Normative data and clinical validity of verb and phonemic fluency tasks in Turkish-speaking older adults.

Objective: Cognitive impairment is increasingly recognized as a core feature of bipolar disorder and may persist during euthymic phases. However, direct comparisons of cognitive profiles between Bipolar I Disorder (BD-I) and Bipolar II Disorder (BD-II) remain limited, particularly in studies that include healthy control groups.Methods: In this cross-sectional study, euthymic patients with BD-I (n = 65), BD-II (n = 32), and healthy controls (n = 65) were assessed using a comprehensive neuropsychological test battery, including the Stroop Test, the WAIS-R Digit Span and Digit-Symbol Coding subtests, and the Verbal Fluency Test. Group differences were initially examined using one-way analysis of variance (ANOVA). Variables demonstrating statistically significant group effects were subsequently evaluated using Pearson correlation analyses.Results: Omnibus ANOVA revealed significant group differences for Stroop Test subtest 4 (F(2,159) = 16.00, p < .001), WAIS-R Digit-Symbol Coding (F(2,159) = 16.55, p < .001), and Verbal Fluency Test scores (F(2,159) = 14.67, p < .001). Post hoc analyses indicated that BD-I patients performed significantly worse than both BD-II patients and healthy controls on Stroop-4 and Verbal Fluency measures, whereas the difference between BD-I and BD-II patients on Digit-Symbol Coding was attenuated after adjustment. Effect size estimates indicated medium-to-large group differences, particularly for comparisons involving BD-I patients and healthy controls.Conclusions: These findings suggest that cognitive impairment persists during euthymic phases of bipolar disorder, with more pronounced deficits observed in BD-I patients, particularly in executive functioning and processing speed. Although cognitive difficulties in BD-II patients appear less extensive, they remain clinically relevant.

Evidence suggests that open-skill team sports, such as basketball, may favor the development of executive functions in childhood. This pilot study compared pre-to-post changes in verbal fluency, anthropometric parameters, physical activity, and physical fitness between 9- to 11-year-old schoolchildren participating in a 12-week after-school basketball program and a control group. Twenty-nine participants were allocated to an intervention (basketball, n = 14) or control (n = 15) group. The intervention comprised two 60-minute sessions per week. Anthropometric parameters (height, weight, waist circumference, body mass index, and waist-to-height ratio), physical activity (PAQ-C), physical fitness (handgrip strength, standing long jump test, 10 × 5 m agility shuttle run test, and six-minute walk test), and executive functions (phonological and semantic fluency) were evaluated. The basketball group showed greater pre-to-post improvements than the control group in phonological fluency and physical fitness measures, while PAQ-C showed a trend toward between-group differences. These findings suggest that participation in a structured after-school basketball program is feasible and was associated with improvements in phonological fluency and physical fitness. However, because no active comparator was included, these changes cannot be attributed specifically to basketball; larger studies with active comparators are warranted.

Human conversations are strongly dependent on the production of informative and fluent connected speech. In people with aphasia, this skill is affected to varying degrees, which can negatively impact social communication and quality of life. However, available coding systems to assess connected speech production based on discourse tasks are labour-intensive and very time-consuming, limiting their utilization in clinical and research contexts. In this study, we investigated and further validated a recently developed, accurate, time-efficient and clinically applicable measure of content word fluency (CWF) during spoken discourse in a large, unselected sample of 76 participants with chronic aphasia following left hemisphere stroke. We report the first identification of lesion correlates of impaired content word production in spoken discourse using state-of-the-art lesion-symptom mapping methods, including voxel-wise disconnection, multivariate lesion-symptom mapping and tract-wise analyses. Discourse responses elicited using composite picture description were analysed using (i) CWF to assess content word production in spoken discourse using a pre-specified checklist without transcription or quantitative analysis and (ii) ‘correct information unit’ (CIU) following the standard transcription and quantitative analysis protocol of discourse samples. We showed a significant, strong positive correlation between CWF scores and the number of CIUs. Item Response Theory analysis revealed that the one-parameter logistic model best fits the data, indicating that items on the CWF checklist are homogeneously measuring a single underlying construct. Moreover, the items on the checklist were found to have distributed difficulties in the sample over a large functional range, indicating that the CWF approach is sensitive to variations in performance across a broad spectrum of aphasia severity. The neuroimaging findings indicated overlapping lesion correlates between CWF and CIU in the left frontal and parietal regions, and anterior dorsal white matter pathways, specifically the middle frontal gyrus, inferior parietal lobe, frontal aslant tract and superior longitudinal fasciculus. These results reveal strong convergence between CWF and CIU, and they provide behavioural, neurological and psychometric validation of the CWF approach, an efficient tool for assessing communication deficits in people with aphasia in both clinical and research settings. These insights have potential clinical implications, from improving targeted rehabilitation strategies to predicting recovery outcomes.

