Journal of NeuroEngineering and Rehabilitation

There are many alternative methods to joystick control for control of Electric Powered Wheelchairs for users with neuromuscular disabilities, such as muscular dystrophy, and spinal cord injuries, such as tetraplegia. However, these methods- which include the sip-and-puff method, head and neck movement, blinking, or tongue movement- hinder social interaction, and are therefore detrimental to user independence. In recent years, research has explored the use of Electromyography (EMG) signals from alternative muscles to control a powered wheelchair, consequently increasing the quality of life of these users. The Auricular Muscles (AM) may be suitable, as they are controlled separately from the facial nerve and are vestigial in humans, making them advantageous for powered wheelchair control for users with tetraplegia. Additionally, they are located around the ear, adding a level of cosmesis when designing wearable sensors and prosthesis. This paper extracts and implements two control strategies from current literature and, for the first time, compares them directly, demonstrating viable implementation approaches for an online EMG-based powered-wheelchair control system. A Support Vector Machine (SVM) was developed and various window lengths were compared, with the most accuracy and real-time effectiveness found at 300ms. A study with three participants demonstrates the feasibility of these methods of control as well as experimental results to guide the potential AM use.

PurposeRobotic walkers are a new and novel technology with growing evidence of benefits for children living with mobility impairments. However, little is known about how using these devices at home impacts families. This study aims to explore parents perceptions of home-based robotic walking and the impacts on their family and their child living with a mobility impairment. Materials and MethodsQualitative interviews were conducted with seven parents who have a child who used a robotic walker in their home for at least six months. Thematic analysis was used to analyze all interviews. Themes were then mapped to the F-words for child development. ResultsUsing a robotic walker at home led to family bonding and created new ways for parents and siblings to interact with the child living with a mobility impairment. Many children enjoyed using the robotic walker. This, combined with being able to direct its use in their own environments, contributed to less parental stress than was associated with other rehabilitation interventions. However, some parents discussed an increase in parental stress due to certain logistical aspects, getting their child in and out and transporting the robotic walker. Finally, parents discussed that obtaining the device was a financial burden for them. ConclusionRobotic walking in the home environment impacts family relationships and parental stress. Understanding families experiences can inform decision-making by families and practitioners around the appropriateness of robotic walker use for a child living with a disability.

Centre of mass (COM) is a key measurement used to assess balance and mobility. Marker-based motion capture systems have traditionally been used to measure COM, but they are time-consuming and prone to marker error. Markerless motion capture systems offer a potential alternative, reducing setup time while maintaining accuracy. The ease of collecting markerless data may be particularly beneficial when study participants have limited mobility, such as those with stroke. This study aimed to determine the differences in COM measurements between marker-based and markerless motion capture systems during balance and mobility tasks in individuals with sub-acute stroke. Seventeen participants completed the following tasks: walking, quiet standing, sit-to-stand, rise on toes, and backward reactive stepping. COM data were analyzed using two markerless models, a default with 17 segments and a fit model with 11 segments to match the marker-based model to be compared as the reference. The results showed high correlations (R2 = 0.75 to 0.999) and low root-mean-square differences (< 2 cm) in the anterior-posterior and medial-lateral directions. Larger differences (> 4 cm) were observed in the superior-inferior direction, particularly with the default model. These findings suggest that markerless motion capture can be used to measure COM in people with stroke, and that model selection plays an important role in COM estimates.

