Rehabilitation Strategies Research Articles

Deep learning enables accurate soft tissue tendon deformation estimation in vivo via ultrasound imaging

Image-based deformation estimation is an important tool used in a variety of engineering problems, including crack propagation, fracture, and fatigue failure. These tools have been important in biomechanics research where measuring in vitro and in vivo tissue deformations are important for evaluating tissue health and disease progression. However, accurately measuring tissue deformation in vivo is particularly challenging due to limited image signal-to-noise ratio. Therefore, we created a novel deep-learning approach for measuring deformation from a sequence of images collected in vivo called StrainNet. Utilizing a training dataset that incorporates image artifacts, StrainNet was designed to maximize performance in challenging, in vivo settings. Artificially generated image sequences of human flexor tendons undergoing known deformations were used to compare benchmark StrainNet against two conventional image-based strain measurement techniques. StrainNet outperformed the traditional techniques by nearly 90%. High-frequency ultrasound imaging was then used to acquire images of the flexor tendons engaged during contraction. Only StrainNet was able to track tissue deformations under the in vivo test conditions. Findings revealed strong correlations between tendon deformation and applied forces, highlighting the potential for StrainNet to be a valuable tool for assessing rehabilitation strategies or disease progression. Additionally, by using real-world data to train our model, StrainNet was able to generalize and reveal important relationships between the effort exerted by the participant and tendon mechanics. Overall, StrainNet demonstrated the effectiveness of using deep learning for image-based strain analysis in vivo.

Improving Functional Capacities and Well-Being in Older Adults: Strategies in Physical Medicine and Rehabilitation.

As life expectancy continues to increase, improving the quality of life (QoL) for older adults becomes an important issue. This study investigated the impact of a two-week intensive rehabilitation program at the Techirghiol Balneal and Rehabilitation Sanatorium on older adults' QoL, focusing on physical and cognitive function. The study employed a comprehensive geriatric assessment to evaluate the progress of 156 patients over 65 from admission to discharge. We used the Scale for Identifying Fall Risk Factors (STRATIFY) scale to assess the risk of falling, the Visual Analogue Scale (VAS) to assess pain levels, and the Functional Independence Measure (FIM) to assess motor and cognitive abilities. The program included multi-parametric evaluations and personalized treatment plans. Statistical analysis of these data led to the following results: The STRATIFY scale showed a significant improvement in patient functionality and a decrease in the risk of falling during hospitalization, with a mean difference in scores between admission and discharge ranging from 0.141 to 0.372, with a p-value of less than 0.001, confirming the clinical significance of this improvement. The VAS showed a significant reduction in pain or symptom intensity, reflected by a mean decrease of -3.141 between admission and discharge. The FIM recorded a mean increase of 1.436 in patients' motor capacity between admission and discharge, reflecting improved adaptation to daily activities, especially in the areas of self-care, sphincter control, transfer, and locomotion. Social participation and health status were positively influenced, demonstrating the benefits of short-term, intensive rehabilitation. The two-week rehabilitation program significantly improved the QoL of older adult patients. These outcomes suggested that active aging strategies could be effectively integrated into medical and institutional care frameworks, highlighting the necessity for policies that support older adults' involvement in economic and social contexts.

Comparative Analysis of Neuromuscular Activation Patterns Associated with Force between Semi-Professional Female Soccer Players with Previous Anterior Cruciate Ligament Surgery and Healthy Players in Thigh Musculature Related to Valgus Collapse

This study investigates electromyography activation and force development differences in key lower limb muscles between female football players with previous anterior cruciate ligament injuries compared with healthy players. Twenty-two semi-professional players were divided into ACL-injured (n = 11) and non-injured groups (n = 11). Participants underwent maximal voluntary isometric contractions while electromyography activation, peak and average, and peak torque of force were measured. Results indicated significant differences in electromyography activation patterns between anterior cruciate ligament players and non-injured players, particularly in biceps femoris and gluteus maximus muscles. These differences were also evident when comparing between limbs within anterior cruciate ligament players. Interestingly, both groups exhibited similar peak torque of force during maximal contractions, suggesting a compensatory neuromuscular strategy that supports a return to sport based on kinetic and kinematic factors. However, these findings underscore persistent muscle integration imbalances potentially contributing to the high rate of anterior cruciate ligament reinjury. In conclusion, this study highlights the importance of evaluating electromyography activation alongside force development in understanding neuromuscular adaptations post anterior cruciate ligament injury. These insights emphasize the need for comprehensive rehabilitation strategies that address muscle imbalance to mitigate the risk of recurrent anterior cruciate ligament injuries in female football players.

