to -0.86, P < 0.001) in reducing pain (VAS). Similarly, Strong evidence suggests that hip strengthening training (SMD = 1.205, 95%; CI 0.968 to 1.443, P < 0.001) was significantly more effective than knee strengthening training (SMD = 1.023, 95%; CI 0.722 to 1.325, P < 0.001) in improving knee function (AKPS). Additionally, moderate evidence suggests that hip strengthening training significantly increased hip abductor strength (SMD = 0.848, 95%; CI 0.508-1.187, P < 0.001) and external rotator strength (SMD = 0.780, 95%; CI 0.416-1.145, P < 0.001), while strong evidence suggests that knee strengthening training did not significantly enhance knee extensor strength (SMD = 0.212, 95%; CI -0.014 to 0.439, P = 0.066). Therefore, clinicians should use hip strengthening as one of the primary training interventions when treating patients with PFP., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: Describe abobotulinumtoxinA (aboBoNT-A) dosing parameters in the real-world management of lower limb spasticity (LLS)., Methods: Prospective, observational study (NCT0​4050527) following ambulatory adults with unilateral LLS treated with aboBoNT-A., Results: The effectiveness population included 384 adults with LLS. Across the study, total lower limb doses were higher in patients who received only lower limb injections (n = 131, median 771U) than those who also received ≥ 1 upper limb injection (n = 253, 567U). Total doses increased over subsequent cycles in both subgroups. Six muscles (gastrocnemius medial and lateral heads, soleus muscle, tibialis posterior, flexor digitorum longus, and flexor hallucis longus) were identified as the main targets for the treatment of LLS; other lower limb muscles were injected in fewer than 15% of patients. The most frequent therapy interventions (mean ± SD of 1.8 ± 1.3h/week with a qualified therapist and 5.3 ± 5.9h/week self-rehabilitation in Cycle 1) were task-specific practice, passive stretch, strength training, and positioning., Conclusions: This study demonstrates how a diversity of muscle patterns are currently treated in routine practice where the primary goal was related to the lower limb and highlights important issues for further debate, such as potential underdosing and the need to balance upper and lower limb priorities when devising a treatment plan.

Spinal deformities characterized by malalignment of the spinal column, including scoliosis, hyper kyphosis, and lordosis, can significantly impact lower limb kinematics, potentially leading to altered gait patterns. We aimed to synthesize existing literature investigating the effect of spinal deformities on lower limb kinematics during walking. We searched Four databases including PubMed, Web of Science, Scopus and Embase from their inception through 29th December 2024. The Newcastle-Ottawa Scale was applied to assess quality of included studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE system) was employed to assess the overall quality of the evidence in the meta-analysis. Mean differences and 95% confidence intervals (CI) were calculated with random effects model in RevMan version 5.4. The review included 35 studies with 1941 participants. Regarding scoliosis, strong evidence suggested a significant increase in right leg stance% and non-significant changes in left leg cadence, right and left leg speed and ankle transverse ROM in individuals with scoliosis compared to controls. Sensitivity analysis showed strong evidence of decrease in right leg stride length and ankle sagittal ROM, decrease in left leg single support and non-significant change in left leg step length. Individuals with sagittal malalignment showed strong evidence of significant reduction in velocity; moderate evidence suggested a significant increase in double support and a decrease in stride length, knee and hip sagittal ROM. Sensitivity analysis revealed strong evidence of a significant decrease in cadence during walking in individuals with sagittal trunk malalignment compared to controls. Participants with adult spinal deformity exhibited strong evidence of increased double support and decreased cadence during walking compared to controls. Spinal deformities significantly alter lower limb kinematics during gait. Our findings highlight the essential need for clinicians to take gait alterations into account when developing targeted interventions for individuals with spinal deformity., Competing Interests: Declarations. Declaration of competing interest: The author(s) declare no competing interests., (© 2025. The Author(s).)