BackgroundDespite recommendations in clinical guidelines, clinical experience indicates that engagement with splints and orthotics varies amongst people after stroke. ObjectivesThe aim of the study was to understand the factors that influence engagement with splints and orthotics in people after stroke. MethodsPeople after stroke who had been wearing a splint or orthotic (also known as devices) for at least 2 months under the care of one Community Neurosciences Team in the UKs National Health Service were included. Semi structured interviews based on the constructs of Banduras Social Cognitive Theory (SCT) were used to gather participants views, and a framework analysis applying the constructs of SCT was completed using NVIVO software. ResultsFour key themes were identified: 1. Self-Regulation; difficulties applying the device and aesthetic acceptability. 2. Self-Efficacy; increased confidence when wearing the device and reduced motivation to wear the device. 3. Outcomes Expectation; reduced falls risk, improved gait, improved balance, maintaining range of movement, and negative effects such as discomfort, pain, itching. 4. Social Support; support needed to apply the device and the burden on family members/carers to apply the device correctly. ConclusionsThe findings of this study highlight key factors that influence engagement with orthotics and splints. These include difficulty applying the device after stroke, device aesthetics, comfort, and the importance of continued support from carers. Manufacturers should consider how people after stroke can independently don and doff devices. Education of carers and family members also appears key to support their engagement.

BackgroundIndividuals with severe mobility impairments (SMI) often experience significant psychological distress and chronic pain. Virtual walking (VW) presents an innovative rehabilitation approach to improve mood and alleviate pain. This study aimed to develop a home-based VW system with integrated mood and symptom tracking and to report on its feasibility and usability in a user study with individuals with SMI. MethodsA multidisciplinary, iterative frame-work guided the systems development. Following initial contextual research and design iterations, a user study was conducted with 11 participants with SMI. A repeated measures pre-post design was employed. Feasibility and usability were primarily assessed through post-study qualitative interviews, analyzed via content analysis. Changes in mood and symptoms were measured immediately before and after each session. Momentary mood was captured using an in-virtual reality (in-VR) two-dimensional (2D) affect grid, while embedded single-item state ratings were used to track anxiety, depressed mood, and pain. Daily mood changes and symptom trajectories were analyzed using logistic regression and generalized estimating equations (GEE), respectively. ResultsContextual research guided the system design towards enhancing accessibility, ergonomics, and therapeutic engagement. The final VW system featured three core modules: locomotion, multi-sensory feedback, and mood/symptom tracking. Qualitative analysis of the user study revealed high acceptance for the VW system, alongside challenges related to content variety and hardware ergonomics. Each intervention session was significantly associated with an immediate positive mood shift (odds ratio (OR) = 1.83), as measured by the affect grid. Furthermore, GEE models revealed a significant reduction in self-reported depression and anxiety symptoms over the intervention period (all P < 0.01). ConclusionsThis study confirms the feasibility and acceptability of the novel VW system for home-based use by individuals with SMI. The preliminary evidence suggests the system has high potential as a tool for improving mood and alleviating psychological distress. Future large-scale randomized controlled trials are warranted to establish its clinical efficacy. Trial registration numberNCT07073144-07/17/2025.

BackgroundAdapted dance is a promising rehabilitation intervention for physical and psychosocial impairments in people with chronic stroke. However, in-person attendance is hindered by limited community ambulation, transportation, and schedule conflicts. At-home participation with a live-streamed dance program could address these issues, but psychosocial benefits may be diminished because of reduced social interactions. The primary objective of this study was to assess the feasibility and safety of a live-streamed dance program for chronic stroke. Secondary objectives were to characterize participants who choose live-stream vs in-person options and quantify pre-post changes in balance, gait and social connection. MethodPeople with chronic stroke were given the choice of attending a live-streamed adapted dance program either in-person or at home twice a week for 4 weeks. A priori feasibility criteria were tracked, and participants were characterized with self-report (Center for Epidemiologic Studies Depression Scale; CES-D) and performance-based measures (e.g., Montreal Cognitive Assessment, Chedoke McMaster Assessment) at baseline. Pre-post measures of secondary outcomes included gait speed, Mini Balance Evaluation Systems Test (Mini-BESTest), Activities of Balance Confidence Scale (ABC), and Inclusion of Community in Self scale (ICS). Unpaired median/mean differences in baseline clinical presentation were used to compare in-person and live-stream participants. Paired median/mean differences were used to examine change in secondary outcomes with dance. ResultsInterest and enrollment rates for both groups combined were 87% and 38% respectively. Of the 13 people who enrolled, 8 chose in-person and 5 chose live-stream. In-person and live-stream attendance rates were 83% and 89% respectively, and retention rates were 80% and 75% respectively. At baseline, the in-person group had greater depressive symptoms (CES-D score, median [IQR] difference: 11.5 [-21.5, -5]), and faster mean gait speed (-25.8cm/s [-50.98, 0.006]) than the live-stream group. There were no pre-post changes in secondary outcome measures. ConclusionsA live-streamed dance intervention featuring in-class and at-home participation is safe and feasible for people with chronic stroke. These results will inform a future randomized controlled trial to investigate the effects of a live-stream dance program with a longer duration while considering how factors such as gait function and mood may relate to the choice between in-person and at-home attendance.

