Cancer cachexia affects up to 80% of patients with advanced cancer. While exercise has shown benefits for early-stage cancer patients, its role in managing cachexia remains unclear. This study examined whether severe weight loss impedes the benefits of exercise in cancer patients. This prospective study analyzed the feasibility and efficacy of a 12-week supervised exercise program in cancer patients with BMI-adjusted weight loss grades 3-4. Feasibility was the primary outcome and was evaluated through attrition, attendance, and safety, while secondary outcomes included changes in nutritional status, physical performance, exercise levels, and fatigue. Outcomes were compared with those of matched cancer patients without advanced BMI-adjusted weight loss who followed the same exercise program. Twenty-three patients with BMI-adjusted weight loss grades 3-4 were enrolled and 14 completed the program, attending an average of 17.1 ± 4.3/24 sessions. No adverse events occurred. Intervention improved endurance (+7.06% of theoretical 6MWT distance, p < 0.001). Positive trends emerged for lower limb strength (+2.69 repetitions at 30-s sit-to-stand test, p = 0.005), lean mass (+1.78kg, p = 0.003), and dietary intake (+ 2.5/10 SEFI, p = 0.003). Functional benefits were also observed in patients without weight loss (n = 14, endurance = +11.33%, lower limb strength = +4, p < 0.001). The exercise intervention demonstrated promising efficacy in managing cancer weight loss, providing benefits like those observed in non-cachectic patients, with added gains in nutritional status. While no exercise-related adverse events occurred, feasibility criteria were only partially met due to a higher-than-expected attrition rate. Further research is needed to optimize recruitment strategies, energetic balance, and tailor interventions for this population. The study is registered on ClinicalTrial.gov (Trial registration: NCT06651125).

Virtual reality (VR) has been increasingly adopted as a digital tool in rehabilitation for balance training, coordination improvement, and motor recovery, yet the literature remains dispersed across clinical rehabilitation, exercise-based interventions, and broader motor-related applications. This fragmentation makes it difficult to determine how the field has evolved and where research emphasis has shifted. This study mapped the research landscape and thematic evolution of VR for balance, coordination, and motor rehabilitation using bibliometric analysis and topic modeling. A total of 1258 articles indexed in the Web of Science Core Collection from 2011 to 2025 were analyzed. Only English language articles and reviews relevant to VR-based balance, coordination, or motor rehabilitation research were included, yielding a final dataset of 1258 publications. CiteSpace and VOSviewer were used to examine keyword co-occurrence, clustering patterns, and temporal trends, while Latent Dirichlet Allocation (LDA) was applied to identify latent themes and their temporal dynamics. The field has moved beyond early feasibility testing toward a more differentiated landscape shaped by distinct clinical targets, population groups, and training purposes. Seven recurring themes were identified, including vestibular rehabilitation and immersive training, post-stroke upper-limb rehabilitation, efficacy and adverse-effect assessment, balance and gait training interventions, evidence synthesis and review-based evaluation, elderly exercise and cognitive interventions, and skill-oriented virtual task training with recent expansion toward broader population groups and task-specific applications beyond traditional rehabilitation settings. VR research on balance, coordination, and motor rehabilitation has evolved into a more thematically differentiated field rather than remaining a single rehabilitation-oriented domain. By combining bibliometric mapping with topic modeling, this study clarifies where evidence is concentrated and which thematic directions are gaining visibility, providing a clearer basis for future evidence synthesis and more comparable intervention reporting.

