Frontiers in rehabilitation sciences最新文献

{"title":"Feasibility and safety of a 6-month outpatient rehabilitation program combining therapeutic electrical stimulation using belt electrodes and nutritional management in patients with rheumatoid arthritis: a pilot study.","authors":"Norikazu Hishikawa, Shogo Toyama, Koshiro Sawada, Suzuyo Ohashi, Yasuo Mikami","doi":"10.3389/fresc.2026.1920901","DOIUrl":"10.3389/fresc.2026.1920901","url":null,"abstract":"<p><strong>Background: </strong>Although resistance training with nutritional intervention is recommended for sarcopenia, effective programs are often difficult to implement in patients with rheumatoid arthritis (RA). This pilot study aimed to assess the feasibility and safety of a 6-month outpatient rehabilitation program combining therapeutic electrical stimulation (TES) using belt electrodes with nutritional management in patients with RA.</p><p><strong>Methods: </strong>This pilot study was conducted as a prospective observational study with a single-arm before-after framework and enrolled outpatients with RA in remission or with low disease activity. Participants received an outpatient rehabilitation program as part of routine clinical practice once or twice weekly over 6 months, including TES applied to the lower limbs using belt electrodes (20 min per session; 20 Hz; maximum tolerable intensity) and the daily intake of an L-leucine-enriched protein-containing nutritional supplement. Feasibility and safety were evaluated based on study completion, TES session frequency, verbally confirmed adherence to nutritional supplementation, adverse events documented during the program, and maintenance of disease activity. Lower-limb lean mass, knee extensor muscle strength, and gait speed were assessed as exploratory clinical outcomes at baseline and after 6 months.</p><p><strong>Results: </strong>Of the 14 recruited outpatients with RA, 10 completed both the 6-month program and the final outcome assessment, corresponding to a study completion rate of 71.4%. Participants received a median of 34.5 TES sessions over 6 months. As exploratory clinical outcomes, the median paired changes in lower-limb lean mass, knee extensor muscle strength, and gait speed were 0.08 kg (95% confidence interval [CI], 0.00 to 0.25; <i>P</i> = 0.043), 1.58 kgf (95% CI, -0.35 to 7.25; <i>P</i> = 0.084), and 0.18 m/s (95% CI, -0.04 to 0.24; <i>P</i> = 0.084), respectively. Disease activity remained within the low disease activity to remission range and did not significantly change during the 6-month observation period (<i>P</i> = 0.214). No joint-related or cardiovascular adverse events were documented.</p><p><strong>Conclusions: </strong>This pilot study provides preliminary information on the feasibility and safety of a 6-month outpatient rehabilitation program combining TES using belt electrodes and nutritional management in patients with RA. These findings may inform the design of future studies.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1920901"},"PeriodicalIF":2.5,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do patients give a damn? An exploratory study of patient perspectives on clinician swearing during physical rehabilitation.","authors":"Andrew Mercer, Adam Meakins, Roxanne St Martin, Garrett Trummer, Libbi Geoghagan, Kara Muscha, Nicholas B Washmuth","doi":"10.3389/fresc.2026.1719743","DOIUrl":"10.3389/fresc.2026.1719743","url":null,"abstract":"<p><strong>Background: </strong>Swearing is a common linguistic tool associated with positive benefits. In healthcare, however, the impact of clinician swearing on patients remains unclear. This exploratory study investigated patients' lived experiences with clinicians who swore and examined patient perspectives on when clinician swearing is perceived as appropriate or inappropriate.</p><p><strong>Method: </strong>A cross-sectional, mixed methods, retrospective study was conducted with physical rehabilitation patients (<i>N</i> = 57). Patients completed an <i>ad hoc</i> survey assessing experiences, perceptions, and attitudes toward clinician swearing. Logistic regressions tested whether clinician swearing frequency predicted the following patient reported outcomes: motivation, self-confidence, and treatment adherence. Linear regressions evaluated whether clinician swearing frequency predicted: professionalism, patient-centeredness, offensiveness, and ability to enhance the rehabilitation experience. Qualitative responses were analyzed using cognitive network analyses.