BackgroundSedentary behavior is highly prevalent following traumatic brain injury (TBI) and compounds existing risks for cardiovascular, neurodegenerative, and affective disorders. The cognitive and behavioral sequelae of TBI, including impaired decision-making, blunted reward processing, and cognitive fatigue, create particular barriers to adopting and maintaining an active lifestyle. Despite this, effective behavior change interventions targeting physical activity in community-dwelling TBI survivors remain scarce. Here, we evaluated the feasibility, compliance, and preliminary efficacy of a 12-week remotely delivered walking intervention combining planning, behavioral reminders, and monetary micro-incentives. MethodsFifty-six adults aged 40-80 years with a mild-to-moderate TBI diagnosed between 3 months and 15 years prior were randomized to either a planning, reminders, and micro-incentives intervention (n=23) or a health advice control condition (n=25). Participants wore a Fitbit Inspire 3 continuously throughout the study. Intervention participants completed weekly phone calls to plan five 30-minute walks for the following week, received daily text message or email reminders on planned walk days, and earned small monetary incentives upon walk completion. Control participants received weekly health education calls. Feasibility was assessed through recruitment, retention, and adverse event rates. Compliance was assessed via phone call completion rates and Fitbit wear time. Efficacy outcomes included weekly walk counts, walking duration, and step counts, modeled using Poisson generalized linear mixed models and linear mixed-effects models over 12 weeks. ResultsForty-eight participants completed the study (retention rate: 84.2%), with high phone call compliance in both groups (intervention: 98.4%; control: 98.1%). Intervention participants completed significantly more walks than controls from week 1 onward (aIRR = 5.33, 95% CI: 2.27-12.5, p < 0.001), with the group difference growing over time (interaction aIRR = 1.09 per week, 95% CI: 1.01-1.17, p = 0.029). Estimated marginal means indicated that intervention participants completed 5.5 times more walks than controls at week 1, increasing to 15.5 times more by week 12. The intervention group also walked significantly longer at week 1 (b = 62.14 min, 95% CI: 1.05-123.23, p = .046), with the advantage growing over time; by week 12, intervention participants walked 5.3 times longer than controls. Similarly, the intervention group accumulated significantly more steps during walks at week 1 (b = 4,779 steps, 95% CI: 45.50-9,513.00, p = .048), accumulating 3.1 times more steps than controls by week 12. ConclusionsA remotely delivered, multicomponent walking intervention targeting planning, behavioral reminders, and micro-incentives was feasible, well-tolerated, and produced meaningful increases in walking activity in community-dwelling adults with TBI. With high retention and compliance, and consistent effects on walk counts, duration, and steps across the intervention period, these findings provide compelling support for a larger, fully powered trial.

