Annals of the New York Academy of Sciences

Purpose: To identify, through iterative user-centered design, the auditory biofeedback requirements and sound preferences supporting gait training in children with cerebral palsy (CP), and to determine which feedback variables, sound mappings, and sound types yield clinically viable and movement-interpretable paradigms. Methods: The iterative process spanned two prototype phases. Prototype A comprised seven paradigms demonstrated to two experienced physiotherapists (Workshop 1A). Two of these were subsequently discarded owing to poor sound-movement interpretability and two were modified. Six paradigms were added to Prototype B, demonstrated to four children, five parents, and one therapist (Workshop 1B) and two therapists (Workshop 2B). Data were analyzed using systematic text condensation. Results: Within-child sound preferences varied with energy level and sensory state on a given day. Sound-movement interpretability tended to suffer for paradigms with greater acoustic complexity (e.g. computer-generated music). Therapists endorsed a repertoire spanning both movement quality and movement quantity targets. Participants independently proposed paradigms rewarding restrained and controlled movement, a feedback category absent from the current prototype. Conclusions: Session-level calibration is preferable to fixed sound profiles, requiring real-time interface support for paradigm adjustment. Acoustic complexity must remain subordinate to movement-sound interpretability. Paradigms targeting movement restraint are a development priority unaddressed in the literature.

PurposeHuman anatomy remains foundational to clinical practice, yet reduced instructional hours raise concerns about graduate competence and preparedness for patient care. Although trainees often report confidence, supervisors may perceive deficiencies, creating a gap between self-assessment and external evaluation. This study examined stakeholder perspectives on anatomical competence within physical therapy education to identify areas of discordance in perceived capability. MethodsA cross-sectional web-based survey collected responses from 165 stakeholders associated with an entry-level Doctor of Physical Therapy program featuring a 16-week dissection curriculum. Participants rated four domains of anatomical competence using a 5-point ordinal scale. Group differences were analyzed with the Kruskal-Wallis test appropriate for ordinal data. This methodology ensured robust assessment of stakeholder perceptions and comparative analysis. ResultsMedian ratings of preparedness and capability were 4 of 5 (quite prepared). Significant discordance emerged in three domains: recent graduates rated their foundational knowledge and ability to explain complex concepts to lay audiences higher than faculty or clinical instructors, whereas faculty expressed lower confidence in graduates ability to explain patient symptoms using anatomical principles. No significant differences were observed in the ability to describe structures by location, suggesting shared perceptions of basic anatomical understanding despite variation in applied reasoning. ConclusionsStakeholders generally viewed graduates as well prepared, yet disagreement persisted regarding clinical application of anatomical knowledge. Faculty skepticism about symptom explanation indicates that mastery of anatomy alone does not guarantee clinical reasoning. Curricular strategies emphasizing vertical integration and explicit connections between anatomical science and patient-centered reasoning may help bridge perception gaps and enhance professional competence.

Objective: To develop the first inventory to measure psychosocial concerns about use of the non-preferred hand, toward the long-term goal of identifying the casual factors of left-right hand choices ("hand usage"). Design: Cross-sectional Setting: Online question battery Participants: 181 healthy adults Interventions; Not applicable Main Outcome Measures: Self-reported concerns about emotional and physical consequences of using the non-preferred hand. Results: Emotional and physical consequences reflected internally consistent categories (Cronbach's > 0.9) that were moderately correlated with each other ({rho} = 0.783 p = 0.002). Concerns were activity-dependent in each category ({rho} < 1x10-100). Reliability analysis and principal components analysis were used to reduce the battery to the 51-item Changed Hand Usage Concerns inventory, which encompasses everyday tasks and concerns about physical and emotional consequences of using the non-preferred hand in those tasks. Conclusions: Concerns about emotional vs. physical consequences of non-preferred hand use reflect coherent and internally consistent categories The Changed Hand Usage Concerns inventory allows assessment of psychosocial concerns about usage of the non-preferred hand for future attempts to manipulate hand usage via rehabilitation in patients with unilateral or asymmetric impairment.