Introduction: The global rise in lower-limb amputations is mainly due to diabetes and vascular complications. Amputations cause serious physical and psycho-social disabilities which impair locomotion and compromise patients quality of life. Biopsychosocial factors such as altered gait parameters, poor prosthetic fit, depression, fear avoidance behaviours and stigma increase the risk of individuals incurring lower back pain; the leading cause of secondary disability amongst persons with lower-limb amputation. Exploring the potential mechanistic pathways of lower back pain development is important to inform timely patient-centred programmes of care. Currently, limited information exists to inform the design of such programmes. Thus, there is a pressing need to understand the bio-behavioural, psychological, and social features of individuals with lower-limb amputation in the presence of lower back pain., Methods and Analysis: This proposed study protocol employs a prospective longitudinal study design that aims to explore the determinants of lower back pain amongst 30 adults with unilateral lower-limb amputation over 12-months. Biomechanical gait variables, trunk and lower-limb muscle activations, and objective pain measurements will be monitored every 3-months, and their relationship will be investigated. This information can be used to explore the characteristics of lower back pain and will inform future care management and rehabilitation processes. A data repository will be created and will be accessible through the University of Bath library website (https://library.bath.ac.uk/home)., Trial Reference Number: The study is registered at IRAS ID: 321729 and at ClinicalTrials.gov: NCT06243549., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Withey et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Although kinematic assessments for stroke-induced lower limb impairments offer a promising alternative to conventional scale evaluations, interpreting high-dimensional kinematic data remains challenging due to numerous metrics reported in past studies. This study aimed to provide an exhaustive overview of existing studies using kinematics data to assess the gait impairments in individuals with stroke, along with examining their clinimetric properties for future clinical applications., Evidence Acquisition: A systematic search was conducted across PubMed (08/2024), Scopus (08/2024), Web of Science (08/2024), CINAHL (08/2024), EMBASE (08/2024), and IEEE (08/2024). We included articles that recruited individuals over 18 years old with stroke and utilized motion capture technologies to evaluate lower limb kinematics. Similar metrics were consolidated in the analysis, and the COSMIN Risk of Bias Checklist was used to evaluate the methodological quality of studies investigating the clinimetric properties of kinematic metrics. Convergent validity of metrics was evaluated by examining their association with the Fugl-Meyer scale of lower limbs and walking speed. Moreover, the GRADE approach was used to rate the quality of evidence., Evidence Synthesis: A total of 383 studies were classified into 10 categories. Seven studies on metric reliability were rated high for methodological quality. Metrics with satisfactory reliability included spatiotemporal, spatial metrics, and a data-driven score. Six studies with high methodological quality assessed convergent validity. The dynamic gait index, angular component of the coefficient of correspondence (ACC), change in cadence, stride length, and hip range of motion showed satisfactory validity. Among the 13 studies, 12 studies were rated as moderate quality of evidence using the GRADE approach., Conclusions: There are significant variations in measurements across studies, and high-quality studies evaluating clinimetric properties are scarce. For a more standardized evidence-based approach to kinematic lower limb assessment, further high-quality research validating these assessments' clinimetric properties is essential.

Rotational and angular variations of the lower extremities in children are common conditions seen in primary care. These visits are often due to parental concerns about the appearance of their child's lower extremities. Common variations include intoeing (metatarsus adductus, internal tibial torsion, and femoral anteversion); out-toeing (external tibial torsion, femoral retroversion, and pes planus); and angular variations (genu varum and genu valgum). History, particularly age of onset; duration; progression; appearance and impact; prenatal and birth history; nutritional deficiencies; growth and development; medical and family history of related disorders, including rheumatologic, autoimmune, or neurologic conditions, can help differentiate normal variations from true deformities. In addition to a routine physical examination, a focused examination measuring a variety of parameters, such as foot progression angle, internal and external hip rotation, thigh-foot angle, joint laxity, and other condition-specific tests should be performed. If an underlying cause is identified, it should be treated; however, these conditions typically do not require further evaluation or treatment if measurements are within age-related normal ranges and patients are asymptomatic, and parents can be reassured that they are benign. There is minimal evidence to support the use of orthotics or braces. Referral to a pediatric orthopedist should be considered when measurements are more than 2 standard deviations outside of normal values, children have pain, or function is affected.

Background: Lymphedema is a chronic, progressive condition that has major physical and psychological consequences. It was aimed to examine the respiratory functions, respiratory muscle strength, physical activity level, and functionality of patients with lower extremity lymphedema and to compare them with healthy controls. Methods and Results: A total of 82 individuals (29.3% male, 70.7% female, with a mean age of 49.89 ± 15.07 years) with lower extremity lymphedema (Group 1) and healthy individuals (Group 2) were included. Respiratory functions of the participants were evaluated by spirometry, respiratory muscle strength by maximum oral pressure measurements, physical activity levels using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), functionality by Lower Extremity Functional Scale (LEFS) and Timed Up and Go test (TUG test). All respiratory function test measurements were lower in mean Group 1 than in Group 2 ( p < 0.05). While inspiratory muscle strength did not differ between the groups ( p > 0.05), expiratory muscle strength was lower in Group 1 than Group 2 ( p < 0.05). Although spent time and energy for sitting were higher in Group 1 ( p < 0.05), IPAQ vigorous-, moderate-, and light-intensity physical activity (MET-min/week) and IPAQ-total score did not differ between groups ( p > 0.05). In Group 1, mean of LEFS score was lower and TUG test (seconds) in Group 1 was longer compared to Group 2 ( p < 0.05). Conclusions: Respiratory functions, expiratory muscle strength, and functionality in patients with lower extremity lymphedema were adversely affected; however, inspiratory muscle strength and physical activity levels were similar to those of healthy controls.