Modeling the richness and spatial distribution of the wild relatives of Iranian pears (Pyrus L.) for conservation management

The preservation of the genetic resources of crop wild relatives (CWRs) is crucial for food production systems and is considered a vital measure for global agricultural health and food security. The identification of potential areas where CWRs can thrive is one of the first steps towards their conservation. In this study, we used a maximum entropy model (MaxEnt) to determine the habitat suitability of seven wild relatives of pears (Pyrus L.) for the first time. We aimed to identify high-priority areas for conservation and determine the hotspots for rich biodiversity in Iran. The study showed excellent predictive performance for all species studied (AUC value ≥ 90). The soil depth, solar radiation, minimum temperature of the coldest month (Bio6), and precipitation of the wettest quarter (Bio16) were the main environmental factors that influenced the habitat suitability of all seven species, according to permutation importance. The projected maps revealed that P. elaeagnifolia had the largest suitable habitat area, while P. glabra had the lowest. The results also showed that less than 5% of the suitable habitats for these seven species were in protected areas. This research highlights the need for national preservation policies and the development of cultivation and rehabilitation strategies for these threatened species.

PFC/M1 activation and excitability: a longitudinal cohort study on fatigue symptoms in healthcare workers post-COVID-19

BackgroundFatigue is one of the most common neurological symptoms reported post coronavirus disease 2019 (COVID-19) infection. In order to establish effective early intervention strategies, more emphasis should be placed on the correlation between fatigue and cortical neurophysiological changes, especially in healthcare workers, who are at a heightened risk of COVID-19 infection.MethodsA prospective cohort study was conducted involving 29 COVID-19 medical workers and 24 healthy controls. The assessment included fatigue, sleep and health quality, psychological status, and physical capacity. Functional near-infrared spectroscopy (fNIRS) was employed to detect activation of brain regions. Bilateral primary motor cortex (M1) excitabilities were measured using single- and paired-pulse transcranial magnetic stimulation. Outcomes were assessed at 1, 3, and 6 months into the disease course.ResultsAt 1-month post-COVID-19 infection, 37.9% of patients experienced severe fatigue symptoms, dropping to 10.3% at 3 months. Interestingly, the remarkable decreased activation/excitability of bilateral prefrontal lobe (PFC) and M1 were closely linked to fatigue symptoms after COVID-19. Notably, greater increase in M1 region excitability correlated with more significant fatigue improvement. Re-infected patients exhibited lower levels of brain activation and excitability compared to single-infection patients.ConclusionsBoth single infection and reinfection of COVID-19 lead to decreased activation and excitability of the PFC and M1. The degree of excitability improvement in the M1 region correlates with a greater recovery in fatigue. Based on these findings, targeted interventions to enhance and regulate the excitability of M1 may represent a novel strategy for COVID-19 early rehabilitation. Trial registration: The Ethics Review Committee of Xijing Hospital, No. KY20232051-F-1; www.chictr.org.cn, ChiCTR2300068444.

Chemodiversity of dissolved organic matter and its association with the bacterial community at a zinc smelting slag site after 10 years of direct revegetation