</p><p><strong>Results: </strong>Thirty-one patients (54.39%) reported that their clinician swore during treatment. Among these, most indicated swearing increased motivation (61.13%), improved self-confidence (58.06%), and supported adherence (51.61%). Patients generally agreed that swearing was patient-centered (54.84%) and improved the rehabilitation experience (64.52%), while no patients stated the swearing was unprofessional or offensive. When swearing frequency was dichotomized into high vs. low, patients in the high-frequency group reported greater motivation, self-confidence, and adherence compared to the low-frequency group, though confidence intervals included null effects. However, the small sample size limited statistical power; therefore, these nonsignificant findings should be interpreted cautiously. High-frequency swearing was associated with higher ratings of patient centeredness [<i>B</i> <i>=</i> -1.00, 95% CI (-1.95, -0.05), <i>p</i> = 0.04]. Qualitative findings indicated swearing was considered appropriate when used to build rapport, comfort, or motivate, and inappropriate with young or older patients, when directed at rather than with patients, or during serious discussions.</p><p><strong>Conclusion: </strong>Due to the study's limitations, the findings should be interpreted with caution. Most patients who experienced clinician swearing reported neutral to positive outcomes, suggesting swearing may enhance aspects of rehabilitation. Patients emphasized that appropriateness depends on context, relationship, and patient characteristics, suggesting that swearing may be a potentially effective communicative tool best applied with sensitivity.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1719743"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond rehabilitation: toward developmental and trans-sectoral systems of support for complex acquired brain injury in children.","authors":"Christiaan Gmelig Meyling, Sandra Bakker, Marike Reinders, Jeanine Voorman, Bas Oude Ophuis, Geeke Blenk, Hannemieke van der Lei, Marjolijn Ketelaar, Mireille Donkervoort, Jan Willem Gorter","doi":"10.3389/fresc.2026.1936032","DOIUrl":"10.3389/fresc.2026.1936032","url":null,"abstract":"<p><p>Pediatric acquired brain injury (ABI) can disrupt developmental trajectories across physical, cognitive, behavioral, emotional, and social domains. While rehabilitation pathways typically focus on recovery during the acute and subacute phases, many children and youth experience persistent or emerging difficulties long after formal rehabilitation treatment has ended. These difficulties may become more visible as developmental, educational, and social demands change, particularly during transitions across childhood and adolescence. Current systems, however, are often organized around sector-specific and time-limited models of service, resulting in fragmented support across healthcare, education, children and youth services, and settings. In this Perspective Paper, we introduce 'pediatric ABI with complex consequences' (ABI+) to draw specific attention to children and youth with ABI whose support needs in the community extend beyond acute care and sub-acute conventional rehabilitation pathways. ABI + is not proposed as a new diagnostic category, but as a vulnerable population as a result of ongoing dynamic interaction between neurological injury, child development, family functioning, and environmental factors over time. We argue that pediatric ABI rehabilitation should move from a phase-based, healthcare-centered model toward a developmental and trans-sectoral system of support. To illustrate this perspective, we describe the Dutch Pediatric ABI Network (Netwerk Kind & NAH), an integrated national network connecting community-based support, multidisciplinary expertise, research, policy, and lived-experience. Drawing on initial lessons learned from the development of this network, we aim to offer transferable insights that may inform the design of integrated systems supporting recovery, participation, and family functioning throughout the developmental course of children and youth with ABI.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1936032"},"PeriodicalIF":2.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reference ranges and dimensional structure of upper body posture parameters in adults: a cross-sectional study.","authors":"Lianhua Yin, Chendong Ruan, Xiaojin Zhuang, Lijuan Wu, Xuling Ni, Jing Tao, Lidian Chen","doi":"10.3389/fresc.2026.1930857","DOIUrl":"https://doi.org/10.3389/fresc.2026.1930857","url":null,"abstract":"<p><strong>Background: </strong>Upper body posture assessment using surface topography can support population-level screening, but adult reference data for these parameters remain limited, restricting clinical interpretability. This study aimed to establish reference ranges for upper body posture parameters in adults and characterize their underlying dimensional structure.