Pedaling and schoolwork: Stability in academic performance, cognition, and neuroelectric function during moderate-intensity cycling in children.

ABSTRACT Purpose Our study conceptually replicated and extended prior investigations of the longitudinal stability of hybrid models of dyslexia by using a measure of word reading fluency alongside measures of nonsense word fluency and oral reading fluency. Method Drawing from a nationally representative sample of students, we estimated the one-year stability of 11 dyslexia classification indices for 492 Grade 1 students who were 47.4% female, 49.8% White, 25.0% Latinx, 12.0% Black or African American, and 85.4% of whom were classified as non-English learners. The classifications defined dyslexia as low reading performance, unexpected low reading performance, a dual discrepancy, or a hybrid model of dyslexia. For each model, incidence rates and stability estimates were obtained for cut points at the 25th, 15th, and 5th percentiles. Results We replicated findings that hybrid models tend to exhibit longitudinal stability, and the degree of stability reflects assumptions about how the data are distributed. Specifically, our estimates were sensitive to the cut points examined and assumptions about a residualized metric of vocabulary. Regardless of our assumptions, we found that low achievement and dual discrepancy indices can exhibit comparable stability to hybrid models in the presence of weak slope-intercept correlations. Conclusion Our results affirm that hybrid models of dyslexia can exhibit longitudinal stability. However, they add nuance by clarifying that the relative stability of hybrid models depends on the measures and sample in question. Further, multi-measure models are simultaneously more exposed to measurement error and more resilient to it than other models, resulting in meaningful tradeoffs.

Successful coordination of the functional networks underlying reading is highly dependent on the underlying white matter tracts that connect these regions. Continuous theta burst stimulation (cTBS) can temporarily inhibit brain activity in targeted brain networks and has been shown to modulate reading ability. It was hypothesized that measures of diffusivity would predict change in reading efficiency following stimulation to the left temporal-parietal junction (TPJ), a targeted node of the dorsal stream of the reading network. Fifty-three adults between the ages of 18 and 50 years (M = 22.79, SD = 5.40; 34 female) with a range in reading ability completed sight word and pseudoword fluency measures prior to and immediately following cTBS to either the left or right TPJ or a control site. Participants also completed an MRI session including anatomical and diffusion weighted imaging sequences. Regression analyses were conducted to predict change in reading fluency following cTBS. Tracts associated with the reading network including the arcuate fasciculus, inferior longitudinal fasciculus, and portions of the superior longitudinal fasciculus, as well as the corpus callosum significantly predicted reliable change in a test of word reading efficiency–sight word efficiency subtest following stimulation of the left TPJ. These findings suggest that increased diffusivity of white matter tracts associated with the left hemisphere reading network and their right hemisphere homologues may support the impact of cTBS following stimulation to a targeted node of the reading network. Individual differences in white matter diffusivity may underlie differences in behavioral outcomes following neuromodulation.

