Static, one-size-fits-all protocols in postoperative orthopedic rehabilitation fail to adapt to individual recovery dynamics, potentially leading to suboptimal rehabilitation efficiency or an elevated risk of secondary injury. To address this critical gap, we propose and provide a simulation-based proof-of-concept validation for a novel closed-loop management system that deeply integrates patient-generated health data (PGHD) with deep reinforcement learning (DRL), offering a potential technical pathway for real-time personalized optimization of rehabilitation regimens and continuous prediction of long-term functional outcomes. A three-tier system architecture was constructed, comprising an intelligent sensing layer, an AI decision-making and prediction layer, and an interactive feedback layer. Through wearable inertial measurement units (IMUs) and surface electromyography (sEMG) devices, the system continuously collected multi-dimensional PGHD, including movement quality, training intensity, adherence, and pain feedback. These heterogeneous data were encoded into a comprehensive "patient state space" through a standardized feature engineering pipeline. A proximal policy optimization (PPO) algorithm was employed to train a DRL agent to learn the optimal policy for dynamically adjusting the next-cycle rehabilitation prescription (including exercise type, intensity, frequency, and progression pace). The agent aimed to maximize a hierarchical cumulative reward function that integrates short-term safety (ΔVAS pain score monitoring), mid-term adherence (training completion rate), and long-term functional improvement. Critically, a temporal convolutional network (TCN) prognostic module was deeply coupled with the DRL agent, providing prospective predictions of future functional recovery curves that inform the agent's long-term reward calculation, equipping the system with the capability of "making decisions based on predictions." A proof-of-concept validation was conducted in a simulated environment for a post-operative anterior cruciate ligament reconstruction (ACLR) scenario. The trained DRL agent demonstrated the ability to generate differentiated rehabilitation strategies: in stratified analysis, it prescribed distinct progression paces for virtual patients with fast vs. slow recovery trajectories. Under this simulation setting, compared with a static conservative protocol, the DRL-driven strategy reduced the simulated time to "safe return to light activity" by an average of 15% and, compared with a static aggressive protocol, relatively decreased simulated "re-injury" events by 40%. The mean absolute errors (MAEs) of the TCN prognostic module for predicting functional scores at 2, 4, and 8 weeks into the future were 3.2, 4.8, and 6.5 points (on a 100-point scale), respectively, outperforming the ARIMA, LSTM, and GRU baseline models. An ablation study confirmed the TCN module's independent contribution, as its removal led to a relative increase in the simulated re-injury rate. This proof-of-concept study provides foundational evidence for the technical feasibility of a DRL-based closed-loop rehabilitation system. The proposed framework uniquely couples a wearable sensing layer with a symbiotic DRL-TCN architecture, demonstrating the potential to safely and dynamically personalize rehabilitation strategies in a simulated environment. These findings lay the groundwork for future prospective clinical trials, which are the necessary next step to validate safety, efficacy, and clinical utility in real-world settings.
This cross-sectional study used functional near-infrared spectroscopy (fNIRS) to explore cerebral cortical activation and functional connectivity in children with Unilateral Cerebral Palsy (UCP) at resting state, during traditional non-virtual reality (non-VR) and single-session VR throwing motor tasks, aiming to clarify the differences in neural responses between VR and non-VR tasks, and provide preliminary neuroimaging evidence for VR application in pediatric cerebral palsy rehabilitation. A total of 35 children with UCP (18 males, 17 females, mean age 9.67 ± 2.4 years; 16 with left hemiplegia, 19 with right hemiplegia; 3 graded MACS Level Ⅰ, 13 Level Ⅱ, 19 Level Ⅲ) were enrolled, with the affected hemisphere standardized to the left. All participants completed fNIRS data acquisition in a randomized order under three conditions: 6-minute resting state (seated quietly with eyes closed), a single-session semi-immersive VR throwing task (8 s per movement cycle, with real-time audio-visual reward feedback for successful hits on horizontally moving virtual targets via ToF 3D motion capture), and a traditional non-VR throwing task with matched movement rhythm but no targets or feedback. fNIRS was used to monitor oxygenated hemoglobin (HbO₂) concentration in 6 regions of interest (ROIs): bilateral prefrontal (LPFC/RPFC), premotor (LPMC/RPMC) and sensorimotor cortices (LSMC/RSMC). One-way repeated measures ANOVA with FDR correction was applied for statistical analysis, which was verified by a professional biostatistician. Cerebral functional connectivity strength analysis showed that after FDR correction, there were significant main effects of task condition on the FCS of LSMC-LPMC [F(2,68) = 16.956, p < 0.001, ηₚ2 = 0.333], LPMC-RPFC [F(2,68) = 16.256, p < 0.001, ηₚ2 = 0.323], and LPMC-LPFC [F(2,68) = 22.725, p < 0.001, ηₚ2 = 0.401], all with large effect sizes (ηₚ2 ≥ 0.14). The FCS of these ROI pairs showed a consistent trend: resting state > single-session VR throwing motor task > non-VR throwing motor task, with significant differences between any two conditions (PFDR < 0.05). No statistically significant differences were observed in FCS between other ROIs (PFDR > 0.05). Cerebral activation level analysis showed that after FDR correction, there were significant main effects of task condition on the activation levels of the affected-side LSMC [F(2,68) = 15.952, p < 0.001, ηₚ2 = 0.319] and affected-side LPFC [F(2,68) = 13.606, p < 0.001, ηₚ2 = 0.286], both with large effect sizes (ηₚ2 ≥ 0.14). Specifically, the activation level of LSMC followed the order: single-session VR throwing motor task > non-VR throwing motor task > resting state; the activation level of LPFC followed the order: single-session VR throwing motor task > resting state > non-VR throwing motor task, with significant differences between any two conditions (PFDR < 0.05). No statistically significant differences were detected in activation levels of other brain regions (PFDR > 0.05). Based on functional near-infrared spectroscopy (fNIRS) technology, this cross-sectional study confirmed that children with unilateral cerebral palsy (UCP) exhibit distinct cerebral cortical neural activity patterns during a single-session VR throwing motor task, compared with the resting state and traditional non-VR throwing motor task. Specifically, the single-session VR motor task was associated with significantly higher activation levels in the left sensorimotor cortex (LSMC) and left lateral prefrontal cortex (LPFC) - the two regions in the affected hemisphere uniformly standardized to the left for all subjects - and modulated the functional connectivity between the premotor cortex and its functionally related brain regions. Compared with the traditional non-VR throwing motor task, the single-session VR throwing motor task elicited greater activation in the above-mentioned motor-related and higher-order cognitive brain regions, and induced a significantly different neural response pattern of the motor-cognitive network. The findings of this study reveal the cortical neural response characteristics of children with UCP during a single-session VR motor task, and provide preliminary neuroimaging evidence for subsequent studies exploring the neural mechanisms of VR-based rehabilitation in children with cerebral palsy.
Longitudinal research examining community reintegration among military veterans with invisible injuries remains limited, despite widespread recognition that post-separation adjustment encompasses multiple interconnected domains including mental health, physical health, social functioning, and overall well-being. This study investigated associations between changes in reintegration outcomes and changes in health-related quality of life, social support, and flourishing over a two-year period among U.S. military veterans with invisible injuries who separated from service within the previous five years. Seventy-five veterans diagnosed with invisible injuries (post-traumatic stress disorder, anxiety, depression, traumatic brain injury, or adjustment disorder) completed assessments at baseline, 6, 12, 18, and 24 months. Reintegration was measured using the Military to Civilian Questionnaire (M2C-Q) and Community Reintegration of Injured Service Members computer-adaptive test (CRIS-CAT). Health and well-being outcomes included the Veterans RAND Health Survey (VR-12), Patient Health Questionnaire-15 (PHQ-15), Multidimensional Scale of Perceived Social Support (MSPSS), and Secure Flourishing Index (SFI). Mixed-effects models examined associations between changes in reintegration measures and psychosocial outcomes while controlling for demographic characteristics and PTSD symptoms. M2C-Q scores remained stable across waves (F(4,236) = 1.73, p = .14), while CRIS-CAT Participation scores improved significantly (F(4,238) = 10.10, p < .001). Improvements in community participation (CRIS-CAT) were positively associated with subsequent secure flourishing and physical health quality of life. Reductions in reintegration difficulties (M2C-Q) positively influenced social support, secure flourishing, somatic symptoms, and mental health quality of life. Social support and secure flourishing increased significantly between 6 and 24 months, while physical and psychological symptoms remained relatively stable throughout the study period. Findings demonstrate that improvements in community participation and reductions in reintegration difficulties precede positive changes in psychosocial outcomes and physical symptoms. The relative stability of reintegration challenges alongside improvements in community participation suggests these constructs may represent distinct aspects of veteran adjustment. Results suggest the potential for interventions targeting community engagement and social connection during the critical transition period, emphasizing holistic approaches that address both functional participation and subjective reintegration experiences to enhance long-term veteran well-being.