Dissolved organic matter (DOM) plays a critical role in driving the development of biogeochemical functions in revegetated metal smelting slag sites, laying a fundamental basis for their sustainable rehabilitation. However, the DOM composition at the molecular level and its interaction with the microbial community in such sites undergoing long-term direct revegetation remain poorly understood. This study investigated the chemodiversity of DOM and its association with the bacterial community in the rhizosphere and non-rhizosphere slags of four plant species (Arundo donax, Broussonetia papyrifera, Cryptomeria fortunei, and Robinia pseudoacacia) planted at a zinc smelting slag site for 10 years. The results indicated that the relative abundance of lipids decreased from 18 % to 5 %, while the relative abundance of tannins and lignins/CRAM-like substances increased from 4 % to 10 % and from 44 % to 64 % in the revegetated slags, respectively. The chemical stability of the organic matter in the rhizosphere slag increased due to the retention of recalcitrant DOM components, such as lignins, aromatics, and tannins. As the diversity and relative abundance of the bacterial community increased, particularly within the Proteobacteria, there was better utilization of recalcitrant components (e.g., lignins/CRAM-like compounds), but this utilization was not invariable. In addition, potential preference associations between specific bacterial OTUs and DOM molecules were observed, possibly stimulated by heavy metal bioavailability. Network analysis revealed complex connectivity and strong interactions between the bacterial community and DOM molecules. These specific interactions between DOM molecules and the bacterial community enable adaptation to the harsh conditions of the slag environment. Overall, these findings provide novel insights into the transformation of DOM chemodiversity at the molecular level at a zinc smelting slag sites undergoing long-term revegetation. This knowledge could serve as a crucial foundation for developing direct revegetation strategies for the sustainable rehabilitation of metal smelting slag sites.

Neural-Targeted Rehabilitation Strategies to Restore Typical Activation after Joint Injury.

In patients with musculoskeletal injury, changes have been observed within the central nervous system that contribute to altered movement planning. This maladaptive neuroplasticity potentially explains the clinical disconnect where residual neuromuscular dysfunction and high rates of reinjury that are often observed even after individuals clear return-to-activity functional testing. An improved understanding of these neural changes could therefore serve as a guide for facilitating a more complete recovery and minimizing risk of re-injury. Therefore, we propose a paradigm of neural-targeted rehabilitation to augment commonly used therapeutic techniques targeting sensorimotor function in order to better address maladaptive plasticity. While most treatments have the capability to modify neural function, optimizing these treatments and combining them with integrative therapies (e.g. implementation of motor learning strategies, transcranial direct current stimulation) may enhance neural efficiency and facilitate return-to activity in patients with musculoskeletal injury. To complete this model, consideration of affective aspects of movement and associated interventions must also be considered to improve the durability of these changes.

Association between the length of stay in rehabilitation and mortality among the adults with Parkinson's disease: 2009-2019 Korean National Health Insurance Service Databases.

Rehabilitation is recognized as an effective means of alleviating the symptoms of Parkinson's disease (PD) and improving the physical and cognitive functions of patients with PD. However, research often focuses on short-term outcomes such as functioning and quality of life. This study investigated the association between the length of stay in rehabilitation and mortality among patients with PD. Using the Korean National Health Insurance Service database, we identified 636 participants diagnosed with PD who received rehabilitation. The main outcome was all-cause mortality. We used a Cox proportional hazards regression model to examine the relationship between length of stay in rehabilitation and mortality among patients with PD. The final sample comprised 374 females (58.81%) and 262 males (41.19%). A survival analysis revealed a significant association between the length of stay in rehabilitation and mortality, with a decrease in mortality of 16.1% in patients with PD who received one year of rehabilitation (hazard ratio = 0.839, 95% confidence interval = 0.788-0.895). Our findings underscore the potential benefits of timely implementation of rehabilitative interventions in patients with PD and the need for comprehensive and long-term rehabilitation strategies. It also highlights the necessity of such services for patients with PD and the importance of developing patient-centered rehabilitation guidelines.

Law Enforcement Against Drug Abusers Through Medical Rehabilitation and Social Rehabilitation

Drug abuse is a global threat that damages society. Although various efforts have been made, there is still a lot of confusion and misunderstanding in the community about the dangers of narcotics. Patterns of drug use have pathological features, causing physical and psychological dependence. Law enforcement against drug abuse involves medical and social rehabilitation to help individuals recover and return to functioning in society. A holistic and collaborative approach from various parties as well as the use of new disciplines and technologies are needed to effectively address this problem. NThis research uses a normative legal analysis approach that focuses on law enforcement against drug abuse. The normative approach is used by analysing the synchronisation of vertical and horizontal legal norms and related legal systematics. The implementation of medical and social rehabilitation emphasises the importance of a holistic approach in helping individuals affected by drug abuse. This approach includes medical, social, and spiritual dimensions, such as Ruqyah, Dhikr, and spiritual contemplation methods, to design a more comprehensive and effective rehabilitation strategy. Recommendations for enforcement for people who misuse drugs should promote a holistic approach that includes medical, social, and spiritual aspects, such as Ruqyah and Dhikr, to support comprehensive recovery. Law enforcement should focus on treatment and recovery rather than punishment, and be supported by communities and based on social and humanitarian understanding.