Abstract This study investigates the relationship between speech rhythm, utterance fluency, and native listeners’ perceptions of comprehensibility and fluency in second language (L2) English. Eighty-two advanced Spanish–Catalan bilingual learners of English completed a spontaneous speaking task, from which temporal rhythm measures (including durational variability metrics and vowel reduction measures) and fluency measures (speed, breakdown, and repair) were extracted. Speech samples were rated for comprehensibility and fluency by L1 English listeners. Correlational and regression analyses revealed that while rhythm and fluency measures did not consistently relate to one another, both independently contributed to listeners’ ratings. In addition, vowel reduction ratios were stronger predictors of ratings than traditional durational variability metrics. These findings suggest that rhythm and fluency constitute partially independent constructs that both shape global speaking proficiency perceptions. Pedagogically, the results highlight rhythm as a promising instructional target for enhancing learners’ fluency and comprehensibility.

Speaking fluency is vital for students participating in EMI courses, as it enables them to effectively communicate in discussions, give presentations, and engage in seminars and tutorials․ However, EFL students typically lack opportunities for sustained speaking practice, face heightened anxiety levels, and receive inadequate individual feedback․ AI tools such as conversational chatbots, speech recognition, and AI-based feedback tools can be used to address these challenges․ This quasi-experimental study explored the impact of speaking practice with AI tools on EMI students' oral ‌fluency development after a 4-week intervention․ Participants (60 undergraduate EMI students with a B1-B2 level of expertise) were assigned to a control group and an experimental group․ The experimental group experienced an intervention where students had to perform role-plays with ChatGPT, use speech-to-text applications, and incorporate AI-generated feedback, whereas the control group engaged in customary speaking activities․ Fluency measures (speech rate in words per minute, pauses per minute, and mean length of utterance) were collected pre- and post-intervention․ In the experimental group, fluency statistics showed a considerably increased speech rate, decreased pause rate, and improved confidence as compared to participants in the control group․ The results indicate that AI-supported practice is an effective way to provide low-anxiety, individualized speaking practice that can help students make progress towards their speaking goals outside the classroom․ The pedagogical implications of using AI tools in blended learning EMI settings suggest that mediation by instructors is important for students' effective use of AI-assisted learning in developing their speaking skills․

Cognitive impairment (CI) is a common and disabling manifestation of multiple sclerosis (MS), yet it remains underdiagnosed in clinical settings. This study aims to identify the volumetric MRI markers of CI in MS patients. A total of 79 MS patients were enrolled; after exclusions, 63 with relapsing-remitting MS (RRMS) and 7 with primary progressive MS were analyzed. All participants underwent neuropsychological testing (CVLT, BVRT, CTT, VFT, VST, and SDMT). Brain volumes were analyzed using FreeSurfer. In RRMS, 59% had CI (35% single-domain, 24% multidomain). Multidomain CI was linked to reduced left cerebellar white matter and bilateral pallidum volumes, slight choroid plexus enlargement, and higher lesion volume versus cognitively preserved patients. Significant correlations were found between brain volumes and cognitive test scores: cerebellar and cerebral white matter, corpus callosum, subcortical gray matter, and thalamus volumes correlated positively with measures of processing speed, memory, and verbal fluency, while higher lesion load and larger choroid plexus volumes were associated with poorer cognitive performance. CI in MS is linked to both global and regional brain atrophy, as well as lesion load. Volumetric MRI, including choroid plexus analysis, may represent candidate imaging correlates of CI; however, longitudinal and externally validated studies are needed to confirm their predictive value and clinical utility.