</p><p><strong>Methods: </strong>This cross-sectional study analyzed DIERS three-dimensional surface topography data from 1,859 adults (mean age 46.9 ± 11.9 years; 52.7% male). Descriptive statistics were generated for 45 DIERS-derived parameters spanning six measurement domains. Participants were classified into three screening categories of scoliotic posture, scoliosis risk, and unclassified, based on pelvic obliquity, vertebral rotation, and apical vertebral deviation. Group differences by age, sex, and screening category were examined using ANOVA and <i>t</i>-tests with false discovery rate correction; effect sizes were quantified with <i>η</i> ² and Cohen's <i>d</i>. Exploratory graph analysis (EGA) with 1,000-iteration bootstrap validation identified the dimensional structure of the retained parameters.</p><p><strong>Results: </strong>The screening category distribution was scoliotic posture 35.9%, scoliosis risk 5.8%, and unclassified 58.4%, with no significant variation by age or sex. Sex-related differences were pronounced: 13 of 31 significantly different parameters showed large effects (Cohen's <i>d</i> ≥ 0.80), concentrated in distance measurements, postural reference points, spinal curve angles, and shoulder parameters. Age-related between-group differences were observed across multiple parameters, but effect sizes were predominantly trivial to small (<i>η</i> ² < 0.06). EGA identified a stable five-dimension structure (bootstrap support: 98.5%): trunk size and segmental length, coronal deviation and axial rotation, sagittal spinal structure and postural balance, upper-body angular asymmetry, and pelvic asymmetry.</p><p><strong>Conclusions: </strong>This study established adult population reference ranges for upper body posture parameters derived from surface topography. The analysis revealed pronounced sex-related differences, suggesting that sex-stratified reference values may be more appropriate for clinical interpretation. Five distinct dimensions of upper body posture parameters were identified, indicating that future research should consider coordinated changes across multiple anatomical structures. Together, these findings provide a quantitative basis for interpreting surface topography results in health management and scoliosis screening.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1930857"},"PeriodicalIF":2.5,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662147/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing is everything: the effect of measurement timing on trailing limb angle in gait analysis.","authors":"Sally Kenworthy, Stacey Gorniak","doi":"10.3389/fresc.2026.1897235","DOIUrl":"https://doi.org/10.3389/fresc.2026.1897235","url":null,"abstract":"<p><strong>Introduction: </strong>Progress towards a meaningful clinical measure of propulsion has been achieved through the trailing limb angle, which describes the position of the trailing limb at the time of peak propulsion. However, variations in the timing of the calculation could limit its clinical translation. The purpose of this study was to compare commonly used approaches to trailing limb angle measurement.</p><p><strong>Methods: </strong>Nineteen middle-aged adults (mean age [SD]: 56.42 [4.14]) without impairment completed three-dimensional gait analysis while walking on an instrumented split-belt treadmill. Propulsion was defined as the anterior component of the ground reaction force. Peak trailing limb angle was calculated and compared to the angle measured at the time of peak propulsion. Heel strike and toe-off timing were calculated to describe the time of peak propulsion relative to key gait events. Kinematics of the trailing and leading limb hip, knee, and ankle joints were also calculated.</p><p><strong>Results: </strong>Peak propulsion occurred at 47.50% of the gait cycle, just before contralateral heel strike (49.99%). Peak trailing limb angle (22.77°) was statistically significantly larger than its value when measured at peak propulsion (16.08°, <i>P</i> < 0.001), regardless of the distal landmark used for calculation. Peak trailing limb angle occurred just after (.50%) toe off, a statistically significant difference (<i>P</i> < 0.05).</p><p><strong>Discussion: </strong>Our findings challenge the assumption that peak trailing limb angle is equivalent to the trailing limb angle measured at peak propulsion. Calculation methods should reflect this critical distinction to ensure methodological consistency in both research and clinical settings.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1897235"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of group and individual therapy in physiotherapy, occupational therapy, and speech therapy: a systematic review.","authors":"Michael Minor, Elisabeth Plath, Carsten Volland, Silke Neusser, Anna Bußmann","doi":"10.3389/fresc.2026.1904321","DOIUrl":"https://doi.org/10.3389/fresc.2026.1904321","url":null,"abstract":"<p><strong>Introduction: </strong>This review aimed to determine the effects of (digital) group therapies in comparison to individual therapies within physiotherapy, occupational therapy, and speech therapy.</p><p><strong>Methods: </strong>Embase, PubMed and Web of Science were searched until May 2025. RoB 2 and GRADE were used to rate the risk of bias and the certainty of the evidence. Mean differences were used to analyze differences between group and individual therapy.