AIMExecutive functions (EF) are advanced cognitive processes that play an essential role in daily functioning and may be of increased importance in cerebral palsy (CP), given the complexity of primary and associated impairments. This study aims to synthesize existing evidence on the relation between EF and domains of the International Classification of Functioning, Disability and Health (ICF) in individuals with CP, and to quantify the magnitude of these associations through meta-analysis. METHODA systematic literature search was conducted in eight electronic databases up to 14 July 2025, examining associations between EF and ICF domains in CP. EF outcomes were classified into inhibitory control, working memory, cognitive flexibility, higher-order EF, and EF composite scores. Outcome measures were mapped onto ICF domains: Body Functions and Structures, Activity, Participation, and Contextual factors, using the CP Core Sets. Correlation coefficients were transformed to Fishers z and entered into three-level meta-analyses to estimate pooled effect sizes. Single moderator analyses examined CP subtype, EF domain, EF assessment type, and mean age. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. RESULTSFrom 4637 identified records, 38 studies were included, comprising a total sample of 1633 participants with CP. There was substantial heterogeneity in CP subtype, participant age, and EF conceptualization, while the ICF Contextual factors domain was underrepresented. A medium-to-large association was found between EF and functioning across all ICF domains combined (r=0.26, p<0.001). Domain-specific analyses showed a medium association of EF with Body Functions and Structures (r=0.21, p<0.01), a medium-to-large association with Activity (r=0.38, p<0.001) and Participation (r=0.26, p<0.01). CP subtype and mean age significantly moderated the overall EF-functioning association, with mixed CP and younger age associated with stronger effects. INTERPRETATIONEF are meaningfully associated with multiple domains of functioning in individuals with CP. These findings support the relevance of routine EF assessment and suggest that EF are an important cognitive correlate to consider when addressing broader aspects of daily functioning. WHAT THIS PAPER ADDSO_LIExecutive functions (EF) showed medium-to-large associations with all ICF domains in people with cerebral palsy (CP) C_LIO_LIThe strongest and most consistent associations were found between EF and ICF Activity C_LIO_LIOverall associations highlight the relevance of EF as a meaningful intervention target in CP C_LI

BackgroundPeople with hip or knee joint arthroplasties are commonly advised to avoid high-impact physical activities, despite increasing demand to return to sport and vigorous exercise. Current implant testing standards do not reflect real-world loading during high-impact tasks, and few studies have quantified implant loads in high-functioning individuals who have returned to such activities. MethodsHigh-functioning adults with a total hip arthroplasty (THA, n = 11), total knee arthroplasty (TKA, n = 4), or unicompartmental knee arthroplasty (UKA, n = 3) performed a range of low-to high-impact activities, including walking, running, hopping, countermovement jumps, landings, and change-of-direction tasks. Three-dimensional trunk and lower-limb kinematics and ground reaction forces were collected. Musculoskeletal modelling was used to quantify three-dimensional hip and knee joint contact forces. Linear mixed-effects models were used to rank implant loads across activities and to compare peak resultant joint loads with healthy controls from a prior study. ResultsFor people with THR, relative to walking, a 45{degrees} change of direction generated the highest predicted hip contact force (8.38 BW, 95% CI 7.70-9.06), followed by running and unilateral hopping (all >1.5x walking, p < 0.05). Unilateral hopping and running produced the highest predicted knee contact force in TKA and UKA participants (8.0-9.1 BW), and both significantly greater than walking (p < 0.05). Compared with healthy controls, THA participants exhibited a lower predicted HCF during walking (-1.58 BW, 95% CI -2.46 to -0.69), but no group differences were observed for running, hopping, or jumping. ConclusionHigh-impact activities vary widely in model-estimated hip and knee contact forces. Several tasks were not substantially higher than walking. These data provide a biomechanical basis for evidence-informed activity prescription, regulatory implant testing, and future computational simulation of implant performance under realistic loading conditions.