Oral health is a vital component of overall well-being; however, individuals with hearing impairments often experience substantial challenges in accessing appropriate dental care. In Jordan, limited research has explored oral health disparities among individuals with hearing impairments, emphasizing the need for a focused investigation. This study aimed to assess the utilization of dental services among individuals with hearing impairments in Jordan and to identify key barriers affecting their access to dental care, in comparison with individuals without hearing impairments. A cross-sectional comparative study was conducted involving 289 participants, including 140 individuals with hearing impairments and 149 individuals without hearing impairments. Data on dental service utilization, reasons for dental visits, and perceived barriers to accessing care were collected using a validated, self-administered, closed-ended questionnaire. Participants were recruited through convenience sampling from centers and associations supporting individuals with hearing impairments. Data analysis was performed using SPSS® version 22, with statistical significance set at p < 0.05. Group differences were examined using Chi-square tests and contingency table analyses. Participants with hearing impairments reported fewer dental appointments in the past year compared to controls (47% vs. 64%, respectively; p < 0.05). Toothache was the most common reason for the most recent dental visit in both groups (60.8% vs. 62.4%). Participants with hearing impairments reported significantly more barriers to dental care than controls. These included distance to dental offices (25% vs. 12.8%; p = 0.008), inaccessible parking (14.3% vs. 6.0%; p = 0.020), inadequate dental facilities (14.3% vs. 3.4%; p = 0.001), lack of dentist knowledge about treating individuals with disabilities (16.4% vs. 6.1%; p = 0.005), limited availability of specialists (18.6% vs. 9.4%; p = 0.024), and embarrassment (26.8% vs. 9.4%; p < 0.001. This study demonstrated socioeconomic disparities in dental service utilization among individuals with hearing impairments, alongside multiple barriers to accessing care. The findings highlight the most commonly perceived obstacles to oral health services within this population and provide valuable insights to guide the development of targeted health policies and interventions aimed at improving access to dental care and reducing oral health inequalities within this vulnerable population.
Significant others (SOs) play an important role in health, recovery processes and in the return to (or stay at) work. However, the extent to which they are included in rehabilitation programs, especially those aimed at enabling participation in working life, is unclear. This scoping review's objective is to create an overview of research on vocational rehabilitation interventions including SOs and to assess in what way SOs are addressed in these. This scoping review was guided by the framework of Arksey and O'Malley. A two-stage search was conducted in Medline (PubMed), Web of Science, PsycINFO, and Social Sciences Citation Index, including studies which addressed vocational rehabilitation approaches involving SOs. Data was extracted using a charting table based on the TIDieR-Rehab checklist, capturing study characteristics, intervention details, characteristics of SOs and the conceptual basis for including SOs. Eight studies published between 1985 and 2024 were included. They adopted different quantitative, qualitative and mixed-methods approaches. One group of interventions directly targeted families of rehabilitants while a second group focused on rehabilitation professionals. A third group investigated the conceptual or contextual background. The interventions varied regarding what kind of rehabilitants they were tailored for. Most did not conceptualize their rationale for including SOs. This scoping review shows that the inclusion of SOs in vocational rehabilitation remains rare. Existing interventions are heterogeneous and rarely concept-driven. Future research should focus on the development and evaluation of structured, theory-informed approaches that integrate SOs in a targeted and needs-based manner, while also considering potential burdens and conflicting roles.
Pressure injuries (PIs) are widely recognized as indicators of patient safety and quality of care in acute hospitals, yet their burden in rehabilitation settings remains underexplored. Patients admitted to rehabilitation often present with high clinical complexity and functional dependency, potentially increasing PI-related risks. This multicenter retrospective cohort study was conducted across 15 inpatient rehabilitation facilities of the Fondazione Don Gnocchi network in Italy. All adult patients admitted for full-time rehabilitation between March 23 and April 23, 2024, were included, excluding those with stays shorter than 5 days. Data extracted from medical records included demographic and clinical characteristics, functional status (Barthel index), PI risk (Braden Scale), presence and characteristics of PIs at admission, incident PIs during hospitalization, healing outcomes, length of stay, and discharge destination. Prevalence and cumulative incidence were estimated, and cause-specific Cox regression models were applied to evaluate the association between PIs and time to routine discharge. Among 1,013 patients, 175 had at least one PI at admission, corresponding to a prevalence of 17.3% [95% confidence interval (CI): 15.0%-19.8%]. Most lesions were stage 1-2 and primarily located at the sacrum and heels. Patients with PIs were older, more functionally dependent, and had higher rates of neurological comorbidities, dysphagia, incontinence, and medical device use. During rehabilitation, patients with PIs at admission showed a higher cumulative incidence of new PIs than those without (14.3% vs. 4.2%). Overall, 41.5% of lesions present at admission healed during hospitalization, with substantially lower healing rates for advanced-stage injuries. In multivariable analysis, the presence of PIs at admission was independently associated with prolonged time to routine discharge (adjusted hazard ratio 0.67, 95% CI: 0.54-0.83). Pressure injuries are highly prevalent at admission to rehabilitation and are associated with poorer clinical outcomes and increased resource utilization. These findings support the need for integrated preventive and management strategies spanning acute and rehabilitation care pathways.