ABSTRACT Introduction: As digital platforms increasingly mediate language learning, the challenge is no longer simply how to deliver content online but how to design environments that cultivate authentic multilingual practice. While multilingualism has long been linked to enhanced metalinguistic awareness and domain-general cognitive flexibility, the role of multimodal digital environments in fostering these outcomes remains underexplored. Purpose: Grounded in sociocognitive and multimodal interactionist perspectives, this study examines how a cross-device metaverse platform can support multilingual development through spatially organized, task-based, and avatar-mediated interaction. Specifically, it investigates whether multilingual engagement in language-zoned virtual spaces improves learners' communicative performance, affective engagement, and cognitive control compared to conventional instruction. Methodology: Using a quasi-experimental cluster-assigned pretest-posttest control group design, learners engaged in communicative scenarios across English, Filipino, and Mandarin within language-zoned virtual spaces that cued role-appropriate language use. Data were collected using performance-based role-play assessments (code-switching accuracy, communicative competence), oral fluency measures (WPM), motivation and anxiety questionnaires, and a Stroop interference task to assess cognitive flexibility. Findings: Compared to peers in a control condition, learners in the metaverse environment demonstrated significantly greater gains in code-switching accuracy, spoken fluency, motivational engagement, and cognitive control. Specifically, experimental participants showed improved context-appropriate language selection and reduced cross-language interference when shifting between English, Filipino, and Mandarin during task-based role-play scenarios. They also produced more fluent spoken output and demonstrated stronger communicative competence ratings in completing real-world interaction tasks. In addition, learners reported higher motivational engagement and cognitive results, further revealing improvements in inhibitory control and attentional regulation. Collectively, these outcomes suggest that spatially cued multilingual interaction in the metaverse supports integrated gains in linguistic performance and executive functioning. Originality/Value: This study provides empirical evidence that multilingual development is shaped not only by linguistic input but by how digital learning ecologies choreograph spatial, social, and multimodal cues into context-responsive language use. By operationalizing multilingual interaction through spatial language zoning, avatar-mediated tasks, and AI-supported multilingual dialogue, the study positions the metaverse as a semiotically rich pedagogical ecology that can simultaneously foster code-switching competence, oral fluency, motivational engagement, and domain-general executive control. The findings advance multimodal multilingual education theory by demonstrating how context-sensitive interaction design can generate co-emergent communicative, affective, and cognitive benefits in multilingual learners.

Abstract: Hans Zulliger’s three-card inkblot test was created in the 1940s to function as a short-form of Rorschach’s inkblot method. Despite having been continually published and used, the Zulliger has undergone less stringent research than the Rorschach. We administered both tests to 101 psychiatric outpatients using the Rorschach Performance Assessment System (R-PAS) as the basis for administration and coding, to investigate the Zulliger Test’s convergent validity and utility of assessment. In this study, we focused on Complexity and Simplicity, as these constructs represent a fundamental dimension of Rorschach data. We conducted a principal component analysis on 13 variables from both tests to compare their underlying structure. To assess linear correspondence and between-method agreement, we analyzed Complexity (as standard scores) and F%, along with two study-derived proportion variables: Fluency (R/per card) and Density (Complexity per response). We employed scatterplots with Loess smoothing, Pearson correlations, t tests, predictive performance metrics, and Bland–Altman analyses for these four variables. The underlying structure of R-PAS and Zulliger data showed convergence, confirming our hypothesis that data from the two tests are generated in a comparable manner. Further, we found that Zulliger provides unbiased measures of Complexity, F%, Fluency, and Density. However, Bland–Altman analyses revealed wide limits of agreement for Complexity and F%, indicating potential limitations in clinical utility at the individual level. Predictive performance metrics showed satisfactory specificity and negative predictive values (NPV), but sensitivity and positive predictive values (PPV) varied widely and were poor at some thresholds. Overall accuracy ranged from 71% to 85%, suggesting moderate to strong agreement between R-PAS and Zulliger scores.