BACKGROUND: Falls among older adults are a major public health concern, with an estimated 5,000 deaths annually. Individuals with type 2 diabetes (T2D) may have a greater risk of falls due to complications, but it is unclear if participation in a community fall prevention program reduces this risk compared to individuals without T2D. OBJECTIVES: To examine whether individuals with T2D have a higher fall risk than those without T2D when participating in a community-based fall prevention exercise program. METHODS: This secondary analysis included 143 participants in Zoomers in Balance, a peer-led exercise program that challenge balance, offered 3 times per week for 48 weeks, in person or online. Inclusion criteria were &gt; 12 weeks of participation and completion of all questionnaires at baseline and at 1-year follow-up. The primary exposure was the Zoomers in Balance intervention. The primary outcome was self-reported falls at baseline and 1-year follow-up. T2D status was also self-reported. RESULTS: Of 143 participants (97% female; mean age 66.6 +/- 6.6 yrs), 14.0% (n=20) had T2D. At baseline, falls were reported by 42.8% of individuals with T2D and 59.7% without T2D (p&lt;0.001). At 1-year follow-up, falls decreased to 25.0% in T2D and 39.7% in non-T2D groups (p&lt;0.001), with within-group changes for individuals with T2D p=0.06 and without T2D p=0.31. Logistic regression adjusted for confounders revealed no significant association between T2D status and fall risk at baseline (OR: 0.70 (0.25-1.97; p=0.502)) or 1-year follow-up (OR: 0.62 (0.19-2.00; p=0.427)). DISCUSSION: Individuals living with T2D are participating in a community fall prevention program. Participation in a community fall prevention program reduced falls among older adults, including those with T2D. Although not statistically significant, the 17.8% reduction in falls among individuals with T2D supports promoting group-based fall prevention programs for all older adults.

This article explores the theoretical foundations and historical perspectives of fiscal policy, emphasizing its role in economic stabilization and the management of economic cycles. It traces the evolution of economic ideas, from classical orthodoxy, focused on strict budgetary balance and limited state intervention, to the Keynesian revolution, which positioned fiscal policy as a strategic tool for influencing aggregate demand. The article also examines the main instruments of fiscal policy, including public spending, taxation, and debt, while detailing their effectiveness and limitations in various economic contexts. Finally, particular attention is given to automatic stabilizers and fiscal approaches specific to developing countries, highlighting the importance of balanced management to achieve sustainable growth and macroeconomic stability.

Introduction: Diabetes Mellitus (DM) is a chronic metabolic disorder characterised by persistent hyperglycaemia, which leads to systemic complications affecting the musculoskeletal and nervous systems. This contributes to lower limb weakness, sensory deficits, and impaired postural control, thereby increasing the risk of falls. While most balance assessments focus on anticipatory control. Reactive balance is critical for responding to sudden disturbances, which is often overlooked. The Balance Evaluation System Test (BESTest) includes a reactive balance component, making it a suitable tool for this purpose. Aim: To evaluate the impact of lower limb muscle strength on forward reactive stepping in diabetic and non diabetic patients. Materials and Methods: A cross-sectional study was conducted among 46 diabetic (aged 45-60 years, diabetes duration 3-5 years) and 46 non diabetic individuals in the Department of Endocrinology and Physiotherapy Outpatient Department (OPD) Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India, from February 2025 to April 2025. Diabetic neuropathy patients were excluded using the Diabetic Neuropathy Symptom Score. Handheld Dynamometer (HHD) was used to measure the strength of hips abductors, knee extensors and ankle plantar flexors. Forward reactive stepping was assessed through the compensation stepping correction component of the BESTest, and parameters like First Step Length (FSL) and First Step Time (FST) were analysed using Tracker 6.1.3 software. Pearson’s correlation and Independent t-tests were applied. Effect sizes were reported. Statistical significance was set at p-value&lt;0.05. Results: In diabetic participants, muscle strength showed no significant correlation with FSL but demonstrated moderate negative correlations with FST (r-value=-0.448 to -0.548, p-value &lt;0.001). In non diabetic participants, weak positive correlations were found between muscle strength and FSL (r-value=0.285– 0.350), and moderate negative correlations were found with FST (r-value=-0.331 to -0.560). Between-group comparisons showed significant differences in correlations, suggesting diabetes influences the strength- balance relationship. Conclusion: In diabetic individuals, lower limb muscle strength alone may not significantly influence reactive balance, likely due to sensory or neuromotor impairments. Thus, effective balance interventions should include components beyond strength training.