BackgroundLong Covid, also referred to as post-acute sequelae of SARS-CoV-2 infection (PASC), is characterized by symptoms that persist or emerge weeks to months following acute COVID-19 illness. Cognitive impairments affecting attention, memory, and executive functioning--commonly described as "brain fog"--are frequently reported. Currently, limited evidence-based cognitive rehabilitation interventions specifically target these impairments. ObjectivesThis pilot randomized controlled trial aims to evaluate the feasibility and acceptability, and to develop preliminary data regarding efficacy of Attention Process Training-3 (APT-3), a computerized attention training program, for individuals with Long Covid-related brain fog. MethodsThis study uses a three-arm randomized controlled design. Participants are randomized to (1) Immediate Attention Training, (2) Delayed Attention Training, or (3) Music Activity. Participants complete comprehensive cognitive assessments at baseline, post-intervention, and one-month follow-up. The Immediate Attention Training group completes a 4-week APT-3 intervention, while the Music Activity group engages in a 4-week music-based listening activity. The Delayed Attention Training group dont receive any intervention for 4 weeks. Following completion of the final assessment, participants in the Music Activity and Delayed Attention Training groups are offered the APT-3 intervention. Feasibility and acceptability outcomes include recruitment, retention, and adherence numbers, and participant satisfaction. Preliminary data regarding efficacy will be determined using objective cognitive tests and subjective self-report measures. ConclusionsThis pilot trial will inform the feasibility and acceptability of APT-3 and generate preliminary efficacy data to guide the design of a future fully powered randomized controlled trial targeting brain fog associated with Long Covid.

Objective: To evaluate the feasibility of nurse-led ultrasound hip screening for newborns and infants during home visits, focusing on whether trained public health nurses (PHNs) can obtain interpretable images for orthopedic pediatric surgeons' diagnosis, imaging error patterns, immediate operational challenges, and follow-up results of infants with suspected developmental dysplasia of the hip (DDH). Design: Pilot prospective cohort study. Sample: Forty-two infants were screened. PHNs conducted ultrasound hip screenings during home visits. Measurements: Diagnostically interpretable images, as determined by two pediatric orthopedic surgeons. Results: Diagnostically interpretable images of 75/84 (89.3%) hips were obtained. Surgeons identified three error patterns: incomplete visualization of the ilium (n = 2), joint capsule (n = 1), or bony roof (n = 2). Infant crying was an operational challenge (n = 1). Thirty-three (78.6%) hips were normal, four (9.5%) had abnormal findings requiring abduction exercises, three (7.1%) were referred to a hospital, and two (4.8%) failed imaging. One hip was diagnosed with subluxation, which went undetected by physical or risk screening. Conclusion: Nurse-led ultrasound hip screening for newborns and infants during home visits is feasible and may aid in early DDH detection. Further studies should assess diagnostic accuracy, cost-effectiveness, and long-term outcomes.

BackgroundMirroring is a foundational method used in Dance Movement Therapy (DMT), assumed to foster empathy and therapeutic attunement, yet its embodied dynamics remain insufficiently studied. In this paper, we provide the first quantitative exploration of client-therapist mirroring across dyadic and triadic formats, examining how synchrony unfolded during a structured mirroring exercise in which participants alternated between leading and following roles. MethodologyUsing optical motion capture and time-series modelling, we quantified movement coordination in dyadic (female client-therapist; male client-therapist) and triadic (therapist with both clients) interactions. ResultsIn dyadic tasks, the female client-therapist interaction was marked by tight temporal alignment, significant synchrony, robust predictive accuracy, and clear client-to-therapist influence, consistent with kinaesthetic empathy and affect-sensitive entrainment. By contrast, the male client-therapist dyad exhibited weaker and more delayed temporal coupling, alongside reduced phase synchronisation and fewer directional dependencies, despite comparable levels of interpersonal proximity. In the triadic task, temporal entrainment attenuated: therapist movement had few matching qualities to clients movement, yet recurrent synchrony with both clients persisted, suggesting a strategic shift from fine-grained entrainment to stable postural scaffolding under divided attention. DiscussionThese findings demonstrated that mirroring is not a uniform technique, but a family of embodied coordination modes flexibly recruited according to relational context and client expressivity. They align with theories of embodied simulation and affect attunement, implicating rapid motor resonance in dyadic entrainment and interoceptive-affective scaffolding in triadic stability. Clinically, the results underscore the need for training in flexible embodied strategies, split attention, and equitable allocation of attunement in group work. More broadly, they open a translational agenda linking kinematic synchrony to neural, interoceptive, and autonomic mechanisms, positioning mirroring as both an experiential hallmark and a measurable mechanism of change in embodied psychotherapy.