</p><p><strong>Results: </strong>Eleven studies were included in this review (eight of physiotherapy, two of speech therapy, and one of occupational therapy). The studies cover various diseases and exhibit a high degree of heterogeneity in interventions and outcomes. For 67 of the 76 outcomes, no significant differences were reported between group and individual therapy post-intervention. Group therapy showed better results in five outcomes, individual therapy showed better results in four outcomes. Three studies raised some concerns, and eight studies showed a high overall risk of bias. Certainty grading was (very) low for all outcomes.</p><p><strong>Discussion: </strong>This review found no clear evidence favoring either group or individual therapy in therapeutic services. The evidence's derivation from heterogeneous low-quality studies with small sample sizes necessitates a careful interpretation of the results. Further research is needed to validate these findings.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1904321"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the biomechanical mechanisms of neuromuscular joint facilitation intervention in patients with knee osteoarthritis: a finite element analysis.","authors":"Yu Qu, Hualong Xie, Peipei Wang, Xin Zhang, Shan Liu, Ming Huo","doi":"10.3389/fresc.2026.1945210","DOIUrl":"https://doi.org/10.3389/fresc.2026.1945210","url":null,"abstract":"<p><strong>Introduction: </strong>Knee osteoarthritis (KOA) causes joint pain and gait disorders in older adults. Exercise is an effective non-pharmaceutical therapy. Neuromuscular joint facilitation (NJF) improves knee joint function by combining neuromuscular facilitation with intra-articular joint motion; however, its biomechanical mechanism remains unclear. Finite element analysis, the mechanisms by which two NJF movement patterns-knee extension with lateral tibial rotation and knee flexion with medial tibial rotation-affect the stress distribution on the meniscus and major ligaments in patients with KOA.</p><p><strong>Methods: </strong>Six KOA patients were recruited. Inertial motion capture and handheld dynamometer measured tibial rotation angles and force conditions: active knee extension/flexion (AKE/AKF) pattern, distally single-resisted knee extension and flexion (DKE/DKF) pattern, and NJF technique (double-resisted movement). A knee finite-element model was built from one subject's CT/MRI. Loaded parameters were used to analyze the stress distribution characteristics of the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior/posterior cruciate ligament (ACL/PCL), and medial/lateral menisci at flexion angles of 0°, 30°, 60°, and 90°.</p><p><strong>Results: </strong>Knee rotation ICCs from inertial motion capture were all >0.75 (<i>P</i> < 0.05). In the knee flexion-medial tibial rotation pattern, at all flexion angles, meniscal stress was highest during AKF and lowest during NJF; conversely, ligament stress was lowest during AKF and highest during NJF. In the extension-lateral tibial rotation mode, meniscal stress was highest during AKE and lowest during NJF, whereas ligament stress changes were angle-dependent. The NJF technique can produce a traction effect along the long tibial axis by coordinating proximal and distal tibial resistances. This applies a force of approximately 30° to the long axis of the tibia, thereby reducing the load within the joint capsule.</p><p><strong>Discussion: </strong>The NJF technique can redistribute load between the meniscus and ligaments in this subject-specific finite element model, reducing peak meniscal load while moderately increasing ligament mechanical stimulation. These computational findings suggest a distinctive biomechanical profile of NJF compared with traditional resistance training in this subject-specific model. This provides a preliminary theoretical basis for future research, but the clinical relevance of these biomechanical observations requires confirmation through prospective clinical trials.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1945210"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Pathological similarities between degenerative enthesopathy and rheumatic enthesitis: the role of ECM stiffness and Wolff's Law-based mechanical stimulation as a therapeutic strategy.","authors":"Kang Ahn, Aerisa Ahn, Seung Jun Oh, Hyun Sung Kim","doi":"10.3389/fresc.2026.1999671","DOIUrl":"https://doi.org/10.3389/fresc.2026.1999671","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/fresc.2026.1716050.].