Recovery of upper extremity function remains a major unmet need for individuals with chronic cervical spinal cord injury (SCI). Pairing vagus nerve stimulation (VNS) with task-specific rehabilitation has been shown to enhance neuroplasticity and motor recovery in stroke, but evidence in SCI is limited. To evaluate the safety and feasibility of pairing VNS with upper extremity rehabilitation in individuals with chronic cervical SCI, and to explore preliminary effects on upper extremity function. This single-site, triple-blind, randomized, sham-controlled pilot trial enrolled adults with chronic traumatic incomplete cervical SCI. All participants underwent implantation of a VNS device and were randomized 1:1 to receive active VNS paired with rehabilitation or sham VNS paired with rehabilitation. Participants completed 18 in-clinic rehabilitation sessions over 6-8 weeks, followed by a 90-day home-based exercise program. Primary outcomes were safety and feasibility; exploratory outcomes included standardized upper extremity motor measures and patient-reported experiences. The randomized design was intended to assess feasibility of trial procedures rather than estimate treatment effects. Six participants were implanted and completed study procedures through 90-day follow-up. No serious adverse events, unanticipated adverse device effects, or unresolved surgery-related complications were observed. In-clinic therapy adherence was high, supporting the feasibility of the intervention. At the immediate post-intervention, all participants receiving active VNS demonstrated mild-to-moderate improvements in upper extremity motor function, whereas no improvements were observed in the sham group. At 90 days, two active VNS participants sustained these gains. Participants receiving active VNS reported subjective improvements in coordination, movement quality, and daily task performance. This pilot randomized trial demonstrates that pairing invasive VNS with upper extremity rehabilitation in individuals with chronic cervical spinal cord injury is safe, feasible, and well-tolerated. While clinical improvements were exploratory, positive participant-reported experiences and observed patterns of improvement support further investigation in larger trials designed to rigorously assess efficacy, durability, and optimal dosing parameters. ClinicalTrials.gov, identifier NCT05601661.
PLP1-related disorders, including the Pelizaeus-Merzbacher disease spectrum and X-linked spastic paraplegia type 2, are rare hypomyelinating conditions characterized by progressive gait impairment, lower limb spasticity, and motor disability. Evidence supporting rehabilitation strategies in these disorders remains limited, particularly for technology-assisted interventions. We report the case of a 29-year-old man with progressive PLP1-related spastic paraparesis, prominent gait impairment, recurrent falls, lower limb spasticity, and preserved independence in activities of daily living. Genetic testing identified a hemizygous PLP1 variant, classified as likely pathogenic. The patient underwent a 20-session outpatient rehabilitation program organized into two sequential blocks: 10 sessions of anti-gravity treadmill training (Alter-G), followed by 10 sessions combining Alter-G and EXOPULSE Mollii Suit stimulation. Clinical, gait analysis, and posturographic outcomes were collected at baseline (T0), after the first block (T1), and after completion of the full intervention (T2). Across the intervention period, balance, lower limb strength, and spasticity showed overall improvement, whereas timed mobility and endurance displayed an initial worsening at T1 followed by partial recovery at T2. Instrumental gait analysis revealed marked step-length reduction after the first block, with substantial recovery by T2, alongside side-specific changes in gait quality indices. Static posturography showed progressive normalization of foot load distribution under eyes-open conditions, while residual asymmetry persisted with eyes closed. Fatigue scores, assessed during the second block only, improved over time. This case suggests that sequential technology-assisted rehabilitation combining body weight-supported treadmill training and wearable electrical stimulation is feasible in PLP1-related spastic paraparesis and may be associated with improvements in selected domains, including balance, strength, spasticity, and selected gait parameters. Given the single-case design, multimodal treatment structure, and potential confounding factors, these findings should be considered exploratory and hypothesis-generating.
Weaning in early neurological-neurosurgical rehabilitation (ENNR) is an interdisciplinary process performed by physician-led multidisciplinary teams including speech language pathologists (SLP) and in an increasing number of institutions also respiratory therapists (RT). This study analyzes the role, the competencies, the collaboration and their mutual perception of SLPs and RTs involved in ENNR Weaning. Two profession-specific web-based surveys (43 items each) were developed to assess work experience, interventions in tracheostomy, communication, secretion and dysphagia management and perceived therapists' role within the multidisciplinary team. Surveys were distributed to ENNR units and center. Twenty-seven SLPs and sixteen RTs completed the surveys. SLPs reported more ENNR-specific experience, whereas RTs had more overall clinical experience. Both professions rated their own recommendations-regarding tracheostomy tube selection, timing of cuff deflation, choice of communication methods, and secretion-management strategies-as more important than those of the other group. Both agreed that dysphagia assessment is primarily an SLP responsibility. However, they differed on whether all patients should undergo instrumental examinations such as FEES or tracheoscopy, despite broad agreement on the objectives of these procedures. Both professions regularly trained other team members in tracheostomy management, dysphagia, weaning, and FEES, underscoring their educational roles within the team. As RTs become more involved in ENNR weaning, enhanced interprofessional education is necessary, particularly regarding communication-focused interventions. Clear job descriptions and SOPs should define shared objectives, procedures, and responsibilities. Training should emphasize above-cuff vocalization, in-line speaking valves (e.g., Passy Muir Valve), and appropriate timing of FEES and tracheoscopy. A targeted educational program for both professions-and for the broader weaning team-may support more efficient weaning, improved communication and swallowing, and better overall patient outcomes.