Influence of limb dominance on compensatory foot contacts during unilateral standing in adults with reduced plantar sensation.

Postural balance is a foundational component of human motor behavior, yet it remains conceptually ambiguous and methodologically heterogeneous across the clinical, educational, and sport sciences. This narrative review aims to provide an integrative framework that clarifies key concepts (postural control vs. postural balance), synthesizes the main sensorimotor and biomechanical mechanisms underpinning balance, and organizes current assessment approaches and functional implications across populations. Narrative literature synthesis was conducted to integrate evidence covering multisensory integration and sensory reweighting, central neural control (spinal, brainstem, cerebellar, and cortical contributions), neuromuscular and biomechanical strategies (e.g., ankle/hip/stepping), and cognitive influences (e.g., dual-task effects). We further summarize commonly used instrumental outcomes derived from force-platform center-of-pressure metrics and widely adopted clinical and functional balance tests, highlighting their typical applications and limitations across the lifespan including pediatric, general adults, older adults, and athletic populations. This review proposes a closed-loop, systems-based model in which postural balance is conceptualized as an emergent functional outcome arising from distributed postural control processes shaped by task, environmental, and individual constraints. In conclusion, integrating mechanistic understanding with population-specific assessment enhances interpretability and supports more precise, context-sensitive balance evaluation and intervention in both health and performance settings.

Evaluating the sound magnetic balance intervention in a randomized controlled trial: Effects on psychological distress, somatic pain, and physiological arousal.

Late effects of chemotherapy in older breast cancer (BC) survivors remain understudied. We evaluated the long-term impact of taxane chemotherapy on patient-reported neuropathy, balance problems, and falls among older BC survivors. Using Texas Cancer Registry-Medicare linked data, BC survivors age 65 years or older at diagnosis, with local or regional disease diagnosed between 2012 and 2013 were identified. Survivors completed questionnaires including patient-reported outcomes and clinical characteristics between April 2018 and October 2019. Rao-Scott chi-square tests and multivariable logistic regression models evaluated associations between taxane chemotherapy and neuropathy in the past 7 days, and balance problems and fall outcomes in the past 12 months. Among 1,493 BC survivors, the majority were non-Hispanic White (80.8%), had hormone receptor-positive BC (78.1%), and had localized disease (75.6%). 26.5% received chemotherapy, and 89% of those received a taxane. Survivors who received chemotherapy were more likely to report neuropathy (61.8% v 36.0%, P < .01). Those who received paclitaxel had worse neuropathy than survivors treated with docetaxel (73.3% v 55.7%, P < .01). Although taxane use was not significantly associated with falls (adjusted odds ratio [aOR], 1.2 [95% CI, 0.83 to 1.64]), those treated with a taxane were more likely to report balance problems than those who did not receive chemotherapy (aOR, 1.6 [95% CI, 1.13 to 2.24]). Although Black BC survivors were more likely to report neuropathy (aOR, 1.8 [95% CI, 1.10 to 3.07]), Hispanic (aOR, 1.5 [95% CI, 1.01 to 2.31]) survivors were more likely to receive a provider intervention to prevent falls or treat balance problems relative to White survivors. Older BC survivors who received taxane chemotherapy were more likely to report neuropathy and balance problems but not falls. Future research should evaluate effective fall prevention and balance interventions in this population.

