Ragab Kamal Elnaggar

Objective: Optimal management of adolescent patellofemoral pain syndrome requires evidence-based interventions that maximize physical recovery without overloading the patellofemoral joint. This study investigated the efficacy of aquatic plyometric (Aquatic-Plyo) exercises on pain, muscle strength, and functional disability and health-related quality of life in this demographic. Design: A dual-arm randomized controlled trial. Subjects/Patients: 56 adolescents with patellofemoral pain syndrome (age: 10–18 years). Methods: Adolescents were allocated to an experimental Aquatic-Plyo group or a control group performing conventional exercises. Both arms completed 45-min sessions twice weekly for 12 weeks. Pre- and post-treatment assessments included pain intensity, isokinetic knee (quadriceps and hamstrings) torque at 120°/s and 180°/s, functional disability, and health-related quality of life. Results: Mixed-model ANOVA confirmed the therapeutic dominance of the Aquatic-Plyo protocol. It yielded superior pain relief (p = 0.004, η2p = 0.14) and larger increases in quadriceps [120°/s (p = 0.006, η2p = 0.13); 180°/s (p = 0.008, η2p = 0.12)] and hamstring [120°/s (p = 0.007, η2p = 0.13); 180°/s (p = 0.023, η2p = 0.09)] peak torque. Moreover, the Aquatic-Plyo intervention drove greater reduction in functional disability (p = 0.03, η2p = 0.08) and notable enhancement in perceived health-related quality of life (p = 0.023, η2p = 0.09). Conclusion: Aquatic-Plyo exercises effectively reduces pain and disability while improving muscle strength and health-related quality of life in adolescents with patellofemoral pain syndrome, making it a valuable addition to conservative rehabilitation strategies.

Background: Screen exposure in early childhood has evolved beyond traditional duration-focused “screen time” to encompass a multidimensional construct including content quality, context of use, co-viewing, caregiver mediation, and developmental trajectories. Understanding these dimensions is essential for comprehensive assessment, particularly in rapidly digitizing cultural contexts such as Saudi Arabia and the broader Middle East. Objectives: This scoping review aimed to systematically map and synthesize peer-reviewed evidence on multidimensional screen exposure and developmental outcomes in children aged 0–5 years, with specific focus on language, cognitive, and socio-emotional outcomes. Methods: This scoping review followed PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Scopus, Web of Science, and Google Scholar (2016–2026). Inclusion criteria were primary empirical studies (randomized trials and observational designs), children aged 0–5 years (up to 72 months, provided primary exposure was assessed within the 0–5-year window), quantitative screen exposure measurement, and validated developmental outcome assessment. Data were extracted and synthesized narratively across the developmental domains. Results: Twenty-seven studies demonstrated that content quality, context of use, and caregiver behavior (including co-viewing and active guidance of screen use) consistently modified the strength of associations between screen exposure and early developmental outcomes. Language development was the most extensively studied domain; co-viewing emerged as a key protective factor, and longitudinal trajectory analyses identified heterogeneous exposure patterns with differing developmental implications across cognitive, socio-emotional, and physical domains. Conclusions: Screen exposure in early childhood is a multidimensional phenomenon requiring assessment tools that capture content, context, co-use, and caregiver mediation alongside duration. Findings highlight the need for culturally adapted measurement instruments in the Saudi Arabian context to support evidence-based early childhood practice and align with Vision 2030 objectives.

Objective: To analyse physical fitness trajectories in paediatric burn survivors from discharge to 2 years post-injury, compare them with an age- and gender-matched control group, and identify baseline demographic and clinical determinants. Design: Prospective and longitudinal cohort study. Participants: The study included participants with burn injuries (burn group, n = 45), aged 10–17 years, with burns involving ≥25% of total body surface area, and an age- and gender-matched group of healthy children (control group, n = 45). Main measures: Participants underwent standardised fitness assessments at discharge and 24 months later. Health-related physical fitness was quantitatively assessed using the validated EUROFIT physical fitness test battery. Results: Longitudinal analysis revealed significant improvements in seven of nine fitness domains for participants with burn injuries over two years (pFDR < 0.001). Despite these gains, these participants exhibited persistent fitness deficits compared to healthy controls across all domains at follow-up (all p < 0.001). Among those with burn injuries, greater total body surface area (β = –0.007, p = 0.03) and third-degree burn percentage (β = –0.57, p < 0.001) predicted lower overall fitness, while longer rehabilitation predicted higher fitness (β = 0.50, p < 0.001). No baseline clinical factors significantly predicted the rate of fitness change over time (all interaction p > 0.05). Conclusion: Paediatric burn survivors demonstrated significant improvements in physical fitness over 2 years but failed to close the performance gap with their healthy peers. Injury severity and rehabilitation duration were strong determinants of fitness level, but they did not predict the rate of improvement.

Cerebral palsy (CP) represents a group of permanent, non-progressive neurological disorders originating from a disturbance in the developing fetal or infant brain, primarily affecting movement and ...