Neuronal autoantibodies are linked to cognitive impairment in neurologic diseases and can be associated with tumors. In patients with cancer, IgA/IgM N-Methyl-D-Aspartate receptor (NMDAR) autoantibodies are most common, yet their clinical relevance is unclear. We assessed cognitive function in cancer patients with serum NMDAR autoantibodies and compared the results with matched controls. For this cross-sectional case-control study in Germany, we recruited 1,055 patients with cancer and tested for neuronal serum autoantibodies. Cognitive assessment was performed blinded to antibody status and after excluding patients with potential confounders of cognitive dysfunction. The tests included verbal memory (Rey Auditory Verbal Learning Test), visuospatial memory (Rey-Osterrieth Complex Figure), and working memory. Fifty-six patients with IgA/IgM NMDAR autoantibodies (median age 61.0 years [28.0-86.0], 35.7% female) were matched 1:1 to autoantibody-negative patients by age, sex, cancer type, and stage. Autoantibody-positive patients showed impairments in verbal memory (mean score ± SD: 9.7 ± 3.6 vs 11.4 ± 3.2; p = 0.01; Cohen d = 0.49), visuospatial memory (19.4 ± 7.0 vs 22.6 ± 5.6; p = 0.01; d = 0.50), and working memory (6.2 ± 1.9 vs 7.0 ± 2.1; p = 0.04; d = 0.40). Memory function decreased with increasing IgA NMDAR autoantibody levels. Both groups performed similarly on measures of attention, executive function, and verbal fluency. Serum NMDAR autoantibodies are associated with isolated memory deficits in patients with cancer and might serve as a potential biomarker for cancer-related cognitive impairment.

Diagnostic performance of verbal fluency measures: a cross-sectional study in the stages of cognitive continuum.

BackgroundDevelopmental dysplasia of the hip (DDH) is a common pediatric orthopedic disease, and health education is vital to disease management and rehabilitation. The emergence of large language models (LLMs) has provided new opportunities for health education. However, the effectiveness and applicability of LLMs in education with DDH have not been systematically evaluated.ObjectiveThis study conducted an integrated 2-phase evaluation to assess the quality and educational effectiveness of LLM-generated educational materials.MethodsThis study comprised 2 phases. Based on Bloom’s taxonomy, a 16-item DDH question bank was created through literature analysis and collaboration. Four LLMs (ChatGPT-4 [OpenAI], DeepSeek-V3, Gemini 2.0 Flash [Google], and Copilot [Microsoft Corp]) were questioned using standardized prompts. All responses were independently evaluated by 5 pediatric orthopedic experts using 5-point Likert measures of accuracy, fluency, and richness, the scales of Patient Education Materials Assessment Tool for Printable Materials, and DISCERN. The readability was measured by a formula. The data were examined using Kruskal-Wallis tests, ANOVA, and post hoc comparisons. In phase 2, an assessor-blinded, 2-arm pilot randomized controlled trial was conducted. A total of 127 caregivers were randomized into an LLM-assisted education group or a web search control group. The intervention included structured LLM training, supervised practice, and 2 weeks of reinforcement training. Measured at baseline, postintervention, and 2 weeks following, the outcomes were eHealth literacy (primary), DDH knowledge, health risk perception, perceived usefulness, information self-efficacy, and health information-seeking behavior. Cohen d effect sizes and linear mixed-effects models were used in an intention-to-treat manner.ResultsThere were significant differences between the 4 LLMs concerning accuracy, richness, fluency, Patient Education Materials Assessment Tool for Printable Materials Understandability, and DISCERN (P<.05). ChatGPT-4 (median 63.67, IQR 63.67-64.67) and DeepSeek-V3 (median 63.67, IQR 63.33-64.67) generate more accurate text than Copilot (median 59.00, IQR 58.67-59.67). DeepSeek-V3 (median 64.00, IQR 64.00-64.00) was language richer than Copilot (median 52.33, IQR 51.33-52.67). Gemini 2.0 Flash (median 72.67, IQR 72.33-73.00) was more fluent than Copilot (median 65.67, IQR 63.33-65.67). In phase 2, the intervention group showed higher eHealth literacy at T1 (33.62, 95% CI 32.76-34.49; d=0.20, 95% CI 0.13-0.56) and T2 (33.27, 95% CI 32.38-34.17; d=0.36, 95% CI 0.01-0.80), greater DDH knowledge at T1 (7.87, 95% CI 7.48-8.25, d=0.71, 95% CI 0.33-1.11) and T2 (7.12, 95% CI 6.72-7.51; d=0.54, 95% CI 0.17-0.96), and slight improvements in health risk prediction and perceived usefulness.ConclusionsMainstream LLMs demonstrate varying capacities in generating educational content for DDH. They generated DDH caregiver education materials that were associated with modest improvements in eHealth literacy and knowledge. Although LLMs can address general informational needs, they cannot completely substitute clinical evaluation. Future research should focus on optimizing plain language, refining dialogue design, and enhancing audience personalization to improve the quality of LLMs’ materials.Trial RegistrationChinese Clinical Trial Registry ChiCTR2500108410; https://www.chictr.org.cn/showproj.html?proj=271987