BackgroundThoracic spine mobilization (TSM) has been proposed to influence autonomic nervous system (ANS) activity, yet evidence remains inconsistent and feasibility of standardised protocols is unclear. This study aimed to evaluate whether a randomized TSM protocol can be implemented successfully in healthy participants and to provide preliminary estimates of its effects on heart rate variability (HRV) and heart rate (HR). MethodsA randomized feasibility trial was conducted with healthy young adults receiving six manual therapy sessions consisting of rotational mobilizations above Th5 over 14 days. Feasibility outcomes included adherence, absence of unexpected adverse events (UAE), and practicality of autonomic data acquisition. Physiological outcomes comprised HRV parameters, high-frequency (HF), low-frequency/high-frequency ratio (LF/HF) and HR, analyzed using autoregressive (AR) and fast Fourier transform (FFT) methods. ResultsProcedural safety and methodological integrity were confirmed (no UAE; complete datasets), but feasibility was only partially achieved due to adherence shortfalls, higher attrition, and device-related delays. Physiologically, large effect sizes were observed in the intervention group: at evening assessment, HF_AR showed ES = 0.80 (p = .008); at morning assessment, HF_FFT ES = 0.72 (p = .016), HF_AR ES = 0.78 (p = .010), and LF/HF_AR ES = 0.70 (p = .021). HR remained unchanged. These findings suggest repeated TSM may modulate HRV, primarily through HF-related changes associated with vagal activity, while LF/HF interpretation remains controversial. ConclusionA randomized TSM protocol is safe and methodologically viable with logistical refinements. Preliminary evidence indicates potential vagal modulation, warranting larger trials with respiratory control, ECG-based HRV, multimodal ANS measures, and clinical populations to confirm efficacy and translational relevance.

BackgroundReactive balance training using repeated perturbations may reduce falls, however, training methods are not easily replicated or translatable to clinical settings. This study aimed to examine the effects of a novel reactive balance training program on balance recovery from laboratory induced trips and slips and fall risk factors in older people using simple and low-cost equipment. MethodsWe conducted a randomised controlled trial involving 88 older people. An intervention group (n = 43) received the ReacStep program which involved tether-release reactive stepping and intentional slips once a week for 6 weeks. Both the intervention and control (n = 45) groups received home-based strength training for 8 weeks. Blinded staff assessed reactive balance (laboratory induced falls), physical functions at baseline (week 1) and post intervention (week 8). Weekly SMS surveys ascertained falls in daily life over 12 months. ResultsBoth groups were comparable in demographics, with a mean age of 72 years (SD = 5.6). Adherence to ReacStep sessions was high (90%). There were no significant differences between groups in laboratory-assessed reactive balance falls at post-test or daily-life falls over one year (P =.19). However, at post-test, the intervention group demonstrated significant improvements in usual gait speed, maximum step length, and choice stepping reaction time compared to controls (P <.05). ConclusionsThe ReacStep program demonstrated excellent adherence, was well tolerated, and improved gait parameters required for balance recovery following postural perturbations in older people. Nevertheless, it appears this program is not sufficient to improve reactive balance against unexpected trips and slips. Key pointsO_LIThe ReacStep program is acceptable, demonstrates excellent adherence and improves gait measures in older people, potentially reducing fall risk. C_LIO_LIThe generalisability against unexpected trips, and slips, and falls in daily life may be limited. C_LIO_LIFuture research should explore more ecological perturbations while maintaining its accessibility and acceptability. C_LI