Background: Children with Autism Spectrum Disorder (ASD) frequently present with postural and balance impairments. Physical therapy interventions focused on these balance and posture deficits are crucial for increasing functional independence and improving social participation among autistic children. Objective: The objective of this narrative review is to synthesize controlled intervention literature from the past five years, 2020–2025 (1-5) regarding balance training for autistic children and youth focusing on Center of Pressure (CoP) metrics as outcome variable. Methods: A total of 5 controlled trials, including randomized controlled trials and quasi-experimental designs, were included in this narrative review analysis. Findings: Multiple balance focused interventions including psychomotor programs, virtual reality, short session of hippotherapy and therapeutic horseback riding showed consistent improvement in CoP measures and other parameters associated with posture and balance in children and youth with autism. Conclusion: Structured, individualized balance intervention programs support autistic population in their balance improvement and rehabilitation. Despite the positive correlation seen in all these experiments, study heterogeneity and limited number of strictly experimental studies focused on CoP metrics for postural sway in autistic children in the given time period are clear limitations which must be considered for future studies.

Pulmonary Arterial Hypertension (PAH) is a significant comorbidity that can complicate the care of patients in the Intensive Care Unit (ICU). PAH's hemodynamic burden and systemic effects add complexity to managing fluid balance, ventilatory support, and other critical care interventions. This study aims to investigate the impact of fluid balance in ICU patients with PAH. We conducted a retrospective cohort study using the MIMIC-IV v3.1 database. Patients with diagnosed PAH (ICD-9: 4160; ICD-10: I270) and complete ICU records were included. Exclusions were applied for missing data, duplicate ICU stays, and secondary causes of pulmonary hypertension. An initial cohort of 178 patients was identified. Further data validation led to a final cohort comprising 102 patients. Analyses were conducted in Google BigQuery and Python-based tools (Google Colab). Among 102 patients, 77 (75.4%) had a positive fluid balance, and 25 (24.5%) had a negative balance. Positive fluid balance was associated with higher ICU mortality (14.49% vs. 5.88%), shorter ICU stays (2.29 vs. 3.06 days), and a 74% increase in ICU mortality odds (OR: 1.74, 95% CI: 1.10-2.85). The lowest ICU mortality was seen in patients with net fluid balance between -2000 mL and +2000 mL. Severely positive balance (>+5000 mL) was associated with the highest ICU mortality (19%) and longest ICU LOS (6.16 days). This study highlights the critical importance of fluid balance in PAH patients, a population uniquely susceptible to right ventricular failure. The findings suggest that even modest positive fluid balance may worsen outcomes, supporting prior physiologic models linking volume overload to RV dysfunction. While limited by retrospective design and lack of hemodynamic data, the results underscore the potential benefit of individualized fluid strategies and the selective use of advanced monitoring. Further prospective research is needed to define safe fluid thresholds and guide therapy in this high-risk group. Our findings suggest that both excessive positive and severe negative fluid balance may be detrimental in ICU patients with PAH. A moderate fluid balance range (-2000 mL to +2000 mL) showed the most favorable outcomes.

Previous research has documented time use patterns among mothers of children with disabilities, but few studies have examined how time allocation across specific occupational domains influences perceived time deficiency. Understanding this relationship is important for developing interventions to support these mothers' well-being and occupational balance. This study is aimed at investigating differences in mothers' time use across occupational domains based on whether their child has a disability and examining how time allocation affects perceived time deficiency. This study included 210 mothers (105 with children with disabilities and 105 with typically developing children) residing in Seoul, Gyeonggi, and Incheon, South Korea. Participants completed 24-h time diaries, which were categorized according to the Occupational Therapy Practice Framework (fourth edition). Data were analyzed using independent samples t-tests, Pearson's correlation analysis, and multiple linear regression. Mothers of children with disabilities spent significantly more time on instrumental activities of daily living (IADLs) than mothers of typically developing children (512.57 vs. 363.90 min, p < 0.001), particularly in child rearing (235.52 vs. 76.67 min, p < 0.001) and healthcare system communication (20.38 vs. 3.05 min, p < 0.001). Conversely, they spent less time on activities of daily living (ADLs) (142.76 vs. 165.52 min, p < 0.01) and work (67.05 vs. 208.10 min, p < 0.001). Mothers of children with disabilities reported significantly higher levels of time deficiency (3.09 ± 0.67 vs. 2.61 ± 0.75, p < 0.001). Among mothers of children with disabilities, increased time spent on ADLs significantly reduced time deficiency (B = -0.004, p < 0.001), whereas IADL time showed a positive but nonsignificant association with time deficiency. Mothers of children with disabilities experience occupational imbalance characterized by substantially increased caregiving demands and reduced personal care time, leading to heightened time deficiency. These findings highlight the need for caregiver support services and occupational balance interventions to improve these mothers' quality of life and well-being.