Sarcopenia refers to a neuromuscular disease characterized by age-related declines in muscle mass and function. Since Professor Rosenberg first introduced the concept of sarcopenia in 1989, numerous operational paradigms have been proposed, tested, and validated against negative outcomes. The most recent recommendations advocate that dynapenia, or reduced of muscle strength, should be used alongside low muscle mass for the identification of sarcopenia. This approach is based on the understanding that impairments in muscle strength are a major consequence of muscle failure. However, empirical evidence has yielded conflicting results regarding the ability of current sarcopenia definitions to identify individuals at higher risk of adverse health-related events. Muscle power - the capacity to generate strength rapidly - has emerged as a critical domain of physical performance in old age. Not only does it decline earlier and more drastically than other measures (e.g., muscle strength), but it is also more strongly associated with adverse outcomes. In this view point, we provide an appraisal of muscle power as a more reliable indicator of muscle failure, compared with other measures (e.g., strength), for identifying individuals with sarcopenia in both geriatric and non-geriatric settings. We also discuss major challenges hindering the conduct of meaningful investigations on this subject., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier B.V. All rights reserved.)

Background: Secondary lymphedema is acquired and caused by obstruction or injury to a normally developed lymphatic system. Loss of mobility is a common problem in patients with secondary lower limb lymphedema (LLL) following cancer treatment. In this study, we examined the effect of complex decongestive therapy (CDT) on motor function and mobility in patients with LLL. Methods and Results: A quasi-experimental study was performed with 24 participants with stage 2 LLL (56.04 ± 14.23 years). Participants received 15 sessions of CDT. Motor function was assessed with a foot tapping test (FTT). Gait speed was measured in single-task (ST) and dual-task (DT) conditions, and DT cost was calculated. All assessments were performed before and after the intervention. The paired t- test and Wilcoxon signed-rank test were used to analyze the effect of CDT on FTT, gait speed, and DT cost. ST and DT gait speed ( p = 0.002, p < 0.001) and DT cost ( p = 0.001) decreased following the CDT, whereas bilateral FTT scores did not change. Conclusion: CDT improves mobility and dual-tasking in LLL, thereby promoting independence in daily life. Future prospective controlled studies are required to corroborate our results.

Background: The aim of this study was to investigate the validity and reliability and identify determinants of the 6-minute walk test (6MWT) in patients with lower limb lymphedema (LLL). Methods and Results: The study included 28 patients with LLL and 28 healthy subjects. To investigate the convergent validity and determinants of the 6MWT, patients were assessed using the following measurements: circumference measurement for lymphedema severity, hand-held dynamometry for muscle strength, time up and go for functional mobility, five-time sit-to-stand test for functional lower extremity strength, Lower Extremity Functional Scale for lower extremity functionality, Lymphedema Life Impact Scale for quality of life, and International Physical Activity Questionnaire-Short Form for physical activity level. The test-retest reliability of the 6MWT was assessed using intraclass correlation coefficients (ICCs). 6MWT, a test-retest reliability analysis was carried out with 28 patients within 3-7 days. The receiver operating characteristic (ROC) curve was employed to determine the cut-off point of 6MWT. The test-retest reliability of 6MWT was detected as excellent (ICC [95%] 0.93 [0.87-0.97]). Significant correlations were found between the 6MWT health-related and disease-specific parameters, indicating sufficient convergent validity ( r ≥ 0.3). The ROC curve indicated a cut-off point of 504 meters (area under the curve [AUC] 0.712 [95%CI: 0.575-0.849]). Multiple linear regression analysis demonstrated that lymphedema severity, hip abduction muscle strength, and lower limb functionality were the predictors of 6MWT. Conclusions: The 6MWT has been shown to be a reliable and valid tool for assessing the functional capacity of patients with LLL.

Background: Falls and sarcopenia are significant public health issues in Vietnam. Despite muscle strength being a critical predictor for these conditions, reference data on muscle strength within the Vietnamese population are lacking., Purpose: To establish the reference ranges for muscle strength among Vietnamese individuals., Methods: The study involved 4096 individuals, including 1419 men and 2677 women aged 18 years and above, from the Vietnam Osteoporosis Study. Muscle strength was assessed using a Baseline hand dynamometer for handgrip strength and a Back-Leg-Chest dynamometer for leg strength. We calculated mean values, standard deviations, interquartile ranges, and peak muscle strength (pMS) for both handgrip and leg strength across various ages. Reference curves were created with the Generalised Additive Model for Location Scale and Shape, and polynomial regression models were employed to analyse the relationship between muscle strength and age., Results: Advancing age was significantly associated with lower muscle strength. Peak muscle strength typically occurred between ages 30 and 40, with earlier peaks in women, especially in leg strength. Men consistently showed higher muscle strength than women, with variations depending on the measurement site. Specifically, average handgrip strength was 36.4 kg ± 8.4 (mean ± SD) for men and 23.2 kg ± 6.0 for women (p < 0.001). Leg strength averaged 63.9 kg ± 27.2 for men and 29.5 kg ± 13.9 for women (p < 0.001). Additionally, we produced a percentile chart illustrating muscle weakness ranges based on the 25th percentile of muscle strength and the appendicular skeletal muscle mass index (ASMI) for the Vietnamese population., Conclusion: These data provide reference ranges for evaluating muscle strength in the Vietnamese population, offering crucial insights for identifying individuals at risk of falls or sarcopenia in clinical settings., (© 2025 The Author(s). Journal of Cachexia, Sarcopenia and Muscle published by Wiley Periodicals LLC.)