</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1999671"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal rehabilitation for hard flaccid syndrome in a retrospective case series.","authors":"Christopher L Mendias, Tariq M Awan","doi":"10.3389/fresc.2026.1970062","DOIUrl":"https://doi.org/10.3389/fresc.2026.1970062","url":null,"abstract":"<p><strong>Introduction: </strong>Hard flaccid syndrome (HFS) is an emerging condition of male sexual dysfunction characterized by a persistent semi-rigid penis in the flaccid state, altered penile sensation, erectile dysfunction, and pelvic or perineal pain. Single-modality treatments have shown limited success, and multimodal protocols have been reported only in single-patient case studies.</p><p><strong>Aim: </strong>To describe clinical outcomes associated with completion of an integrative multimodal rehabilitation protocol in a retrospective case series of men with HFS.</p><p><strong>Methods: </strong>Thirty-two men with HFS completed a comprehensive protocol combining class IV laser therapy, dry needling, radial pressure wave shockwave therapy, therapeutic ultrasound, biofeedback training, manual therapy, therapeutic exercise, behavioral coaching, and daily oral tadalafil. Patient-reported outcomes were collected at treatment initiation and completion.</p><p><strong>Outcomes: </strong>Erection Hardness Scale (EHS), penile function satisfaction, PROMIS Interest in Sexual Activity, and PROMIS Global Health Physical and Mental Component scores.</p><p><strong>Results: </strong>Median EHS increased from 2 to 4 and median penile satisfaction increased from 2 to 5 (both <i>P</i> < 0.01). All 32 patients achieved EHS ≥3 by treatment end, compared to 8 of 32 (25%) at baseline. PROMIS Interest in Sexual Activity, Global Physical Health, and Global Mental Health scores all improved significantly (<i>P</i> < 0.01). Common comorbid features included low back pain (53%), hip or groin pain (38%), pelvic floor pain (31%), and urinary symptoms (28%).</p><p><strong>Discussion: </strong>In this retrospective case series, completion of a multimodal rehabilitation program was associated with improvements in erection hardness, penile satisfaction, sexual interest, and global health in men with HFS. These hypothesis-generating findings warrant prospective controlled studies evaluating efficacy, durability, and component-specific effects.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1970062"},"PeriodicalIF":2.5,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining cerebral palsy: diagnostic boundaries based on the functional maturation of corticospinal motor control.","authors":"Huaifeng Sun","doi":"10.3389/fresc.2026.1936873","DOIUrl":"10.3389/fresc.2026.1936873","url":null,"abstract":"<p><strong>Background: </strong>The 2006 international consensus defines cerebral palsy as a permanent disorder of movement and posture caused by non-progressive brain injury in the developing fetus or infant, yet it sets no upper age limit for the injury; in practice, countries adopt arbitrary chronological-age cut-offs, most commonly 24 months, without any neurobiological basis, and the 2025-2026 updated descriptions, although shifting toward a broader \"description,\" retain the same temporal framework and provide no operational diagnostic boundary.</p><p><strong>Core hypothesis: </strong>The diagnostic essence of cerebral palsy lies not in the chronological age at injury but in whether the injury occurs before the functional maturation threshold of corticospinal motor-control integration in the corresponding functional domain, producing a persistent deviation of that domain's motor developmental trajectory; the gross-motor domain is marked by stable independent walking and the fine-motor domain by accurate pincer grasp as an exploratory extension.</p><p><strong>Theoretical framework: </strong>Stable independent walking is the behavioural read-out of the first functional integration of spinal central pattern generators, brainstem postural control, vestibulo-cerebellar integration, and cortical descending modulation, with the corticospinal system as the final common pathway, so the framework applies to all motor subtypes; a four-criterion scheme justifies marker selection, and a complete operational definition is provided with velocity- and pattern-deviation domains, domain-specific criteria, and a stepwise diagnostic algorithm.</p><p><strong>Testable inferences: </strong>Stratification by integrative-maturation status is predicted to outperform chronological-age stratification in forecasting motor outcomes, with explicit falsification criteria and a multicentre prospective validation roadmap.</p><p><strong>Conclusions: </strong>Replacing the chronological-age criterion with the integrative-maturation status of each functional domain resolves the longstanding diagnostic ambiguity between cerebral palsy and other static motor impairments; all quantitative thresholds are theoretical working benchmarks pending calibration by multicentre prospective cohort studies.</p>","PeriodicalId":73102,"journal":{"name":"Frontiers in rehabilitation sciences","volume":"7 ","pages":"1936873"},"PeriodicalIF":2.5,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}