ObjectiveThis study aimed to assess the impact of combining stroboscopic visual training (SVT) with balance training on balance performance and self-reported ankle stability in individuals with chronic ankle instability (CAI).MethodsThis study followed the PRISMA 2020 guidelines and was registered in PROSPERO (Registration No.: CRD420251076956) in advance. The meta-analysis was conducted using RevMan 5.3 and Stata 16.0 software. A thorough systematic search of six databases, such as PubMed, Scopus, Web of Science, and the China National Knowledge Infrastructure (CNKI), was carried out to find randomized controlled trials that included patients with CAI who received SVT along with balance interventions. Cohen’s d was used to calculate standardized mean differences (SMDs), and a random-effects model was utilized for pooling the effect sizes. Subgroup analyses were executed with balanced and self-reported scale outcome measures. The methodological quality and risk of bias of the included studies were evaluated using the physiotherapy evidence database (PEDro) scale and the Cochrane Risk of Bias 2.0 tool.ResultsThe meta-analysis comprised seven randomized controlled trials, involving 235 participants in total. The participants included 149 males and 86 females, with an average age of 22 years. The meta-analysis showed that combining SVT with balance training had a significant positive impact on the balance ability of individuals with CAI (Cohen’s d = 0.30, p = 0.01). The most significant dynamic balance improvement was in the anterior direction (d = 0.55, p = 0.004), with no significant changes in posterolateral, posteromedial directions, or static balance COP-V. In the same way, the combination of SVT with balance training resulted in a notable improvement in self-reported ankle stability among CAI patients (d = 0.53, p = 0.00). Cumberland ankle instability tool (CAIT) scores showed greatest improvement (d = 0.98, p = 0.00), with significant gains on foot and ankle ability measure (FAAM) -Sport subscale (d = 0.40, p = 0.04), but no change in FAAM- Activities of Daily Living (ADL) subscale.ConclusionPreliminary evidence suggests SVT + balance training may improve ankle stability in CAI. Further high-quality RCTs are needed to confirm these findings.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-025-06353-3.

Male factor infertility accounts for up to 50% of couples' inability to conceive. Despite this significant burden, perspectives on male fertility have evolved over millennia, shaped by cultural, medical, and scientific frameworks. Tracing this trajectory illuminates how historical observations laid the foundations for modern andrological science. This scoping review maps the evolution of male fertility research from ancient civilizations through contemporary precision medicine approaches, identifying key paradigm shifts, persistent knowledge gaps, and emerging frontiers in the field. Following Arksey and O'Malley's framework, we systematically searched historical medical texts, archaeological records, and biomedical databases (PubMed, Embase, Web of Science) from inception to 2025. Sources encompassing ancient fertility practices, medieval to early modern medical writings, the microscopy revolution, the endocrinology era, and contemporary molecular approaches were included. Data were extracted and synthesized thematically across temporal epochs. Our review reveals five major paradigm shifts: (i) ancient empiricism (3000 bce to 500 ce) emphasizing humoral balance and dietary interventions; (ii) medieval stagnation with persistence of Galenic theories; (iii) the microscopic revolution (1677-1900) establishing cellular foundations; (iv) the endocrine era (1900-1990) elucidating hormonal regulation; and (v) the molecular age (1990 to present) introducing genetic, epigenetic, and systems biology approaches. Key milestones include the discovery of spermatozoa, the development of semen analysis, the identification of the hypothalamic-pituitary-gonadal axis, assisted reproductive technologies, and contemporary omics-based diagnostics. Persistent challenges include an incomplete understanding of idiopathic infertility and limited treatment options for specific conditions. Male fertility research demonstrates remarkable continuity alongside revolutionary breakthroughs. While ancient practitioners recognized lifestyle and environmental factors now validated by modern science, contemporary precision medicine approaches promise personalized diagnostics and targeted interventions. Future directions include integration of multi-omics data, artificial intelligence-assisted diagnosis, and regenerative medicine strategies for previously untreatable conditions.