Objective: We investigated the characteristics of hip, knee, and ankle joint reaction forces (JRFs) in stroke patients with spastic hemiplegia during sit-to-stand (Si-St) and stand-to-sit (St-Si) movements and explored the relationship between JRFs and joint moments., Methods: Thirteen stroke patients with spastic hemiplegia and thirteen age-matched healthy subjects were recruited in this study. Three-dimensional motion capture system and force plates were employed to collect kinematic data and ground reaction forces during Si-St and St-Si tasks. Musculoskeletal modeling was used to calculate JRFs and joint moments of the hip, knee and ankle joints during these movements., Results: Those stroke patients exhibited higher JRFs (ranging from 13.49 N/kg to 43.18 N/kg) compared to the healthy group (ranging from 15.81 N/kg to 23.00 N/kg) in hip and knee joints. Furthermore, hip and ankle JRFs exhibited positive correlations with their joint moment in stroke patients during Si-St and St-Si movements., Conclusion: Early rehabilitation strategies should focus on correcting weight distribution and enhancing symmetry in joint loading. Interventions focused on reducing joint moment, particularly for hip and ankle joints, may prove effective in mitigating lower extremity JRFs in stroke patients with spastic hemiplegia during Si-St and St-Si movements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: This study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status., Methods: A retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations., Results: Phase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge., Conclusion: Segmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Background: Grip Strength has been established as a practical and efficient method for screening and diagnosing sarcopenia. It is recognized that with advancing age, there is a more significant decline in lower limb muscle mass compared to the upper limb. However, due to the inherent complexity of assessing lower limb muscle strength compared to measuring Grip Strength, these assessments have not been universally adopted for sarcopenia screening., Methods: We measured the Forefoot Strength, Heel Strength, Knee Extension Strength, and Hip Extension Strength in 98 participants using portable equipment designed for lower limb muscle strength assessment. We compared the efficacy of using lower limb muscle strength cutoff values with grip strength for the screening of sarcopenia., Findings: The optimal cutoff values for screening sarcopenia in males using Knee Extension Strength and Hip Extension Strength were 140.1 N and 121.7 N, respectively, while for females they were 91.6 N and 90.4 N, respectively. In binary logistic regression models adjusted for age and body weight, Knee Extension Strength and Hip Extension Strength were found to be associated with sarcopenia in both males and females. Moreover, the efficacy of sarcopenia screening using Knee Extension Strength or Hip Extension Strength cutoff values was superior to that of grip strength alone, and the combination of Knee Extension Strength and Hip Extension Strength cutoff values yielded the best results for sarcopenia screening., Interpretation: Measurements of Knee Extension Strength and Hip Extension Strength may potentially serve as a promising method for sarcopenia screening., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

Background and Objectives : Kinematic and kinetic data from gait analysis are commonly used for clinical decision making in cerebral palsy (CP). However, these data may not fully capture the underlying causes of movement pathologies or effectively monitor post-treatment changes. Joint reaction forces (JRFs), estimated through simulation-based methods, provide valuable insights into the functional state of musculoskeletal components. Despite their importance, comprehensive evaluations of lower limb JRFs in CP are limited, and comparisons with typically developing (TD) individuals remain underexplored. This study aimed to provide a detailed comparison of lower limb JRFs between children with CP exhibiting mild crouch gait and age-matched TD children during self-selected walking speeds. Materials and Methods : Open-access gait datasets from eight children with CP and eight TD children were analyzed. A full-body musculoskeletal model was scaled to individual anthropometric data in OpenSim. Joint angles and moments were obtained using inverse kinematics and inverse dynamics, respectively. Ankle, knee, and hip JRFs were calculated using OpenSim's Joint Reaction tool. Root-mean-square differences and Pearson correlation coefficients quantified the differences between CP and TD JRFs. Results : The anterior-posterior and vertical components of the hip JRFs in CP were lower than in TD children. CP knee JRFs exceeded TD values across all anatomical axes. For the ankle, the anterior-posterior JRF was lower in CP, whereas the vertical component was higher compared to TD. Conclusions : Children with CP experience distinct lower limb JRF patterns compared to TD children. While some findings align with previous studies, discrepancies in other components highlight the influence of model and patient-specific characteristics. These results emphasize the need for standardization in reporting patient data and systematic evaluations to improve the interpretation and applicability of JRF analyses in CP research and treatment planning.