BackgroundIn critically ill patients admitted to the intensive care unit (ICU), rapid skeletal muscle atrophy frequently develops in the acute phase. This ICU-acquired weakness can significantly impair long-term physical function. Although the biceps brachii cross-sectional area (CSA) is commonly used to assess muscle atrophy, its ultrasound imaging can be technically challenging, and the flexor carpi ulnaris may offer a more accessible alternative. Therefore, this study aimed to investigate whether CSA changes of the flexor carpi ulnaris correlate with those of the biceps brachii in critically ill patients admitted to the ICU, as well as whether the flexor carpi ulnaris CSA reflects systemic muscle atrophy in the acute phase of the ICU stay. MethodsTwenty critically ill patients admitted to the ICU underwent serial ultrasound assessment of the biceps brachii and flexor carpi ulnaris CSAs on days 0, 5, 7, and 14 after admission. Longitudinal changes in CSA were analyzed using the Friedman and Wilcoxon signed-rank tests. Correlations between the biceps brachii and flexor carpi ulnaris were examined using Spearmans rank correlation, and structural equation modeling was applied to explore causal relationships between clinical variables and CSA changes. ResultsSignificant CSA reductions were observed in both the flexor carpi ulnaris (-20.6%) and biceps brachii (-16.3%) by day 14, and the relative CSA changes of the biceps brachii and flexor carpi ulnaris showed a moderate positive correlation ({rho} = 0.5489, p = 0.0122). Structural equation modeling analysis revealed that the biceps brachii CSA change had positive effect on that of the flexor carpi ulnaris ({beta} = 0.249, p = 0.0011). Moreover, body mass index was positively associated with the baseline flexor carpi ulnaris CSA ({beta} = 0.042, p = 0.0004). However, the baseline flexor carpi ulnaris CSA was not a significant predictor of subsequent CSA changes. ConclusionUltrasound measurement of the flexor carpi ulnaris CSA offers a practical alternative to that of the biceps brachii for early detection of muscle wasting in ICU patients. Given its anatomical accessibility and high sensitivity to early atrophic changes, it may serve as a feasible screening tool for ICU-acquired weakness and inform timely interventions.

Restoring communication for people with dysarthria secondary to pontine stroke remains a critical challenge. Intracortical brain-computer interfaces (iBCIs) have demonstrated great potential for speech restoration in people with amyotrophic lateral sclerosis (ALS), with 1-24% word error rates (WERs) on a 125,000-word vocabulary. In pontine stroke, electrocorticography (ECoG) BCIs achieved 25.5% WERs with a smaller 1,024-word vocabulary. Whether intracortical BCI performance improvements extend to people with pontine stroke-induced dysarthria remains unclear. Here, we show that neural activity from a single 64-channel microelectrode array in orofacial motor cortex can predict attempted speech in a person with pontine stroke more accurately than prior ECoG BCI work and comparably to prior iBCI work. We trained a neural network decoder to predict phoneme probabilities from spiking rates and spike-band power as BrainGate2 participant T16 mimed (mouthed without vocalization) sentences from a large vocabulary. A series of language models converted these probabilities into word sequences. This decoding architecture has remained stable more than two years post-implantation, achieving a median 19.6% WER with a 125,000-word vocabulary and a median 10.0% WER with a 1,024-word vocabulary (a 60.8% reduction over prior ECoG studies). This framework also generalized beyond cue repetition, enabling T16 to communicate spontaneously via the iBCI in a question-and-answer setting with a 35.2% WER. These results demonstrate that brain-to-text decoding from a small patch of cortex can outperform ECoG-based systems in individuals with pontine stroke and is comparable to early speech iBCIs in individuals with ALS.

Purpose: Human 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. Methods: A 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. Results: Median 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. Conclusions: Stakeholders 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.

INTRODUCTIONConnected speech analyses can help characterize linguistic impairments in primary progressive aphasia (PPA) and classify variants, however, manual transcription of speech samples is time-consuming and expensive. Automated speech recognition (ASR) may be efficacious for transcribing PPA speech. METHODSTranscripts of picture descriptions (109 PPA, 32 healthy controls (HC)) were generated using a manual, automated (Whisper) or semi-automated approach including a quality control (QC) step. We evaluated transcript accuracy, the reliability of ASR-derived linguistic features, and classification performance. RESULTSWhisper demonstrated lowest error rates for HC, followed by semantic, logopenic and non-fluent PPA variants. Errors correlated with overall disease severity for semantic and logopenic variants. QC of Whisper outputs reduced errors and improved the reliability of linguistic features. Overall, ASR-derived features achieved better classification performance than manual transcription features. DISCUSSIONResults support the use of off-the-shelf ASR for scalable, cost-efficient transcription of PPA speech and classification.