Diabetes mellitus (DM) and its complications have wide-ranging effects on numerous aspects of health, particularly as they affect individual's static and dynamic balance. Balance assessments and interventions have emerged as key components of rehabilitation strategies for individuals with DM. As part of the growing incorporation of virtual reality (VR) technology into rehabilitative, this systematic review aims to synthesize the current evidence on VR-based assessment and interventions for balance in individuals with DM. A comprehensive search of electronic database including PubMed, Embase, CINAHL, Cochrane, and PEDro was conducted from the inception through April 2024. Studies applying VR technology either as balance assessments or interventions among individuals with DM were made potentially eligible for inclusion. A total of 12 studies were included according to the inclusion criteria, which included 345 individuals with DM. Four studies utilized VR for balance assessment, revealing that individuals with DM exhibited impaired balance compared with healthy controls. Eight studies applied VR tools for balance training. Despite variations in statistical significance, all studies reported enhanced balance after VR interventions. This systematic review summarizes VR as an innovative and interactive approach, demonstrating its applicability and usefulness in both balance assessment and intervention among individuals with DM.

The Health and Life in Balance intervention to improve patient capacity for older people with multimorbidity: a pragmatic mixed methods non-randomised pilot study

Single Limb Stance Test (SLST) is a reliable and validated test to estimate balance performance. However, assessment of the SLST performance, e.g. by using the Balance Error Scoring System (BESS), can be time-consuming and subjective. To deliver effective balance interventions, a reliable and accessible balance assessment method is imperative. Can video-based pose estimation be effectively utilized to validate the BESS assessment for SLST, as compared to both human observation and marker-based assessment methods? 60-second eyes-closed SLST trials were recorded using an iPad camera and a marker-based motion capture system. Mediapipe was applied to estimate the whole-body kinematics from the video recordings. The kinematic data were processed by threshold-based error detection algorithms to calculate the corresponding BESS total and sub-scores. To validate the video-based BESS assessment, the results were compared to human and marker-based motion capture system BESS assessments using repeated measures ANOVA and correlation coefficients (CC). There was no significant difference in the BESS total score between the assessment methods and the correlation between assessment methods was good with CC's ranging from 0.69 to 0.77. However, a significant difference in BESS forefoot and heel lifting sub-scores between the video-based and the human or marker-based assessments was found because Mediapipe failed to capture the detail of the foot motion. Video-based pose estimation is a reliable and accessible method to assess SLST performance. It can be used to examine and speed up SLST assessment using the BESS total score. However, future research and development in capturing foot motion is needed.