Scoliosis is a prevalent condition among adolescents, and the spinal manipulation is one of the conservative treatment methods for scoliosis patients. Impairment in movement function stands out as a typical characteristic in cases of scoliosis. This study utilized a single-arm clinical trial design involving 35 patients aged 18 to 20 with idiopathic scoliosis (IS) and Cobb angles ranging from 10° to 30°. The treatment protocol consisted of spinal manipulation sessions three times a week, each lasting 40 min, administered over a span of six weeks. Pre- and post-intervention assessments focused on the Cobb angle and lower limb kinematics and kinetics during functional movements such as level walking, stair ascent, and descent. Patients with IS showed improvements in the Cobb angle, as well as changes in lower limb kinematics and kinetics during functional activities, such as walking and stair navigation, following six weeks of spinal manipulation intervention. The study further demonstrated that spinal manipulation reduced lower limb's sagittal joint mobility, increased stability in individuals with IS. Patients with IS exhibited significant changes in lower limb kinematics and kinetic following spinal manipulation, which may serve as a potential mechanism underlying the alteration of the Cobb angle. Future studies, particularly RCTs, are needed to further validate the effectiveness of spinal manipulation in treating IS., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent to participate was obtained from all subjects and/or their legal guardian(s); this study has obtained approval from the Ethics Committee of the Third People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine (Approval No: 2023-kl-047). It has also been registered with the Chinese Clinical Trial Registry on 11/08/2023, under the registration number ChiCTR2300074648. Consent for publication: Informed consent to participate was obtained from all subjects and/or their legal guardian(s). Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Identifying and diagnosing cognitive impairment remains challenging. Some diagnostic procedures are invasive, expensive, and not always accurate. Meanwhile, evidence suggests that cognitive impairment is associated with changes in gait parameters. Certain gait parameters manifesting differences between people with and without cognitive impairment are more pronounced when adding a secondary task (dual-task scenario). In this systematic review, the capability of gait analysis to identify cognitive impairment is investigated. Twenty-three studies published between 2014 and 2024 met the inclusion criteria. A significantly lower gait speed and cadence as well as higher gait variability were found in people with mild cognitive impairment (MCI) and/or dementia, compared with the group with no cognitive impairment. While dual tasks appeared to amplify the differences between the two populations, the type of secondary tasks (e.g., calculations and recalling phone numbers) had an effect on gait changes. The activity and volume of different brain regions were also different between the two populations during walking. In conclusion, while this systematic review supported the potential of using gait analysis to identify cognitive impairment, there are a number of parameters researchers need to consider such as gait variables to be studied, types of dual tasks, and analysis of brain changes while performing the movement tasks.

Purpose: Monitoring and assessing the level of lower limb motor skills using the Biodex System plays an important role in the training of football players and in post-traumatic rehabilitation. The aim of this study was to build and test an artificial intelligence-based model to assess the peak torque of the lower limb extensors and flexors. The model was based on real-world results in three groups: hearing ( n = 19) and deaf football players ( n = 28) and non-training deaf pupils ( n = 46). Methods : The research used a 4-layer forward CNN neural network with two hidden layers with typical normalization for small data sets and Multilayer Perceptron (MLP) based on MatlabR2023a software with Neural Networks and Deep Learning toolkits and semiautomated learning algorithm selection using ML.NET. Results : The 70-90% accuracy shown in the article is sufficient here. AI provides a highly accurate, objective and efficient means of assessing neuromuscular performance, which can improve injury prevention and rehabilitation strategies. Conclusions : The high accuracy shows that AI-based models can help with this, but their wider practical implementation requires further cross-disciplinary research. AI, and in particular MLP and CNN can support both training methods and various gaming aspects. The contribution of the research is to use an innovative approach to derive computational rules/guidelines from an explicitly given dataset and then identify the relevant physiological torque of the lower limb extensors and flexors in the knee joint. The model complements existing methodologies for describing physiology of peak torque of lower limbs with using fuzzy logic, with a so-called dynamic norm built into the model., (© 2024 Adam Michał Szulc et al., published by Sciendo.)