Virtual reality (VR) technology has emerged as a transformative therapeutic innovation in healthcare, providing immersive three-dimensional, multisensory environments that facilitate experiential learning, rehabilitation, and engagement. While numerous studies highlight its benefits, empirical research on VR-based interventions for autism spectrum disorder (ASD) and physical therapy (PT) remains limited by methodological inconsistencies, small sample sizes, and variable intervention designs. These limitations constrain the generalizability of findings and delay VR integration into standard therapeutic practice. This study conducted a systematic review and meta-analysis to assess the therapeutic effectiveness of VR interventions within ASD and PT contexts. It aimed to determine the extent of improvement achieved through VR-based therapies, identify methodological and practical challenges affecting clinical adoption, and classify the dominant types and features of VR interventions applied across both domains. Following PRISMA 2020 guidelines, a comprehensive search was performed across PubMed, Scopus, and Web of Science for studies published between 2020 and 2025. Eligible peer-reviewed articles provided empirical evidence on VR interventions for autistic individuals or patients undergoing physical rehabilitation. Twenty-three studies meeting inclusion criteria underwent methodological quality assessment and systematic data extraction. Quantitative synthesis used standardized effect size calculations (Hedges' g) and subgroup analyses to evaluate intervention outcomes and contextual moderators. The meta-analysis showed a significant positive impact of VR interventions across both domains (Hedges' g = 0.66, p < 0.001), representing a moderate-to-large therapeutic effect. Among autistic participants, major improvements appeared in social communication, emotion recognition, and adaptive behaviors. In PT populations, VR interventions enhanced balance, gait, and upper-limb motor recovery. Fully immersive systems and programs exceeding eight weeks produced the most substantial clinical benefits. Quality analysis showed that 56.5% of studies met the highest standards, with others slightly lower due to missing control groups or incomplete ethical reporting. VR is an effective adjunctive therapy that enhances motivation, engagement, and adherence. Despite barriers of cost, training, and protocol variability, its scalability and adaptability support broad clinical use. AI-driven personalization, mobile VR, and tele-rehabilitation offer promising future directions. However, these findings should be interpreted with caution given the median sample size of 45, moderate heterogeneity (I2 = 44.3%), 43.5% of studies without a control group, and statistically significant funnel plot asymmetry indicative of potential publication bias (Egger's test: p = 0.0031).
Following severe acquired brain injury (sABI), the inability to maintain orthostatism and prolonged bed rest triggers neurovegetative, haemodynamic, respiratory and osteo-myo-articular adaptations that may significantly affect rehabilitation. Restoring orthostatic tolerance is a key rehabilitation goal to prevent secondary complications. Although the safety of early verticalization with Erigo device has been established, evidence on its effects on muscle hyperactivity, trophism, and consciousness level in the subacute sABI remains limited. This pilot study aimed to monitor lower-limbs hyperactivity in patients with sABI of any aetiology, 1-4 months after the acute event, undergoing verticalization with the Erigo device in addition to conventional rehabilitation. Secondary aims were to evaluate muscle ultrasound characteristics, ankle mobility, disability, arousal level and device tolerability. All patients with early-stage sABI, admitted to the Critical Care Area of the Montecatone Rehabilitation Institute from March 2022 to April 2024, were included. Each patient underwent 10 sessions of approximately 30 min, once a day, 3-5 times per week. Assessments before and after treatment included electroneurography of the lower limbs, muscle ultrasound measurement of the tibialis anterior and medial twin muscles, bilaterally, and rating scales evaluating disability and arousal (Disability Rating Scale - DRS, Levels of Cognitive Functioning - LCF, Coma Recovery Scale Revised - CRS-R). Adverse events related to device were monitored daily. The study includes 22 patients with sABI. Neurophysiologically, there was a reduction or invariance in the H max/M max ratio compared to the initial assessments; the Heckmatt scale scores remained unchanged in all patients. All the mobility measures, the H-reflex amplitude, the Hmax/Mmax ratio and the MAS scores remained stable. The functional measures improved significantly: CRS-R (p = 0.005), LCF (p = 0.002) and DRS (p < 0.001). This pilot study suggests that early verticalization with Erigo is a feasible and well-tolerated intervention in patients with sABI in the subacute phase of rehabilitation. No worsening of muscle hyperactivity or muscle ultrasound characteristics was observed during the intervention period. A significant improvement in cognitive function was observed. Controlled studies are required to determine whether these findings are attributable to the Erigo intervention.