Objective: A questionnaire survey was conducted on the willingness and demand for acupuncture treatment in patients with malignant tumors, and the possible factors affecting patients' willingness and demand for acupuncture treatment were explored. Methods: A voluntary, anonymous survey was conducted between February and May 2025 among patients with malignant tumors aged 18 years and older who visited Beijing Cancer Hospital. The questionnaire included 16 questions addressing three dimensions:current medical purposes,Traditional Chinese Medicine(TCM) literacy, and acupuncture treatment needs.The questionnaire was posted online and completed by respondents using a smartphone interface. Results: A total of 511 valid questionnaires were retrieved in the survey, and 481 patients(94.1%) are willing to receive acupuncture treatment. Among the 481 patients willing to receive acupuncture treatment, the top five symptoms they hoped to improve with acupuncture were: disturbed sleep (245 participants, 50.9%); pain (229 participants, 47.6%); fatigue (177 participants, 36.8%); numbness (165 participants, 34.3%); and poor appetite (144 participants, 29.9%). Among patients who chose to "explicitly accept" acupuncture treatment and those who "accepted acupuncture treatment upon doctor's recommendation", 55% and 56% respectively had good knowledge of traditional Chinese medicine (TCM) culture. In contrast, this proportion was only 36.7% among patients who refused acupuncture treatment, and the difference was statistically significant (P<0.05). The survey results also show that Female patients reported significantly higher demands for pain relief and improved sleep than male patients, with statistically significant differences (P<0.05). Furthermore, those aged 18-45 and with better TCM literacy were more likely to desire acupuncture to improve sleep, with statistically significant differences (P<0.05). Conclusion: Differences in TCM literacy can influence patients' willingness to choose acupuncture treatment. Strengthening patient health education and improving TCM literacy will help increase cancer patients' willingness to choose TCM acupuncture treatment, thereby enabling them to benefit from acupuncture. For patients aged 18-45, those with good TCM literacy female with high acupuncture needs, acupuncture treatment may be recommended as a priority.

Pleasurable urge to move to music is often referred to as groove. Although previous studies have shown an association between the supplementary motor area (SMA) and the groove experience, its causal role remains unclear. Here, we investigated whether the SMA is causally involved in groove experience during music listening using repetitive transcranial magnetic stimulation. Fifteen healthy participants completed three sessions on separate days: excitatory stimulation (intermittent theta burst stimulation; iTBS) over the SMA, inhibitory stimulation (continuous theta burst stimulation; cTBS) over the SMA, and sham stimulation (iTBS or cTBS) over the vertex. After each stimulation session, participants listened to five high-groove and five low-groove musical excerpts and rated urge-to-move and pleasure on a 0-100 scale. Heart rate was additionally recorded as an exploratory physiological measure during music listening. Linear mixed-effects models (LMM) showed that pleasure ratings, but not urge-to-move ratings, were higher following both iTBS and cTBS compared with sham stimulation. In exploratory LMMs, reduced log-transformed heart rate variability (HRV) significantly predicted higher pleasure ratings. These findings suggest that SMA stimulation modulates the pleasurable component of the groove experience, likely via network-level mechanisms rather than a simple linear relationship between SMA excitability and pleasure. They also raise the possibility that reduced parasympathetic activity, reflected by lower HRV, mediates the stimulation-related increase in musical pleasure. Future studies should investigate the causal roles of other brain regions as well as clarify the directionality between autonomic changes and the groove experience.