BackgroundArtificial Intelligence (AI) based approaches to speech analysis have the potential to assist with objective speech error analysis in aphasia but off-the shelf tools often fail to detect speech errors due to prioritizing "fluent transcription." Speech production errors (dysfluencies) are hallmark diagnostic features of the nonfluent (nfvPPA) and logopenic (lvPPA) variants of primary progressive aphasia, yet they can be challenging to detect and characterize even by expert clinicians. This study aimed to evaluate whether the novel automated lightweight Scalable Speech Dysfluency Modeling system (SSDM-L), specifically designed to detect dysfluencies, could accurately distinguish PPA variants using voice recordings of individuals reading a brief passage. MethodParticipants included a total of 104 individuals, 40 with nfvPPA, 40 with lvPPA (matched on disease severity), and 24 healthy controls who read aloud the Grandfather Passage as part of a widely used motor speech evaluation (MSE). We automatically extracted ten speech error (dysfluency) variables using SSDM-L, including insertions, replacements, and deletions at both phoneme- and word-levels, and phoneme-level prolongations and repetitions. Group differences were assessed via ANCOVAs controlling for age, education, and disease severity (MMSE, CDR sum-of-boxes). To test clinical relevance, we performed correlation analyses with MSE ratings provided by experienced speech-language pathologists (i.e., gold standard) within the nfvPPA group. Classification performance was assessed by training random forest and XGBoost machine-learning models including 5-fold cross-validation. ResultsAll individuals read the entire passage in less than five minutes. SSDM-L detected eight of the ten predefined dysfluency features at sufficient frequency to include them in subsequent analyses. All eight features distinguished PPA from controls (p<.006). Individuals with nfvPPA made more errors than the lvPPA group on every feature (all p<.023). Each feature showed a moderate positive correlation with a global MSE apraxia/dysarthria score (r=.31-.56; p<.001-.053). Together, the eight features were able to classify nfvPPA versus lvPPA at AUC=.806 (random forest) and AUC=.776 (XGBoost). DiscussionAI-based automated speech error analysis accurately distinguished nfvPPA and lvPPA variants using a brief reading task. This quick error-sensitive scalable AI system has the potential of providing a practical tool to aid diagnosis in aphasia and motor speech disorders.

Executive dysfunction affects nearly 50% of individuals with traumatic brain injuries (TBI), yet interventions targeting the underlying neural mechanisms remain limited. This study examined whether aerobic exercise modulates functional connectivity to improve executive function in individuals with mild TBI and identified the neural pathways mediating these improvements. In this secondary analysis of a 12-week pilot randomized controlled trial, participants with mild TBI (n=24) were randomized to aerobic exercise (n=12) or active balance control (n=12). Resting-state fMRI with multivariate pattern analysis revealed that aerobic exercise selectively altered functional connectivity patterns of the anterior cingulate cortex (ACC) compared to balance control. Post-hoc seed-to-voxel analyses identified widespread ACC connectivity differences between groups post-intervention while controlling for baseline, across 19 cortical regions spanning default mode, frontoparietal control, and salience networks. Critically, greater anticorrelation between the ACC and insula following aerobic exercise was associated with improved Trail Making Test B-A performance in the aerobic group ({beta}=46.92, p=0.04) but not the balance group, indicating that participants who developed stronger ACC-insula functional segregation showed greater reductions in executive function completion times. These findings establish the ACC-insula circuit as a critical neural substrate mediating exercise-induced executive function recovery after TBI and identify this pathway as a promising therapeutic target for exercise-based rehabilitation interventions.