Perturbation-based estimation of within-stride cycle metabolic cost

Metabolic cost greatly impacts trade-offs within a variety of human movements. Standard respiratory measurements only obtain the mean cost of a movement cycle, preventing understanding of the contributions of different phases in, for example, walking. We present a method that estimates the within-stride cost of walking by leveraging measurements under different force perturbations. The method reproduces time series with greater consistency (r = 0.55 and 0.80 in two datasets) than previous model-based estimations (r = 0.29). This perturbation-based method reveals how the cost of push-off (10%) is much smaller than would be expected from positive mechanical work (~ 70%). This work elucidates the costliest phases during walking, offering new targets for assistive devices and rehabilitation strategies.

Harnessing Artificial Neural Networks for Spinal Cord Injury Prognosis.

Background: Prediction of neurorehabilitation outcomes after a Spinal Cord Injury (SCI) is crucial for healthcare resource management and improving prognosis and rehabilitation strategies. Artificial neural networks (ANNs) have emerged as a promising alternative to conventional statistical approaches for identifying complex prognostic factors in SCI patients. Materials: a database of 1256 SCI patients admitted for rehabilitation was analyzed. Clinical and demographic data and SCI characteristics were used to predict functional outcomes using both ANN and linear regression models. The former was structured with input, hidden, and output layers, while the linear regression identified significant variables affecting outcomes. Both approaches aimed to evaluate and compare their accuracy for rehabilitation outcomes measured by the Spinal Cord Independence Measure (SCIM) score. Results: Both ANN and linear regression models identified key predictors of functional outcomes, such as age, injury level, and initial SCIM scores (correlation with actual outcome: R = 0.75 and 0.73, respectively). When also alimented with parameters recorded during hospitalization, the ANN highlighted the importance of these additional factors, like motor completeness and complications during hospitalization, showing an improvement in its accuracy (R = 0.87). Conclusions: ANN seemed to be not widely superior to classical statistics in general, but, taking into account complex and non-linear relationships among variables, emphasized the impact of complications during the hospitalization on recovery, particularly respiratory issues, deep vein thrombosis, and urological complications. These results suggested that the management of complications is crucial for improving functional recovery in SCI patients.

Impact of Xsens Technology on Analysis of Gait Deviation in Pre- and Post-surgical Total Knee Arthroplasty Patient.

Introduction Osteoarthritis (OA) is a degenerative joint ailment that predominantly affects the knee and is most common in older adults. It destroys the surrounding tissues and cartilage. Following total knee arthroplasty (TKA), patients with end-stage knee OA can have long-term pain reduction and patient satisfaction, although certain functional limitations still exist. While TKA significantly reduces pain and improve function, many patients stillexperience abnormalities post-surgery, such as slower walking and reduced step-length. Gait analysis using technologies like the Xsens Motion Visualization and Navigation (MVN) system (Movella, Henderson, NV, USA)provides insights into these functional limitations, helping to assess knee mobility and predict changes in joint movements during activities. Methods Thirty-four people participated in a study done at the Centre for Advance Physiotherapy Education and Research, Ravi Nair Physiotherapy College, Wardha, both before and after total knee arthroplasty. Participants who ranged in age from 50 to 70 and had undergone unilateral TKA were included. Informed consent was obtained, and demographic data were collected. Participants walked a predetermined distance at their usual speed, and measurements of hip and knee angular velocity and center of mass were recorded for gait analysis. Result The study involved participants aged 50-70, with a mean age of 59.79 years and height ranging from 153.00 to 185.00 cm. Significant gait changes were noted pre- and post-total knee arthroplasty, including a decrease in walking speed from 0.72 to 0.55m/s and cadence from 105.06 to 82.86. Other parameters, such as step length and center of mass, also exhibited considerable differences, highlighting the impact of TKA on gait dynamics. Conclusion The study underscores the significant impact of total knee arthroplasty on gait mechanics and the value of advance of technologies likeXsens for assessing functional outcomes. While TKA provides pain relief and improved mobility, residual gait abnormalities persist, highlighting the need for tailored rehabilitation. Xsens technology enhances patient preparation, recovery tracking, and rehabilitation strategies, setting a new standard for gait analysis in orthopedic practice.