Background/Objective: The Network Pain Rehabilitation Limburg (NPRL) was established to provide integrated, biopsychosocial-based rehabilitation care for patients with chronic musculoskeletal pain, emphasizing the delivery of appropriate care by the right person at the right place and cost. This study examines the perceived interprofessional collaboration practice (ICP) and work satisfaction among primary care healthcare professionals engaged in NPRL. Patients and Methods: A mixed-methods approach involved seven general practitioners (GPs), twenty-four therapists (physiotherapists and occupational therapists), and five mental health practice nurses in eleven semi-structured focus groups and one interview conducted from 2017 to 2020. The Interprofessional Collaboration Attainment Survey quantitatively measured healthcare professionals' ICP abilities before and after NPRL participation. Qualitative analysis, structured around existing ICP frameworks and the Quadruple Aim, was based on interview data. Results: Findings revealed stable ICP and work satisfaction, with discussions focusing on transitioning to a biopsychosocial perspective on chronic pain and its implications, along with concerns about GP burden and insurer reimbursement issues. Significant enhancements were noted in communication and team functioning (p < 0.05). Conclusions: Overall, healthcare professionals reported positive experiences with NPRL's integrated approach, showcasing dedication to providing rehabilitation care for chronic musculoskeletal pain in primary care. Recommendations for improving ICP included advocating for a broader societal biopsychosocial view of chronic pain, introducing case managers in primary care to support GPs, and exploring alternative reimbursement models with insurers. However, significant transformations to impact work satisfaction and ICP may necessitate more time and consideration.

OBJECTIVESDemonstrate correlations of clinic-based measures of International Classification of Functioning, Disability and Health (ICF) Body Structure and Function, capacity and performance with a school-based performance measure in children with Cerebral Palsy (CP) using a transdiagnostic approach. METHODS102 ambulatory children with CP underwent assessment of Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Pediatric Quality of Life Inventory Generic Core Scales (PedsQL), 3-Dimensional Gait Analysis, Gillette Functional Assessment Questionnaire (GFAQ), and Pediatric Outcomes Data Collection Instrument (PODCI) done in clinics, compared with School Function Assessment (SFA) done in schools. Here we report on SFA correlations. For this paper, Spearmans correlations were calculated. RESULTSAll measures showed some significant correlations with the SFA; greatest number of moderate to strong correlations were with PODCI, including PODCI comorbidities scales. PODCI performance questionnaire was correlated with all SFA scales. PODCI, as a performance measure, is broader, more holistic, than the capacity and BSF measures. Findings are demonstrative of a focus on the ICF approach, indicating separate domains of function and well-being, reflective of the transdiagnostic approach. CONCLUSIONSThe transdiagnostic approach, looking at a broader picture than simply diagnosis, thus paralleling concepts presented in the ICF, is beneficial in assessing functioning and well-being in children with CP.

Humanity has always admired and created artwork, but the neurocognitive mechanisms behind artistic experience are still elusive. Professional artists and their intimate relationship with their artworks provide a unique opportunity to study the nature of art experience due to their expertise in both art making and art appreciation. During two fMRI tasks, professional artists (N=20) made aesthetic judgments on their own and other artists paintings (aesthetic appreciation task); they also mentally reconstructed the moments when they conceived their artworks or, as a control condition, when they visited now-familiar places for the first time (reconstruction by imagery task). During art appreciation of their own (as compared to other artists) paintings, participants showed stronger recruitment of bilateral posterior parietal cortices, the left lateral occipitotemporal cortex, and the dorso-central sector of the right insula, that is, action-related brain regions also involved in encoding the emotional components of movements. The reconstruction of their own artistic creation (as compared to episodic memory retrieval) involved the left fronto-parietal network associated with motor cognition. Altogether, these results suggest that the mental representations of the actions involved in creating art are integral to the overall artistic experience of painters, supporting an embodied view of the artists experience of art.

Elite athletes exhibit sport-specific neural adaptations, yet it remains unclear whether such changes reflect general effects of training or the unique demands of individual sports. Skiing requires postural control and whole-body coordination under dynamically unstable environments, placing high demands on somatosensory processing and sensorimotor integration. The present study aimed to identify structural brain characteristics specific to elite skiers by comparing them with athletes from other sports disciplines and non-athletes. T1-weighted MRI data were analyzed using voxel-based morphometry in 13 skiers, 23 non-ski control athletes and 25 non-athletes. Whole-brain analysis comparing skiers with non-ski athletes revealed a significant cluster showing greater gray matter volume in skiers compared with non-ski athletes in the left postcentral gyrus, extending into the superior parietal lobule. The identified cluster primarily encompassed cytoarchitectonic Areas 2 and 5L. These regions are involved in higher-order somatosensory processing and multisensory integration. Importantly, region-of-interest analysis demonstrated that gray matter volume within this cluster was greater in skiers compared with non-ski athletes and non-athletes, with no difference between non-ski athletes and non-athletes. These findings highlight the relative prominence of structural adaptations within somatosensory-parietal networks, reflecting the unique integration of proprioceptive and other sensory information required for elite skiing. Overall, these findings provide evidence for sport-specific structural brain differences in elite athletes and highlight the importance of somatosensory and parietal regions in sensorimotor integration relevant to skiing. These findings may have implications for understanding neural markers of expertise and may inform future approaches to training and performance evaluation in skiing.