Introduction: Advanced rehabilitation technologies are increasingly being implemented in transtibial amputation, although evidence remains limited regarding whether non-immersive virtual reality systems and biofeedback provide additional benefits beyond conventional rehabilitation approaches. Methods: This prospective randomized clinical trial included 21 male patients (mean age 61.7 ± 7.21 years) with transtibial amputation due to vascular disease or type 2 diabetes. Eleven participants received traditional rehabilitation, while ten underwent a combined protocol integrating conventional physiotherapy with D-Wall technology over a 3-week inpatient program. Results: Across the entire sample, functional outcomes related to autonomy and prosthetic mobility improved from baseline to discharge, including the Barthel Index, Functional Independence Measure, and Amputee Mobility Predictor, independent of rehabilitation condition. A non-significant trend toward reduced depressive symptoms was also observed. Baseline psychological characteristics were associated with rehabilitation outcomes. Higher self-efficacy was associated with lower depressive symptoms, anxiety, and body image distress, as well as higher prosthetic mobility. Similarly, better prosthetic adaptation at discharge was associated with lower psychological distress and higher quality of life and functional independence. Exploratory within-group analyses suggested that, in the technology-enhanced group, improvements in body image were associated with reductions in anxiety, while reductions in depressive symptoms were associated with higher functional independence. In the traditional rehabilitation group, reductions in anxiety were associated with improved perceived quality of life. Discussion: Overall, technology-enhanced rehabilitation was not associated with superior functional outcomes compared with traditional rehabilitation in this exploratory sample. However, exploratory findings suggest potential associations with psychological and perceptual processes related to emotional adjustment and body image during rehabilitation. These preliminary observations should be confirmed in adequately powered studies.
To analyze the research status, hotspots, and trends in the field of postoperative rehabilitation treatment for anterior cruciate ligament (ACL) reconstruction in China from 2005 to 2025, so as to provide reference for research in this field. Taking CNKI and Wanfang databases as data sources, the search terms included "anterior cruciate ligament reconstruction" combined with related terms such as "rehabilitation treatment" and "rehabilitation training". A total of 1,052 Chinese literatures published from January 2005 to July 2025 were screened. CiteSpace 6.3.R1 software was used for visual analysis of the trend of publication volume, author and institution cooperation networks, and keywords. The annual number of publications in this field in China showed a fluctuating increasing trend, reaching a peak of 119 in 2024; the density of the author cooperation network was only 0.005, and Ma Yubao was the core author (8 publications); the institution cooperation network was loose, with Sichuan Orthopedic Hospital and other institutions as the main research units; keyword clustering formed 9 core fields including functional training and proprioception, and the research hotspots experienced three stages of evolution: basic rehabilitation (2013-2016), technology integration (2020-2022), and precision rehabilitation (2022-2023). The research on rehabilitation treatment after ACL reconstruction in China is developing well, but there is insufficient cross-institutional and cross-regional cooperation. In the future, it is necessary to strengthen multi-center collaboration and focus on the research and development of intelligent rehabilitation and precision training technologies.
This study aims to perform a network meta-analysis (NMA) to evaluate and compare the effects of various physical therapy modalities in mitigating early postoperative pain following total knee arthroplasty (TKA). This systematic review and NMA was conducted according to PRISMA-NMA guidelines. A comprehensive literature search was conducted across multiple databases, including PubMed, SPORTDiscus, The Cochrane Library, Embase, Web of Science, CINAHL Plus and China National Knowledge Infrastructure, to identify randomized controlled trials (RCTs) assessing the effects of eight physical therapy modalities on early postoperative pain in patients with TKA. Data were synthesized using a frequentist framework, and the outcome was pain reduction, assessed using validated pain scales such as the Visual Analogue Scale. A total of 42 RCTs involving 3,165 participants were included. The NMA demonstrated that electroacupuncture, manual lymphatic drainage (MLD), kinesio taping and cryotherapy all significantly alleviated early postoperative pain following TKA compared to controls. Effect sizes [standardized mean differences (SMDs)] ranged from -0.57 [95% confidence interval (CI): -1.12 to -0.01] for MLD to -0.98 (95% CI: -1.50 to -0.45) for cryotherapy. Among these physical therapy modalities, cryotherapy showed the highest probability of being ranked among the more effective interventions (Surface under the cumulative ranking curve = 88.0%), followed by kinesio taping (83.1%) and electroacupuncture (64.0%). Among these interventions, electroacupuncture (SMD = -0.59, 95% CI: -1.19 to 0.00), kinesio taping (SMD = -0.86, 95% CI: -1.54 to -0.18) and cryotherapy (SMD = -0.95, 95% CI: -1.59 to -0.31) demonstrated significant pain reduction compared to continuous passive motion. However, the overall certainty of evidence ranged from low to very low for most comparisons. This NMA suggests that cryotherapy may be the most effective physical therapy modality for early postoperative pain relief after TKA, followed by kinesio taping and electroacupuncture. However, these findings should be interpreted with caution due to the overall low to very low certainty of evidence and potential risk of bias in the included studies. Further high-quality RCTs are needed to confirm these results and strengthen the evidence base for clinical decision-making. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024518900 identifier CRD42024518900.