Background and Objective: Stroke, a major contributor to long-term disability worldwide, often results in significant impairments in motor function. These impairments can include weakness, impaired balance, and decreased coordination, which can have a significant influence on one's quality of life and independence. Finding an effective protocol for rehabilitation to improve these points will decrease the impact of stroke and its coast of rehabilitation. Materials and Methods: This study was conducted to assess the effect of lower limb plyometric exercises on strength, postural control, and risk of falling in stroke patients. Materials and Methods: This study involved 40 chronic left stroke patients randomly divided into two equal groups. The experimental group participated in a 12-week supervised plyometric training program, while the control group received conventional physical therapy program. Lower limb muscle strength was measured using a handheld dynamometer, and balance and fall risk were assessed via the Biodex Balance System (BBS). These measurements were conducted before and after the intervention period to evaluate treatment effects. Results: The results of this study demonstrated significant improvements in muscle strength and balance parameters among stroke patients who underwent plyometric exercise compared to those receiving a conventional program. The plyometric group exhibited significantly greater increases in knee extension strength ( p < 0.05), hip abduction strength ( p < 0.05), ankle dorsiflexion strength ( p < 0.05), and ankle eversion strength ( p < 0.05). Furthermore, the plyometric group showed significant improvements in overall stability ( p < 0.05), mediolateral stability ( p < 0.05), and anteroposterior stability ( p < 0.05), as measured by the Biodex Balance System (BBS). Conclusions: The results of this study suggest that plyometric exercise may be an effective intervention for decreased risk of falling and enhancing muscle strength and balance during recovery from stroke.

Quantification of pain or discomfort induced by pressure is essential for understanding human responses to physical stimuli and improving user interfaces. Pain research has been conducted to investigate physiological signals associated with discomfort and pain perception. This study analyzed changes in electrodermal activity (EDA), tissue oxygen saturation (StO 2 ), heart rate variability (HRV), and Visual Analog Scale (VAS) under pressures of 10, 20, and 30 kPa applied for 3 min to the thigh, knee, and calf in a seated position. Twenty participants were tested, and relationships between biosignals, pressure intensity, and pain levels were evaluated using Friedman tests and post-hoc analyses. Multiple linear regression models were used to predict VAS and pressure, and five machine learning models (SVM, Logistic Regression, Random Forest, MLP, KNN) were applied to classify pain levels (no pain: VAS 0, low: VAS 1-3, moderate: VAS 4-6, high: VAS 7-10) and pressure intensity. The results showed that higher pressure intensity and pain levels affected sympathetic nervous system responses and tissue oxygen saturation. Most EDA features and StO 2 significantly changed according to pressure intensity and pain levels, while NN interval and HF among HRV features showed significant differences based on pressure intensity or pain level. Regression analysis combining biosignal features achieved a maximum R 2 of 0.668 in predicting VAS and pressure intensity. The four-level classification model reached an accuracy of 88.2% for pain levels and 81.3% for pressure intensity. These results demonstrated the potential of EDA, StO 2 , HRV signals, and combinations of biosignal features for pain quantification and prediction.