Singing is an innate human behaviour present across cultures and the lifespan. Despite lacking direct biological advantages, its ubiquity suggests that it is intrinsically rewarding. This research aimed to investigate the underlying factors that explain variability in sensitivity to deriving reward and enjoyment from natural singing in the general population. In Study 1 (n = 606), an initial pool of items describing daily, non-professional singing behaviours were administered to an international adult sample. Exploratory factor analysis revealed a unidimensional structure of 20 items with acceptable model fit, organized into five facets representing distinct domains of singing-related rewards: 1) pleasure and emotional evocation, 2) social singing reward, 3) singing frequency, 4) mood regulation through singing, and 5) inattentional singing during routine tasks. In Study 2 (n = 430), confirmatory factor analysis in a new sample supported this structure. When both samples were combined (n = 1036), the unidimensional model defined by these five facets showed acceptable to excellent goodness-of-fit indices, supporting the conceptualization of singing reward as a multidimensional construct with differentiated facets. This led to the Barcelona-Aarhus Natural Singing Engagement Questionnaire (BANSEQ), which demonstrated excellent reliability ( = .94) and population-level stability. Study 3 (n = 1036) tested the convergent validity of BANSEQ with measures of music reward and engagement and identified sociodemographic and psychological correlates across the five facets of singing reward. Overall, these findings characterize the sources of individual differences in the hedonic experience of natural singing and propose BANSEQ as a robust psychometric tool for its assessment in the general population.

Motivational music has been shown to improve running performance through delaying fatigue and increasing run duration. Previous studies have highlighted the effect of music tempo, that matching tempo to the runners cadence delays running fatigue. It remains unclear whether the motivational content in music lyrics is also responsible for delaying running fatigue. We designed a cross-sectional study and investigated the effect of tempo and motivational content on running biomechanics, and had participants run at a moderate intensity for up to ten minutes, or until exhaustion. Fifteen adults (age=20.9{+/-}1.3 years, weight=71.2{+/-}12.1 kg, height=174.7{+/-}11.0 cm) participated. Participants finished three trials, starting with running without any stimulus as a baseline trial, and ran with a visual metronome that flashed at a rate that matched their running cadence in the visual stimulus trial (VST). In the visual-auditory stimulus trial (VAST), participants ran with the visual metronome (as described in VST) while listening to a non-rhythmic motivational speech. We recorded run duration, perceived exertion, center of pressure sway during standing before and after each trial, and measured trunk acceleration to obtain root-mean-square (RMS) of acceleration during each minute of the run. Compared to baseline, participants reduced perceived exertion by 0.87 and 0.85 rating during the VST and VAST, respectively, though these changes did not reach significance (p=0.05). Stimulus affected the RMS of acceleration in anterior-posterior (p=0.011), vertical (p=0.008), and resultant directions (p=0.006). Our linear mixed effect model suggested that compared VST, VAST further lowered RMS of acceleration by 0.026g (anterior-posterior), 0.028g (vertical), and 0.036g (resultant). Our results showed that motivational content played an important role in lowering RMS of trunk acceleration, with the potential to delay running-induced fatigue. To maximize the effect of music on running performance, runners should listen to music that they find motivational and that is close to their natural running cadence.