Early assessment of prereading abilities is important for ensuring long-term reading, academic, and career-related success. Speech-language pathologists and educators commonly use prereading assessment tools to identify and support school-aged children's future reading abilities. However, most bilingual children, including Urdu-English bilinguals, do not have access to appropriate early prereading assessments within the school/educational system. This is due to the lack of language-appropriate prereading assessment tools. The current longitudinal study examines the predictive validity of the linguistically and culturally responsive Urdu Phonological Tele-Assessment (U-PASS) tool, including subtests for phonological awareness and rapid automatized naming (RAN), commonly assessed reading precursors. Specifically, we investigated whether kindergarten-level Urdu phonological awareness and RAN skills predict the future Grade 1 Urdu reading accuracy and fluency skills of Urdu-English simultaneous bilinguals in two language contexts: in Pakistan (where Urdu is spoken as a national language; n = 104; Country Context 1) and in our exploratory study in Canada (where Urdu is spoken as a heritage language; n = 50; Country Context 2). Hierarchical linear regression analyses demonstrate predictive validity of the U-PASS tool across the two country contexts. Particularly, Urdu phonological awareness emerged as a consistent longitudinal predictor of Urdu word/nonword reading accuracy and fluency, while RAN was a reliable predictor of the reading fluency measures. The U-PASS tool provides access to linguistically and culturally responsive early prereading assessment and enables speech-language pathologists and educators to examine prereading skills in the heritage language of Urdu-speaking children across classrooms globally.

Age-related declines in cognitive function are often accompanied by changes in brain activity and network organization. This study investigated the relationship between resting state brain activity and age-related differences in speech production. We hypothesized that older adults would exhibit altered functional connectivity and activation intensity, correlating with reduced speech quality. Resting state functional MRI data were collected and a composite measure of speech complexity and fluency was calculated from younger and older adults. Results revealed significantly worse speech performance in older adults, accompanied by less segregated whole-brain networks, reduced amplitude of low-frequency fluctuations, and more heterogeneous brain states. Univariate regression analyses indicated stronger brain-behavior relationships in younger adults, while multivariate regression analyses revealed that age-related differences in resting state brain state patterns critically relate to speech production differences. Notably, the language network remained relatively stable with age, whereas whole-brain status became very important for speech performance in older adults. These findings suggest that resting state brain activity, particularly whole brain network characteristics, may serve as a stable biomarker of age-related changes in speech production.