Background: Patellofemoral pain syndrome (PFPS) is a common disorder affecting the lower extremity. This study aimed to compare the effects of functional strength training (FST) and standard strength training (SST) in PFPS patients., Methods: Forty college students (aged 18-30 years) with PFPS and no exercise habits were randomized into FST group (n = 20) and SST group (n = 20). FST group underwent six weeks of lower extremity training focused on functional adaptations, whereas SST group focus on lower extremity strength training. Function (Kujala Patellofemoral Scale, KPS), pain (visual analog scale, VAS), peak joint angles of hip, knee, and ankle, along with muscle activation (step-down test) of Vastus medialis, Vastus lateralis, Biceps femoris, Semitendinosus, Gluteus maximus, and Gluteus medius were assessed at baseline and after intervention., Results: FST outperformed SST in pain reduction (p = 0.026) and function (p = 0.006) post-intervention. The FST group also showed increased hip flexion (p < 0.001), gluteus maximus activation (p < 0.001), and reduced knee valgus (p = 0.032), while SST group exhibited greater knee flexion (p = 0.008), and higher activation of the lateral femoral (p < 0.001) and semitendinosus (p < 0.001)., Conclusion: Interventions focused on functional adaptations result in differential kinematic and muscle activation changes that may result in greater improvements in pain and knee function than lower limb muscle strengthening alone., Trial Registration: chictr.org.cn. NO: ChiCTR2400087664. Date 01/08/2024., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Over 50% of individuals with lower limb loss report a fear of falling and avoiding daily activities partly due to a lack of plantar sensation. Providing direct somatosensory feedback via neural stimulation holds promise for addressing this issue. In this study, three individuals with lower limb loss received a sensory neuroprosthesis (SNP) that provided plantar somatosensory feedback corresponding to prosthesis-floor interactions perceived as arising from the missing foot generated by electrically activating the peripheral nerves in the residuum. Participants walked on a treadmill while receiving perturbations involving brief increases in the belt speed. Perturbations were initiated during early stance and randomly delivered to intact and prosthetic sides with the SNP active or inactive. With the SNP active, participants exhibited decreased trunk angular sway and peak trunk flexion angular velocity during recovery from both prosthetic and intact side perturbations. For prosthetic side perturbations, peak ground reaction force magnitudes decreased when the SNP was active. For intact side perturbations, peak ground reaction force magnitudes increased on the prosthetic side's first recovery step after the perturbation, which resulted in a more symmetric recovery because the force approached the response on the intact side's first recovery step following a prosthetic side perturbation. These results suggest participants integrated the feedback from the SNP into their sensorimotor control for maintaining stability and gained confidence in relying on their prosthetic limb during recovery. Restoring plantar sensation with a SNP for individuals with lower limb loss could lead to reduced risk of falling by improving recovery from trips., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Purpose: Previous studies have demonstrated significant biomechanical differences between individuals with chronic ankle instability (CAI) and healthy controls during the Y-balance test. This study aimed to examine the effects of kinesio taping (KT) on lower limb biomechanical characteristics during the Y-balance anterior reach task in individuals with CAI., Methods: A total of 30 participants were recruited, comprising 15 individuals with CAI and 15 healthy controls. All participants were randomly assigned three taping conditions: no taping (NT), placebo taping (PT), and KT, followed by the Y-balance anterior reach task. Each condition was separated by one-week intervals. Kinematic and kinetic data of the lower limbs during the movement phase were collected using the Vicon motion capture system (Vicon, T40, 200 Hz) and two Kistler force platforms (Kistler, 1000 Hz)., Results: KT significantly improved the Y-balance anterior reach distance (P = 0.003) and peak ankle eversion angle (P = 0.019) compared to NT. Additionally, KT resulted in increased peak knee flexion angle (P = 0.002, P = 0.011) and peak ankle dorsiflexion angle (P <0.001, P = 0.005) relative to both NT and PT. KT also significantly reduced mediolateral center of pressure (COP) displacement (P = 0.001) and average velocity of mediolateral COP displacement (P = 0.033) in comparison to NT. Furthermore, KT decreased mediolateral center of gravity displacement (P = 0.002, P = 0.003) relative to both NT and PT., Conclusion: KT significantly improved abnormal ankle posture by promoting greater ankle dorsiflexion and eversion angles. Additionally, KT reduced mediolateral COP displacement and average velocity to improve postural stability. These changes may contribute to reduced risk of ankle sprains. Therefore, KT may serve as an effective tool for managing recurrent ankle sprains in individuals with CAI., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2025 Yuan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background:: Given the growing population of the elderly, understanding how aging impacts pain, muscle strength, and balance, especially in individuals with chronic low back pain, is imperative., Objective:: This study aims to investigate age-related differences in lower extremity muscle strength and balance in patients with chronic low back pain., Methods:: In this cross-sectional study, 110 people with chronic low back pain were divided into two age groups (Group 1, age: 29.89 ± 6.82, Group 2, age: 51.42 ± 6.33). Both groups used Oswestry for low back pain and disability assessment, isokinetic device for muscle strength, and Biodex Balance System for balance assessment., Results:: There were no significant differences between groups in terms of pain (p = 0.426) or disability (p = 0.056). In contrast, significant differences were observed in isokinetic muscle strength: peak torque for the dominant side at 60°/s for quadriceps (p = 0.003) and hamstring (p = 0.007), and at 180°/s for hamstring (p = 0.012) and quadriceps (p = 0.011). The balance assessment revealed significant differences in fall risk (p = 0.004) and postural stability (p = 0.006) variables. The most significant regression association was found between dominant side 60°/s quadriceps and fall risk variables across age groups., Conclusion:: Understanding age-related differences in muscle strength and balance among patients with chronic low back pain is critical. Customizing rehabilitation interventions improves efficacy and quality of life. Further research is necessary to optimize clinical approaches and elucidate underlying mechanisms., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Previous studies have evidenced balance training for improving postural control in children with DCD, however none have examined how neuromuscular mechanisms