Prosthetic devices balance functionality and usability to support activities of daily living (ADLs). However, many designs rely on rigid end effectors that, while anthropomorphic in form, lack biomimetic design principles. This mismatch increases cognitive and physical burden, reducing adoption rates. We developed the Human-inspired Actuator Modeling and Reconstruction (HAMR) process, a user-centered framework informed by individual morphology and functional needs, to generate customized agonist/antagonist tendon-actuated end effectors. Using HAMR, we created the Tendon Actuated Prosthetic Hand (TAPH), which integrates human-derived geometry with adaptive force distribution to promote natural object interaction. In a study with 12 participants without limb difference, TAPH was compared to a structurally similar tendon-actuated hand with generalized anthropomorphic geometry across three ADL tasks of varying complexity. TAPH significantly improved task performance and reduced physical effort, mental workload, and frustration, particularly during gross motor tasks. For fine motor tasks, performance improved under stable conditions but not during tasks requiring dynamic precision and continuous coordination. These findings highlight the functional benefits of biologically informed prosthesis design and support biomimetic principles in enhancing performance and user experience.

BACKGROUNDFreezing of gait (FOG) is a disabling feature of Parkinsons disease (PD). Although physical practice (PP) improves gait, maintaining gains remains challenging. Mental practice (MP), including Dynamic Neuro-Cognitive Imagery (DNI), may enhance gait control, but evidence on remote combined interventions is limited. PURPOSETo investigate whether adding MP grounded in DNI principles to remote physical practice supports greater and more sustained improvements than remote physical practice alone in people with PD and FOG. METHODSA prospective, single-blind, parallel-group randomized controlled trial was conducted. Forty-three participants with idiopathic PD and FOG were randomized to an experimental group (EG, n = 20) or control group (CG, n = 23), stratified by cognitive performance. Both groups received 10 remote sessions over 6 weeks. All performed structured physical practice targeting gait components; the EG additionally performed MP based on DNI, while the CG performed time-matched seated stretching. Assessments were conducted at baseline (BI), post-intervention (AI), and 30-day follow-up (FU). The primary outcome was Rapid Turns Test performance; secondary outcomes included FOG severity, motor aspects of daily living, mobility-related quality of life, and global cognition. RESULTSAll randomized participants were included in intention-to-treat analyses; 38 completed all assessments. Significant group x time interactions were found for Rapid Turns Test duration (p = 0.0019) and FOG time (p = 0.0108). Both groups improved short-term, but only the EG maintained gains at follow-up. Additional interactions favored the EG for mobility-related quality of life (p = 0.001) and global cognition (p = 0.0018). Self-reported FOG improved over time in both groups (p < 0.001) without between-group differences, while motor aspects of daily living showed a time effect only (p = 0.001). CONCLUSIONMP based on DNI principles may enhance retention of gains when combined with remote physical practice, supporting its use as an adjunct in FOG rehabilitation. Trial registrationThis trial is registered at ClinicalTrials.gov with trial registration number NCT06957405 (registered on April 25, 2025). Protocol and statistical analysis planThe full trial protocol and statistical analysis plan are available upon request from the corresponding author. Data sharingThe datasets generated, used and analyzed during the trial are or will be available from the corresponding author upon reasonable request. Funding and conflicts of interestThis article was produced as part of the activities of FAPESP Research, Innovation and Dissemination Center for Neuromathematics (grant #2013/07699-0, Sao Paulo Research Foundation). Co-author PRS received individual support from FAPESP (grant number 2025/14403-7). The authors declare no conflict of interest.