Spinal cord injury (SCI) significantly impacts quality of life and economic independence, yet employment rates remain disproportionately low, suggesting a divergence between the legislative intent of inclusion and the clinical goal of functioning. The alignment of social policy with rehabilitation practice is essential. This study conducted a comparative scoping review of federal policies and policy-driven vocational rehabilitation (VR) strategies in the U.S. and Canada to map the evidence landscape and identify critical gaps in cross-national research. The PRISMA guidelines and the Arksey and O'Malley framework were used. We searched Ovid Medline, CINAHL, and Google Scholar, using COVIDENCE for the final review. Guided by the Population-Concept-Context (PCC) framework, we included English-language studies and materials that addressed federal-level policies in Canada and the U.S. related to the employment of persons with SCI. Overall, 10 studies were analyzed. The literature predominantly focused on the U.S., particularly within the Veterans Health Administration (VHA) and state VR systems. A recurring barrier identified across both nations was the "benefits trap," where social protection policies create financial disincentives that affect return-to-work (RTW). On the other hand, integrated interventions such as Individual Placement and Support (IPS) and federally mandated resource allocation (e.g., for assistive technology) demonstrated superior outcomes compared to traditional models. Current policy frameworks, while effective at protecting against discrimination, are often insufficient to overcome structural and financial disincentives to employment. To truly reconcile the goals of rehabilitation and inclusion, future efforts must address policy-driven barriers and prioritize funding for integrated, hospital-based vocational services that translate legal rights into employment outcomes for individuals with SCI.
Access to assistive products remains highly uneven across health systems. Policy discussions in rehabilitation frequently emphasize workforce development, service delivery models, and clinical standards. Less attention has been given to the institutional mechanisms through which assistive products are procured and supplied. Ukraine's prosthetics sector provides a contemporary illustration of how procurement systems influence rehabilitation service delivery. Following the escalation of armed conflict in 2022, Ukraine experienced a sharp increase in demand for prosthetic services. National programmes expanded rapidly to support individuals requiring rehabilitation and assistive technologies. In this context, procurement arrangements - including decentralized purchasing across multiple providers and reliance on imported prosthetic components, have highlighted structural challenges affecting supply chain coordination, pricing transparency, and system scalability. This paper argues that procurement architecture represents an under-recognized determinant of rehabilitation system performance. Drawing on insights from Ukraine's prosthetics sector, the paper explores how fragmented procurement arrangements can reduce cost efficiency in access to assistive technologies even when financing and service delivery capacity expand. It further outlines procurement reform principles that may strengthen rehabilitation systems, including pooled purchasing mechanisms, framework agreements, demand forecasting integration, and digital procurement platforms.
This study examines the availability, adequacy, and functionality of reformation programmes in selected medium-security correctional facilities in Kwara State. The study adopts a descriptive ex-post facto design and utilises a researcher-developed checklist to document observable rehabilitation resources and activities across three custodial centres. Grounded in Bandura's(1977) Social Learning Theory. This study operationalises Social Learning Theory by linking the availability, adequacy, and functionality of reformation programmes to the extent to which correctional environments enable observational learning, behavioural modelling, and reinforcement processes among inmates. It theorizes that limited prosocial modeling through education and vocational training perpetuates recidivism due to inadequate resources and overcrowding. Data were analysed using descriptive statistics. Findings indicate that 67% of the facilities lacked functional educational programmes, while all facilities (100%) had functional religious programmes. Vocational training was present in all centres, but was fully functional in only one facility (33%). Overcrowding was observed in two of the three facilities (67%), significantly constraining programme delivery. Critical digital learning infrastructure, including computers and internet access, was absent or non-functional across all facilities (100%). These gaps limit opportunities for skill acquisition, structured learning, and behavioural development, thereby weakening inmates' prospects for successful reintegration. The study highlights the need for targeted investment in educational infrastructure, digital learning integration, and staffing to enhance the rehabilitative capacity of correctional institutions.