HighlightsWhat are the main findings?•A 12-week exercise program reduced specific primitive reflex retention (e.g., ATNR) and improved fine motor coordination, particularly in children with ASD and ADHD.•The intervention led to significant behavioral improvements in the ADHD group, as evidenced by reductions in Conners 3 Total and Global Index scores.What is the implication of the main finding?•Movement-based interventions focusing on rhythm, balance, and coordination may facilitate motor and behavioral development in neurodevelopmental conditions, though effects may vary by diagnosis.•Such interventions have potential applicability in clinical and educational settings to support self-regulation and developmental outcomes in ASD and ADHD.Objective: Retained primitive reflexes are associated with delayed motor and behavioral development in children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD). This study examined the effects of a 12-week structured exercise intervention on reflex integration, motor coordination, and socio-behavioral outcomes in these populations. Method: Fifteen children with ASD (13 boys, 2 girls) and twelve with ADHD (8 boys, 4 girls), aged 6–12 years, participated in rhythmic, balance, and coordination-based exercises. Primitive reflexes, including the asymmetrical tonic neck reflex (ATNR), were assessed using standardized protocols, and fine motor coordination was evaluated using the Finger and Thumb Opposition Test (FOT). Behavioral outcomes were measured using the Social Responsiveness Scale-2 (SRS-2) for the ASD group and the Conners 3 for the ADHD group. Results: The ASD group showed significant reductions in left-standing ATNR retention scores (p = 0.012) and improvements in right-hand FOT scores (p = 0.023). In the ADHD group, significant improvements were also observed in right-hand FOT scores (p = 0.007). Furthermore, Conners 3 Total and Global Index scores significantly decreased in the ADHD group (p = 0.016 and 0.020, respectively). Reflex retention patterns appeared broader and more bilateral in ASD than in ADHD, suggesting distinct motor developmental profiles. Conclusions: Short-term rhythmic, balance, and whole-body coordination exercise interventions may support behavioral and motor development in children with ASD and ADHD. Tailored programs emphasizing reflex integration hold promise for clinical and educational applications.

Parkinson’s disease (PD) is a chronic and progressive neurological disorder that affects the central nervous system. Recreational Therapy (RT), a structured process applying recreational and activity-oriented interventions to meet the needs of individuals with varying impairments or diseases, offers a holistic approach toward the management of PD symptoms. As the need for effective RT treatments for individuals with PD increases, this case report explores the impact of weekly RT sessions on a specific participant from the community with PD. The aim of the RT intervention was to preserve and improve equilibrium, perceived safety in relation to fall risk, and overall functional ability using static and dynamic balance interventions. Utilized assessments for evaluating intervention effectiveness included the Timed Up and Go (TUG) and the BioSway measurement system. The results suggested that RT intervention(s) can maintain or enhance the functional abilities of participants with PD. The study also suggested that an at-home intervention, while effective at reducing fall risks, may not be as efficient at facilitating positive participant development as in-person sessions. Recreational therapists (RTs) should offer individualized treatment that tailors’ interventions to the specific abilities and functional levels of each participant whether in an individual or group setting. This case report aids RTs in the implementation of comparable therapies in community and residential environments for individuals with PD. These findings highlight the necessity for ongoing research to refine RT techniques and the potential to build upon previous research for more appropriate evidence-based approaches to elevate quality of life and functional outcomes in PD management.

Postural instability linked to fear of movement (FOM) is a frequent impairment among adults with chronic low back pain (LBP). However, progressive stability thresholds on sway control remain poorly characterized. This study aimed to examine differences in sway excursion boundaries and circular stability thresholds during unilateral standing on the dominant and non-dominant limbs in adults with LBP. Eighty adults (35 with LBP and 45 controls) participated in this study. Participants completed the Tampa Scale for Kinesiophobia (TSK) to assess fall-related fear. They performed three unilateral standing trials per limb on a force platform. Sway excursion boundaries were evaluated at 25%, 50%, and 75% circular thresholds within a 10cm radius. During dominant limb standing, there was a group interaction on trial and threshold (F = 6.80, p = 0.01). The LBP group showed greater sway excursions than the control group at 25% and 50% thresholds in the second trial and at 25%, 50%, and 75% thresholds in the third trial. During non-dominant limb standing, however, there was no group interaction on trial and threshold (F = 0.35, p = 0.56). There was no significant TSK interaction, regardless of limb dominance. Adults with chronic LBP exhibit progressive postural instability under increasing balance demands, particularly during dominant limb standing. Although individuals with LBP demonstrated elevated FOM, it did not significantly influence postural sway outcomes. These findings underscore the importance of developing targeted, task-specific balance interventions to enhance dominant-limb stability in adults with chronic LBP.