Engaging in conversational and story-telling discourse involves an interplay of language and cognitive skills, including working memory, attention, and inference-making. Primary progressive aphasia (PPA) provides a model for exploring discourse, as both language and cognitive abilities change over time with changes in cortical atrophy. Here, associations between morphosyntactic discourse skills and patterns of cortical atrophy are measured over time in nonfluent (nfv), logopenic (lv) and semantic (sv) variants of PPA. Participants were 27 individuals with nfvPPA (M = 66.6 years ± 8.3), 30 lvPPA (M = 66.7 ± 7.3), 33 svPPA (M = 64.8 ± 6.7), and 36 healthy controls (HC; M = 65.5 ± 6.8). Picture descriptions were analysed for word density and diversity, sentence complexity, well-formedness, and fluency annually for up to three timepoints. Associations between language measures and cortical thickness on structural MRI scans were analysed. At timepoint 1, nfvPPA performed below other groups on most measures; lvPPA were differentiated from svPPA on fluency measures only. Longitudinally, utterance length declined in all variants. For nfvPPA, this was linked with reduced sentence complexity and cortical atrophy in regions engaged by higher attentional demand. For lvPPA, it was linked with increasing grammatical errors and atrophy extending into perisylvian language network. No associations were identified for svPPA. Findings provide insight into how discourse production is underpinned by a network that extends beyond classic language regions, with morphosyntactic elements of discourse associated in part with regions involved in domain-general cognitive skills such as error-monitoring and elaborative encoding. Findings can also inform assessment, prognosis, and intervention for communication through the PPA disease course.

INTRODUCTIONVerbal fluency tasks are widely used in primary progressive aphasia (PPA), but most studies rely only on total correct responses, overlooking qualitative features of the words produced. We applied a scalable computational framework to extract item‐level features from fluency responses in semantic variant (svPPA) and logopenic variant PPA (lvPPA) to test their value for differential diagnosis.METHODSWe analyzed animal fluency responses from 113 participants (40 svPPA, 40 lvPPA, 33 controls) using an automated pipeline extracting nine psycholinguistic features. Group differences were examined with (co)variance models, classification with logistic regression, and brain–behavior associations via structural magnetic resonance imaging.RESULTSAll features except semantic variability distinguished svPPA from lvPPA. Models including features outperformed (area under the curve [AUC] = 0.86) those using only total correct or clinical variables (AUC = 0.60–0.68). Features related mainly to temporal lobe atrophy, whereas total correct also related to the angular gyrus.DISCUSSIONAutomated item‐level analysis offers a sensitive, scalable method for supporting PPA diagnosis and monitoring.HighlightsAutomated item‐level features from verbal fluency aid semantic variant primary progressive aphasia (PPA) versus logopenic variant PPA diagnosis.Item‐level fluency features outperform total correct responses for classification.Item‐level fluency features map onto syndrome‐relevant temporal lobe atrophy.A scalable, fully automated pipeline enables integration into clinical practice.There is potential to support low‐burden, objective monitoring of disease progression in PPA.

Objective.Sit-to-stand (STS) and sit-to-walk (STW) movements are key functional tasks to master following lower limb amputation. They are core to activities of daily living, enabling patients to regain independence. Physiotherapists assess movement fluency (hesitation and smoothness) by observing STS and STW however, this relies on extensive experience and lacks objectivity. This study aimed to establish objective, accessible and scalable quantitative measurements of movement fluency in amputees using instrumented movement analysis.Approach.12 transfemoral amputees (six limited community and six community ambulators) and six typical individuals completed walking, STS and STW tasks. Movement fluency was assessed using published algorithms to obtain hesitation and smoothness in STS and STW.Main results.In STW, hesitation, and smoothness showed statistically significant differences among the three groups. Community ambulators were significantly less hesitant (p= 0.009) and smoother (p= 0.007) than the limited community ambulators, but significantly more hesitant (p< 0.001) and less smooth (p< 0.001) than typical individuals. In STS, the community ambulators were significantly smoother than the limited community ambulators (p< 0.001), but not significantly different from typical individuals (p= 0.68). Community ambulators walked significantly faster than limited community ambulators (p< 0.001) but significantly slower compared to typical individuals (p< 0.001).Significance.Assessment of movement after amputation is not just about walking speed. Other important functional tasks can differentiate amputees and therefore should be considered. An amputee must learn to master both the STS and STW tasks before they can independently walk. Quantifying movement fluency in functional tasks is important to understanding the restoration of function following limb loss, tracking rehabilitation, and classifying amputees. While the study's small sample size reflects its feasibility design, findings support future research with larger cohorts. Subsequent studies should incorporate power calculations to improve generalisability.