Gait impairment (GI) and freezing of gait (FOG) affect 80% of patients with advanced Parkinsons disease. Continuous deep brain stimulation (cDBS) provides limited adaptability to address the episodic nature of FOG due to fixed parameters. Neural biomarkers for adaptive DBS are limited by signal artifacts and poor FOG classification. Wearable inertial measurement units (IMUs) offer a promising alternative by directly measuring signatures of GI&FOG. We developed Kinematic adaptive DBS (KaDBS), the first intelligent system to dynamically modulate stimulation in response to real-time gait metrics. KaDBS integrates bilateral shank-mounted IMUs with an investigational neurostimulator through a wireless architecture enabling step-detection, arrhythmicity calculation, and probabilistic FOG classification. Two control algorithms were implemented: an arrhythmicity model based on stride variability, and a P(FOG) classifier implementing tri-state control based on stepwise freezing probabilities. In the largest KaDBS cohort to date (n=8), we compared OFF, cDBS, KaDBS, and intermittent DBS during harnessed stepping and free walking. KaDBS was safe and well tolerated with no serious adverse events; symptom-free reports were 87.5% and 71.4% for arrhythmicity and P(FOG) models respectively, compared to 50.0% for cDBS. All symptoms were mild, transient, and resolved without intervention. KaDBS significantly reduced percent time freezing versus OFF during stepping-in-place (35.8%, P= 4.80 x 10-3) and free walking (33.4%, p = 9.00 x 10-). Therapeutic effects concentrated in baseline freezers: two participants with 100% time freezing during OFF achieved complete resolution with KaDBS, while non-freezers maintained stable gait. These findings establish KaDBS as a safe, effective approach to personalized neuromodulation for PD.

AbstractsO_ST_ABSBackgroundC_ST_ABSSelf-management is essential for stroke survivors to maintain a healthy lifestyle and reduce recurrence risk. Although theory-based self-management interventions are widely recommended, the theoretical frameworks underpinning them and their comparative effectiveness remain unclear. AimsTo systematically identify the theories, models, and frameworks (TMFs) used in self-management interventions for stroke survivors, to explore how they guide interventions, and evaluate their effectiveness on self-management behaviors and self-efficacy. MethodsPubMed, Embase, Web of Science, ProQuest Health & Medical Collection and the Cochrane Library were searched from inception to July 15, 2025. Randomized controlled trials or quasi-experimental studies evaluating theory-based self-management interventions for stroke survivors were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias (Cochrane RoB 2.0). Meta-analyses were performed using random-effects models. ResultsFrom 11,495 records, 32 studies with 3,212 participants were included. Sixteen distinct TMFs were identified; self-efficacy theory was most frequent (13/32), followed by social cognitive theory (6/32). All TMFs were middle-range theories. Meta-analysis showed TMFs-based interventions significantly improved self-management behaviors (SMD = 4.26, 95%CI: 0.20-8.31, I{superscript 2} = 98.2%) and self-efficacy (SMD = 0.60, 95%CI: 0.32-0.88, I{superscript 2} = 72.8%). However, the effect for behaviors is likely inflated due to extreme heterogeneity and theoretical diversity. Theory-specific analysis of self-efficacy theory (k = 8) confirmed significant effects on self-efficacy (SMD = 0.64, 95%CI: 0.21-1.08). ConclusionsThis review identified 16 distinct theoretical models; self-efficacy theory was most frequently applied, followed by social cognitive theory. Theory-based interventions significantly improved self-management behaviours and self-efficacy.

Neurological health score (NHS), indicating the health of brain and nervous system, helps in identifying high risk individuals, and in recommending lifestyle modifications. In the present study, we developed NHS based on genetic, lifestyle and biochemical variables associated with eight neurological disorders - dementia, stroke, Parkinsons disease, amyotrophic lateral sclerosis, schizophrenia, bipolar disorder, multiple sclerosis and migraine. UK Biobank data from Caucasian individuals was used to develop the model, and the data from individuals of Indian ethnicity was used to validate the model. Logistic regression and XGBoost algorithms were used in selecting the significant variables for the disorders. NHS developed from the selected variables was found to be very significant after adjusting for age and sex (AUC:0.6, OR: 0.95). Higher NHS was associated with a lower risk of neurological disorders and better social well-being. Highest NHS group (top 25%) showed 1.3 times lower risk compared to the rest of the individuals. Results of our study help in developing a framework for quantifying the neurological health in clinical setting.