Introduction: Adults with spinal cord injury (SCI) often experience reduced or lost sensation and movement, impairing the ability of the brain to locate paralyzed body parts, which, in turn, compromises sensorimotor recovery. This disruption of the internal body map of the brain, or mental body representations (MBR), also contributes to neuropathic pain in about 69% of adults with SCI. Medications for neuropathic pain are often ineffective and can cause adverse reactions. Our previous pilot clinical trial showed that Cognitive Multisensory Rehabilitation (CMR), a physical therapy that restores MBR, produced significant, lasting reductions in neuropathic pain, improved sensorimotor function, and enhanced brain function. Building on these results, we examined whether 8 weeks of CMR or adaptive fitness (1) improved sensorimotor function and reduced pain; (2) greater brain activity and connectivity related to sensorimotor function and MBR in adults with SCI. Methods: Sixteen participants (52+/-8 years old, 13+/-10 years post-SCI) were randomized to 8 weeks of CMR or adaptive fitness (45 min, 3x/week). Ten participants had neuropathic pain of 3/10 or greater. Pain and sensorimotor function were assessed at baseline, post-intervention, and 3-month follow-up using the Numeric Pain Rating Scale (NPRS), ASIA Impairment Scale (AIS), and Neuromuscular Recovery Scale (NRS). Functional MRI included resting-state and 4 tasks: imagining feeling the left leg, imagining moving the left leg, whole-body movement imagery, and a sensation task. Results: After CMR, participants improved on AIS with large effect sizes (touch: d=1.54; pinprick: d=1.83; lower limb motor function: d=1.32), while adaptive fitness had small/moderate effects (touch: d=0.49; pinprick: d=0.53; lower limb motor function: d=0.74). CMR also showed larger effect sizes for NRS (core: d=2.19; upper limb: d=0.69; lower limb: d=0.74) than fitness (core: d=0.73; upper limb: d=0.34; lower limb: d=0.00). Benefits persisted at follow-up. Highest neuropathic pain intensity reduced post-CMR and at 3-month follow-up (d=0.48; d=0.63). Pain increased slightly after fitness (n=6; d=-0.19; d=-0.41). CMR increased brain connectivity and activation during the leg imagery task. Increased activation during whole-body imagery was greater after CMR than fitness. Discussion: These preliminary results support the potential of CMR to improve function and reduce neuropathic pain in adults with SCI, warranting larger confirmatory trials. Clinicaltrial.gov: NCT05167032

BackgroundIn the conflict-ridden Gaza Strip, burn injuries pose significant challenges for affected individuals. Often stemming from accidents involving generators and substandard gas cylinders, these burns can have profound physical and psychological impacts. Access to comprehensive medical care is limited in this context, making specialized burn treatment centers critical lifelines for those in need. This study seeks to explore the outcomes of rehabilitation and physiotherapy for post-surgical skin grafts in specialized burn treatment centers in Gaza, recognizing the crucial role such interventions play in improving the quality of life for burn survivors in this challenging environment. MethodsWe carried out a retrospective descriptive study of patients with post-surgical skin graft (SSG) scars subsequent to burns injury, and enrolled in the MSF post-op outpatient clinics in the Gaza Strip (Gaza City, Beit Lahia, and Khan Younis), between January 2018 and December 2020. Our analysis used five outcome measures to assess the effects of physiotherapy and post-surgical treatment: the reducibility score, which indicates the extent to which scars can be reduced in size or prominence; the Functional Activity for Burn (FAB) score, which evaluates the functional capabilities of patients following burn injury; the Vancouver Scar Scale (VSS), which assesses various aspects of scar appearance such as pigmentation, vascularity, pliability, and height; the Visual Analgesic Scale (VAS), which quantifies pain levels experienced by patients; and the itching score, which measures the severity of itching associated with scar formation ResultsA total of 177 patient records were examined, revealing that the majority of burn victims in Gaza were children under the age of 18 (n=136, 76.8%), with scalding from liquid burns being the primary cause (n=119, 67.6%). The outcomes of the physiotherapy program varied depending on the type of pressure therapy and insert material utilized. However, significant improvements were observed in various outcome measures following enrollment in the program. These improvements included reductions in pain scores (mean initial score: 5.3, SD: 2.5; mean final score: 1.4, SD: 1.8), itching (mean initial score: 3.7, SD: 2.7; mean final score: 2.7, SD: 2.2), scar pigmentation, vascularity, pliability, and height (mean initial VSS: 7.1, SD: 1.8; mean final VSS: 5.7, SD: 1.7). Moreover, treatment correlated with enhancements in overall function (mean initial score: 25.6, SD: 7.1; mean final score: 34.6, SD: 2.3) and a reduction in skin contracture (mean initial score: 2.3, SD: 1.4; mean final score: 0.8, SD: 0.9). ConclusionsOur findings underscore the important role of rehabilitation and physiotherapy in optimizing outcomes for post-surgical skin graft patients in conflict-affected regions like the Gaza Strip. Despite the challenging environment, MSFs clinic in Gaza has demonstrated the feasibility and effectiveness of delivering comprehensive care to burn survivors. Moving forward, further research is needed to refine and validate best practices in rehabilitation interventions tailored to the specific needs of patients in conflict zones, ensuring continued progress in enhancing the quality of care and quality of life for those affected by burn injuries.