Evaluation and Development of Healing Garden Based on Biophilic Design Approach in Harapan Kita Cardiovascular Hospital

Abstract The need for gardens in health facilities became the concern of Harapan Kita Cardiovascular Center Hospital (RSJPDHK). Landscape architecture research has identified the importance of therapeutic green space as a rehabilitation strategy on the physical and psychological resilience that can affect health and work performance. Therefore, the possibility to develop green space need to be designed in conjunction with the restorative function through the healing garden concept with biophilic approach. This research aims to identify the potentials and constraints of 3 chosen sites on RSJPDHK building; evaluate the healing garden value on site 1, which is an existing roof garden; and develop a biophilic-based healing garden design on sites 2 and 3, which are undeveloped roof and corridor yard. The research stages were carried out with reference to modified Booth (1984). The results showed that site 1 is suitable as a healing garden with standard criteria. Meanwhile, design development was carried out on sites 2 and 3 with the concept of healing garden and biophilic approach, entitled ‘rejuvenate’ which produced the output of design recommendations for RSJPDHK.

Effective and ineffective strategies for successful rehabilitation: A comparison of activities in juvenile and adult facilities

This article discusses social rehabilitation among adults and minors, comparing methods used in penitentiary units and facilities for adolescents in conflict with the law. The research underlying this article was conducted in two stages: first, through study visits by the Criminological Scientific Club of the University of Warsaw, followed by a series of structured interviews. This approach enabled the authors to determine what works and what does not in the social rehabilitation system. The research revealed that in prisons, the most beneficial factors for convicts are work opportunities and family contact. In turn, for units housing minors, measurable benefits come from education tailored to the child’s learning level and educational outreach beyond the facility walls. However, the authors attributed the failures to the slow work of the courts, which prolongs the time needed to send adolescents to the facility, and to the lack of proper supervision over the situation of the charges. In the case of adults, problems include poor treatment of convicts by the Prison Service, insufficient therapeutic and educational system, and improper selection of management staff. The authors concluded from their research analysis that there are no universal social rehabilitation methods that can be effectively applied to both adults and minors.

Impaired Memory and Executive Function are Associated with Reduced Social Participation in People with Parkinson’s Disease

Abstract Date Presented 03/22/24 Memory and executive function predict social participation in Parkinson’s disease (PD). It is important to tailor cognitive rehabilitation strategies based on cognitive function to promote social participation in PD. Primary Author and Speaker: Moon Young Kim Contributing Authors: Erin R. Foster

Timing of stroke survivors' hospital readmissions to guide APRNs in primary care.

Caring for patients after a neurovascular incident is common for advanced practice registered nurses (APRNs). Most neurological readmission studies focus on a small subset of neurovascular incident groups, but advanced practice nurses in primary care attend to a diverse neurovascular population and lack time to adequately search hospital records. The aim of this study was to determine readmission risk factors after a neurovascular incident to guide APRNs in the primary care setting. The study is a retrospective observational study that used a crude single predictor model to determine potential risks for readmission. A total of 876 neurovascular participants were studied. Of these, only 317 experienced at least one hospital readmission, with 703 readmissions within 1 year, indicating some were readmitted more than once. Risks for readmission varied across neurovascular events. The main reasons for readmission were because of neurological, cardiovascular, and musculoskeletal complications. Stroke readmission rates are high and require intervention by APRNs. To prevent readmission includes timely follow-up within 30 days and should also include longitudinal follow-up beyond 90 days to prevent hospital readmission. Future studies are needed to create guidelines for APRNs that implement rehabilitation strategies to decrease hospital readmission for the neurovascular population that focus on interdisciplinary communication.

Cortical plasticity in AQP4-positive NMOSD: a transcranial magnetic stimulation study.

Aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) is an autoimmune disease characterized by suboptimal recovery from attacks and long-term disability. Experimental data suggest that AQP4 antibodies can disrupt neuroplasticity, a fundamental driver of brain recovery. A well-established method to assess brain LTP is through intermittent theta-burst stimulation (iTBS). This study aimed to explore neuroplasticity in AQP4-NMOSD patients by examining long-term potentiation (LTP) through iTBS. We conducted a proof-of-principle study including 8 patients with AQP4-NMOSD, 8 patients with multiple sclerosis (MS), and 8 healthy controls (HC) in which iTBS was administered to induce LTP-like effects. iTBS-induced LTP exhibited significant differences among the 3 groups (p: 0.006). Notably, AQP4-NMOSD patients demonstrated impaired plasticity compared to both HC (p = 0.01) and pwMS (p = 0.02). This pilot study provides the first in vivo evidence supporting impaired neuroplasticity in AQP4-NMOSD patients. Impaired cortical plasticity may hinder recovery following attacks suggesting a need for targeted rehabilitation strategies.

Personalized Exercise Prescription in Long COVID: A Practical Toolbox for a Multidisciplinary Approach.

To describe our methodology and share the practical tools we have developed to operationalize a multidisciplinary Long COVID clinic that incorporates progressive, personalized exercise prescription as a cornerstone feature. There is a lack of evidence-based guidance regarding optimal rehabilitation strategies for people with Long COVID. Existing guidelines lack precision regarding exercise dosage. As one of Australia's few established multidisciplinary Long COVID clinics, we describe our novel approach to safely incorporating exercise of both peripheral and respiratory muscles, with essential monitoring and management of post-exertional symptom exacerbation. Working closely with primary health-care providers, our multidisciplinary team screens referrals for people aged 16 and older with Long COVID. Staff apply a three tier model of triage, dependent on the consumer's presenting problems. Exercise-based interventions necessitate detailed monitoring for post-exertional symptom exacerbation both in the clinic and at home. Personalized exercise prescription includes resistance training at a submaximal threshold (4-6 exercises, 3 days/week); whole-body endurance exercise titrated to the individual's progress, at an intensity 4-6/10 (Rate of Perceived Exertion); and for those limited by dyspnoea, high-intensity inspiratory muscle training using a threshold-based handheld device (30 repetitions per day, ≥50% of their maximum inspiratory pressure). We have used these approaches for the past 2 years in 250 consumers with no serious adverse events and promising consumer feedback. Our exercise prescription is less conservative than the methods advocated in international guidelines for people with Long COVID, and these more progressive tools may be valuable in other contexts. In our experience, a multidisciplinary clinic-based approach to safely prescribing progressive exercise in Long COVID is feasible. Both peripheral and inspiratory muscle exercise can be effectively titrated to each individual's symptoms, and careful monitoring for post-exertional symptom exacerbation is crucial.

Rehabilitation after musculoskeletal injury: European perspective.

Trauma is one of the main causes of death in younger people and ongoing disability worldwide. In Europe, while there is generally good organization of trauma reception and acute treatment, rehabilitation from major musculoskeletal injuries is less well defined and provided. This article documents the diverse approaches to rehabilitation after major injury in 6 European nations. The recognition of need is universal, but achieving a robust rehabilitation strategy is more elusive across the varying health care systems. Switzerland has the most robust service in the insured population. In the other countries, particularly where there is a reliance on public institutes, this provision is at best patchy. In the Netherlands, innovative patient-empowering strategies have gained traction with notable success, and in the United Kingdom, a recent randomized trial also showed this approach to be reproducible and robust. Overall, there is a clear need for learning across the national systems and implementation of a minimum set of standards.

Physical Therapy Paradigms in Athletic Return to Play After Hip Surgery

Hip arthroscopy has become the predominant surgical approach for managing femoroacetabular impingement (FAI) and associated intra-articular pathologies, particularly in athletes. Despite advancements in surgical techniques, rehabilitation protocols, especially those governing return to play (RTP), have not kept pace in terms of specificity and objectivity. This article reviews current practices and introduces a comprehensive, multi-factorial continuum for RTP that extends beyond mere time-based criteria to include an athlete's overall readiness, encompassing both physical and psychological aspects. Through a phased rehabilitation strategy beginning in the preoperative phase and extending through to full return to competition, this paper aims to present a more nuanced continuum for RTP that accounts for an athlete's readiness beyond temporal benchmarks. The phases outlined include preoperative preparation, immediate postoperative care, early rehabilitation, reconditioning, performance enhancement, and final return to play, each phase tailored to integrate clinical milestones with biomechanical and psychosocial factors. This approach advocates for a shift towards personalized rehabilitation protocols that align with the biological healing processes and functional milestones essential for a successful return to sports.