controlling balance might be improved with training., Aims: To assess the neuromuscular control of balance before and after training in children with DCD., Methods and Procedures: Eleven children with DCD completed a six-week, game-based intervention to train balance, and lower-limb and core strength. Six children with DCD formed the control group. Stepping behaviour, centre of mass variability, centre of pressure area, and postural muscle onset latencies, using a continuous oscillating platform paradigm, were assessed at baseline, immediately-post and six-week-post intervention., Outcomes and Results: Both groups showed improvement in the oscillating platform task, indicating a learning effect. However, only the training group showed improvements in MABC-2 balance percentile scores from baseline (p = 0.008)., Conclusions and Implications: These findings suggest that children with DCD can learn through repeated exposure to challenging situations, regardless whether training is given. However, only the training group were able to transfer these improvements to the MABC-2 balance assessment. This may suggest the intervention exposed children to increased movement variations which could be transferred to a different task., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In patients with diabetes, peripheral arterial disease, particularly below the knee, is associated with medial arterial calcification. This is a frequent and potentially serious complication, affecting all types of diabetes. In recent years, our understanding of the pathophysiology and clinical significance of medial arterial calcification has improved considerably. Here, we offer a short narrative review of the epidemiology, clinical consequences, and pathophysiology of this complication. Now that medial arterial calcification of the lower limbs is better understood, we also focus on the prospect of treatments targeting arterial calcification., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:, (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: The Gait Deviation Index (GDI) is a metric clinicians use to assess overall gait pathology in children with cerebral palsy (CP) by comparing kinematic data to a normative sample. The Gait Variability Index (GVI) is a related metric that quantifies the variability in spatio-temporal variables during gait. The GDI and GVI have been verified using marker-based motion capture approaches, but video-based markerless motion capture has not been compared using these tools in children with CP., Research Question: Do GDI and GVI scores differ when measured using markerlessTheia3D and a marker-based approach between the more and less affected legs in children with CP?, Methods: Fifteen children with CP (GMFCS levels I-IV) and 24 typically developing children aged 6-18 years were recruited for this study. Overground walking was performed at a self-selected pace while the pelvis and lower limb kinematics were simultaneously recorded using both motion capture systems. Differences in GDI and GVI scores when considering the effect of system and limb impairment were analyzed using two-way repeated-measures ANOVAs., Results: GDI scores were 6.9 points lower (p < 0.05) when measured using Theia3D compared to the marker-based approach and 6.8 points lower (p < 0.05) in the more affected limbs than in the less affected limbs. These GDI score differences are considered clinically significant. No differences were identified in GVI scores between systems or limb impairment. Differences in kinematic measurements were found in children with CP, including pelvic tilt, hip flexion/extension, hip rotation, and foot progression angle, where root mean square differences between systems exceeded 10°., Significance: Theia3D can adequately measure variability in spatio-temporal gait parameters for quantifying GVI scores in children with CP compared to the marker-based approach. However, caution is needed when quantifying lower limb kinematics and interpreting GDI and GVI scores using Theia3D in children with CP., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David Kingston reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In-clinic gait retraining has been effective in modifying suspected biomechanical risk factors for running injury, but its feasibility is often limited by multiple clinic visits. This randomized clinical trial investigated the effects of a telehealth-based gait retraining intervention on running biomechanics, pain, and function in previously injured runners., Methods: Twenty-three participants recovering from lower extremity injuries were randomized to a control or intervention group. The intervention group completed 4 to 6 telehealth gait retraining sessions over 8 to 10 weeks, consisting of visual and verbal cues to transition to a non-rearfoot strike pattern and increase step rate. The control group received standard physical therapy. Biomechanics, pain, and function were assessed pre- and post-intervention using a 2 × 2 mixed model analysis of variance., Findings: Half of the participants (55 %) in the intervention group successfully transitioned to a non-rearfoot strike pattern. No significant differences were observed between groups in step rate, biomechanics, or function. A significant group-by-time interaction for pain was observed (F = 10.55, P = 0.004), with the intervention group reporting greater reductions in pain compared to the control group (mean difference 2.52, 95 % CI 0.91 to 4.12)., Interpretation: Despite only half of participants adopting the desired gait pattern, telehealth gait retraining may offer a low-risk, accessible, and convenient alternative for select patients who lack in-person care options or have not responded to other pain reduction methods when returning to running from a lower extremity injury., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Published by Elsevier Ltd.)

Background: Diabetes-related foot ulcers pose substantial health risks globally, yet the biomechanical intricacies underlying their development remain incompletely understood. This study aimed to evaluate lower limb gait joint coordination variability in individuals with diabetes-related foot ulcers compared to those with diabetes (without diabetes-related foot ulcers) and healthy controls., Methods: A total of 99 participants (diabetes-related foot ulcers cases - 16, Diabetes controls - 50, Health controls - 33) compared three self-paced walking trials. Vector coding, a technique quantifying movement coordination, was employed, analysing hip-knee, knee-ankle, and hip-angle joint couplings in the sagittal plane., Findings: No significant differences in coordination variability were found among the groups. However, distinct coupling pattern frequencies emerged, with diabetes-related foot ulcers cases exhibiting unique anti-phase hip and ankle coupling frequency counts compared to healthy controls., Interpretation: These findings challenge conventional understandings of diabetes-related foot ulcers biomechanics and underscore the complexity of gait in this population., Competing Interests: Declaration of competing interest The authors declare that they have no known conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)