Background: Spinal pain, including neck pain and low back pain (LBP), is a common musculoskeletal condition and major contributor to disability worldwide. Evidence comparing disability, fatigue and mental health across acute and chronic stages remains limited, particularly in conflict-affected and low-resource settings. This study assessed these outcomes among patients with acute and chronic neck pain and LBP in the Gaza Strip. Methods: A comparative cross-sectional study was conducted among 410 adults attending outpatient physical therapy at Nasser Medical Complex, Khan Younis, Gaza Strip. Participants included 204 with neck pain and 206 with LBP, classified as acute neck pain (n=101), chronic neck pain (n=103), acute LBP (n=102) and chronic LBP (n=104). Disability, fatigue, psychological distress and sleep disturbance were assessed using the Neck Disability Index (NDI)/Oswestry Disability Index (ODI), Fatigue Severity Scale (FSS), Patient Health Questionnaire-4 (PHQ-4) and PROMIS Sleep Disturbance Short Form 8a. Independent t-tests, adjusted linear regression, correlation analyses, clinical-threshold analyses and binary logistic regression were performed. Results: Chronic neck pain and chronic LBP were associated with significantly higher disability, fatigue and psychological distress than acute pain. Chronic neck pain patients had higher NDI, FSS and PHQ-4 scores than acute neck pain patients; chronic LBP patients had higher ODI, FSS and PHQ-4 scores than acute LBP patients (all p<0.001). Sleep disturbance did not differ significantly between groups. Female participants reported higher psychological distress in both pain groups, with higher fatigue in neck pain and higher disability in LBP. Adjusted analyses confirmed that chronic pain status remained associated with higher disability, fatigue and psychological distress. Fatigue was the most consistent factor independently associated with chronic pain status. Conclusions: Chronic spinal pain was associated with greater disability, fatigue and psychological distress than acute spinal pain, while sleep disturbance was common across groups. These findings support early multidimensional assessment, including screening for fatigue and psychological distress. Longitudinal studies are needed to clarify whether these factors contribute to transition from acute to chronic spinal pain.

BackgroundCranioplasty following decompressive craniectomy can be performed using various implant materials, with titanium and polyetheretherketone (PEEK) being the most commonly used synthetic options. However, their comparative safety and clinical performance remain debated. This systematic review and meta-analysis aimed to compare titanium-based cranioplasty with PEEK and other synthetic or autologous materials regarding implant survival, complications, functional outcomes, cosmetic results, and operative metrics. MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and registered in PROSPERO (CRD). A comprehensive search was performed in PubMed, Embase, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews (CDSR) without language or date restrictions. A total of 1,026 records were identified (Embase n = 263, Web of Science n = 272, Scopus n = 293, PubMed n = 193). After removal of 550 duplicates, 78 articles underwent full-text review, and 38 comparative studies met the eligibility criteria for qualitative synthesis. Three studies directly comparing titanium and PEEK with extractable infection data were included in the meta-analysis. Risk of bias was assessed using Joanna Briggs Institute (JBI) tools. ResultsForty-one studies encompassing heterogeneous patient populations and study designs were included, predominantly retrospective cohort studies. Titanium demonstrated shorter operative times and lower intraoperative blood loss compared with autologous bone and, in most studies, compared with PEEK and PMMA. Implant survival outcomes were heterogeneous: PEEK frequently showed lower exposure rates but higher rates of subgaleal fluid collection. Compared with autologous bone, titanium had higher exposure rates but avoided resorption-related failures. Infection outcomes varied across materials; however, pooled meta-analysis demonstrated a significantly lower odds of postoperative infection with titanium compared with PEEK (random-effects model), with moderate heterogeneity. Functional and neurological outcomes were largely comparable across materials, and cosmetic satisfaction was generally high regardless of implant type. ConclusionsTitanium cranioplasty provides favorable operative efficiency and competitive complication rates compared with alternative materials. While exposure risk may be higher than PEEK, pooled evidence suggests a lower infection risk with titanium. Overall, implant material selection should consider patient-specific risk factors, defect characteristics, and surgeon expertise. Further high-quality prospective studies are warranted to strengthen comparative evidence.