Falls constitute a significant public health burden across the adult lifespan, affecting both working-age and older populations and compromising functional independence and quality of life through physical and psychological consequences. Current interventions typically address these dimensions in isolation, emphasizing fall avoidance rather than equipping individuals to manage and recover from falls when they occur. This exploratory study evaluated the feasibility, acceptability, and safety of the Floor-Hugging Intervention (Floor-HI), a novel multicomponent program that combines controlled exposure to fall-risk environments with systematic training in post-fall recovery skills, including floor-to-standing transitions, fall imagination, and role-playing scenarios. Eight community-dwelling, middle-aged adults (3 males, 5 females; aged 31-55 years) completed a 3-week program. Outcomes including concern of falling, postural control, floor-rise ability, turning ability, and health-related quality of life were assessed at four time points (Weeks 0, 3, 6, and 9). Recruitment, retention, and adherence rates were 100%, 89%, and 100%, respectively. Significant improvements over time were observed in postural stability (Mini-BESTest, p = .011), floor-rise ability (Sitting Rising Test, p = .011), and turning capacity (360° Turn Test duration, p = .012-.017). Concern of falling (Falls Efficacy Scale-International, p = .145) and health-related quality of life (RAND-36, p > .05) remained unchanged. Intervention acceptability was high across all domains of the Theoretical Framework of Acceptability questionnaire. Only a small number of mild, transient adverse events were reported, all resolving without medical intervention, and no serious adverse events occurred. Despite being limited by the absence of a control group and a small sample size, this study demonstrates that Floor-HI is feasible, acceptable, and safe in community-dwelling middle-aged adults. These findings provide a foundation for future feasibility and controlled trials to establish efficacy and applicability in populations with elevated fall risk.
Women with disabilities are underrepresented in leadership roles despite global commitments to diversity. This systematic literature review examines the barriers and enablers impacting their advancement in these positions, addressing a critical gap at the intersection of gender, disability, and leadership research. In accordance with the PRISMA 2020 reporting standards, a structured search was conducted in Scopus, supplemented by Web of Science and Google Scholar to enhance interdisciplinary coverage, identifying peer-reviewed studies published between 2021 and 2025. The timeframe was selected to capture post-pandemic shifts in organisational practices and inclusion discourse. After screening and eligibility assessment, 20 studies were included in the thematic synthesis. The findings indicate that barriers to leadership advancement are largely systemic, including inaccessible governance structures, ableist organisational cultures, credibility discounting, restricted autonomy, and gendered care burdens. These patterns suggest that leadership exclusion is shaped by multi-level structural and relational constraints rather than individual capability alone. These barriers are further influenced by intersectional factors such as race and socioeconomic status. In contrast, enabling conditions include inclusive leadership practices, openness to feedback, rights-based governance, supported decision-making, and capacity-building through mentoring and development. The review conceptualises leadership advancement as a multi-level process shaped by structural, organisational, interpersonal, and identity-related dynamics. Evidence across studies suggests that leadership trajectories may be cumulative, with early constraints influencing later access to leadership opportunities. By mapping existing evidence and highlighting critical gaps, this review underscores the need for leadership frameworks and policies that recognise women with disabilities as legitimate leaders. These conclusions should be interpreted in light of the relatively small and heterogeneous evidence base. Advancing inclusive leadership ecosystems remains essential for reducing entrenched inequities and fostering more representative systems of governance.
Vestibular rehabilitation training (VRT) has become an indispensable part of treatment for dizziness disorders. VRT is an exercise method that can alleviate dizziness and improve gaze stability and postural control, mainly used for the treatment of patients with vestibular dysfunction. To analyse the current status, hot spots and trends in research on vestibular rehabilitation, data were collected from the Web of Science Core Collection and Scopus databases, and selected publications related to dizziness vestibular rehabilitation from 2014 to 2024. Visual analysis tools were utilized to build knowledge maps of the research field, analyzing the distribution of publications, authors, institutions, journals, collaboration networks, co-occurrence, clustering, and burst detection of keywords. A total of 907 publications were included in this study, with an upward trend in the number of annual publications. The United States led in publication quantity, with the University of Pittsburgh ranking first among institutions. Professor Susan L. Whitney (University of Pittsburgh) was the most productive researcher. Recent research hotspots concentrated on unilateral vestibular hypofunction, vestibular neuronitis, and postural balance, providing clinical evidence for targeted VRT intervention. Research on VRT for dizziness is expanding progressively, with vestibular compensation and postural balance as core hotspots. The findings consolidate VRT's clinical application value in guiding personalized intervention for different vestibular disorders. Future research trends will focus on expanding VRT's application scope, formulating individualized protocols, and developing AI-aided targeted VRT, which will optimize clinical efficacy and promote the standardized development of this field.