Psychological factors play a central role in rehabilitation following athletic injury. This study aimed to translate and culturally adapt the Athlete Fear Avoidance Questionnaire (AFAQ) into Arabic and to evaluate the psychometric properties of the Arabic version (AFAQ-Ar) in Arabic-speaking athletes with musculoskeletal injuries, following the consensus-based standards for the selection of health measurement instruments guidelines. Translation and cross-cultural adaptation followed standardized procedures, including forward and back translation, expert committee review, and pretesting. The AFAQ-Ar was administered to Arabic-speaking athletes with musculoskeletal injuries to assess structural validity, construct validity, internal consistency, and test–retest reliability. Construct validity was examined against a priori hypotheses using correlations with the Tampa Scale of Kinesophobia and the Pain Catastrophizing Scale. Exploratory factor analysis and reliability indices were calculated. Exploratory factor analysis identified 2 closely related factors accounting for 63.49% of the total variance. The AFAQ-Ar demonstrated good internal consistency (Cronbach α = 0.88) and excellent test–retest reliability, with intraclass correlation coefficients ranging from 0.95 to 0.99. Moderate positive correlations with the Tampa Scale of Kinesophobia and Pain Catastrophizing Scale supported construct validity. The AFAQ-Ar is a reliable and valid instrument for assessing fear avoidance beliefs in Arabic-speaking athletes with musculoskeletal injuries.

Objective: To investigate the longitudinal relationship between spatial-temporal gait asymmetries and locomotor capacity in ambulatory children with unilateral cerebral palsy (UCP). Design: A prospective longitudinal study with assessments at baseline, 6, 12, 18, and 24 months. Twenty-seven children with UCP (GMFCS levels I-II, aged 8-15 years) were evaluated for spatial (SAI) and temporal (TAI) gait asymmetry indices and locomotor capacity measures (community balance & mobility: CB&M, functional walking test: FWT, 10-meter Shuttle Run Test: 10m-SRT, and 6-Minute Walk Test: 6mWT). Results: Mixed-effects models analyses indicated that higher SAI was significantly associated with lower CB&M scores ( β =−124.73, P β =−48.79, P β =32.14, P β =−774.86, P β =−118.47, β =−43.93, β =35.18, β =−719.46, respectively; all P <0.001). Trajectory analysis revealed gradual improvements in asymmetry indices over 24 months. Children with lower baseline asymmetry demonstrated faster rates of locomotor improvement compared to those with higher baseline asymmetry. Conclusion: Longitudinal data establish that spatial-temporal gait asymmetries are significantly associated with locomotor capacity in children with UCP, with these relationships persisting over time. This supports the value of gait asymmetry metrics as clinical biomarkers for monitoring heterogeneous functional mobility trajectories within this specific population.

Background: Cardiorespiratory fitness is frequently impaired in survivors of pediatric acute lymphoblastic leukemia (ALL), limiting their functional performance. While aerobic exercise is recommended, evidence is needed to guide the prescription of specific training protocols in this population. Objective: This study sought to compare the efficacy of constant-load (CL-AEx) and graded aerobic exercise (G-AEx) protocols on cardiorespiratory fitness and functional capability in pediatric survivors of ALL. Methods: Seventy-two pediatric ALL survivors were allocated to CL-AEx, G-AEx, or a control group. Cardiopulmonary fitness [peak oxygen consumption (peak VO₂), peak minute ventilation (VE), ventilatory equivalent for oxygen (VE/VO₂), respiratory exchange ratio (RER), peak oxygen pulse (peak O₂P), maximum heart rate (max HR), and one-minute heart rate recovery (HHR₁)] and functional performance [six-minute walk test (6MWT), 4x10-m shuttle run test (4x10-mSRT), and timed up down stairs (TUDS)] were assessed at pre- and post-intervention. Results: The G-AEx group exhibited significantly enhanced cardiorespiratory and functional outcomes compared to both the CL-AEx and control groups (all p < 0.05). The G-AEx group demonstrated more pronounced improvements, showing significant increases in peak VO₂, VE, VE/VO₂, peak O₂P, and HHR1, alongside a more efficient RER. Functionally, the G-AEx intervention led to superior improvements in 6MWT distance, and significantly faster completion times in the 4x10-mSRT and TUDS, highlighting multi-domain functional gain. Conclusions: In pediatric survivors of ALL, G-AEx demonstrated superior improvements in cardiorespiratory fitness and functional performance compared to CL-AEx over 12 weeks. These findings suggest that G-AEx is an effective modality for addressing acute physical deconditioning in this population. Incorporating G-AEx into clinical rehabilitation may enhance immediate physiological and functional recovery during the survivorship phase.

Background: Children with hemiparetic cerebral palsy (Hemi-CP) often face challenges in strength and function, limiting participation in daily activities. While plyometric exercise (Plyo-Ex) has shown promise in improving neuromuscular performance in other populations, its applications in pediatric neurorehabilitation remains understudies. Objective: To assess whether a 12-week Plyo-Ex program could elicit meaningful improvement in muscle strength and upper extremity function in children with Hemi-CP. Methods: A prospective, randomized controlled trial involving 58 children with Hemi-CP was conducted. Participants were assigned to either a Plyo-Ex group or a control group receiving standard exercise approaches. The Plyo-Ex group completed supervised upper-extremity-oriented Ply-o-Ex program (∼45 min, twice weekly for 12 weeks), with at least 48 h between sessions. Measurements at the baseline and post-treatment included muscle strength (shoulder flexors, external rotators, abductors, elbow extensors, and wrist extensors), unilateral upper extremity function (movement quality, spontaneity, dynamic segmental alignment, and grasp-release capability), and bimanual hand function. Results: Compared to the control group, the Plyo-Ex group demonstrated significant moderate-to-large increases in muscle strength across all tested muscle (all P < 0.05; η ² p = 0.07–0.18). Improvements were also seen in unilateral upper extremity function [quality of function ( P = 0.006, η ² p = 0.13), spontaneity ( P = 0.003, η ² p = 0.14), dynamic segmental alignment ( P = 0.018, η ² p = 0.10), and grasp-release capability ( P = 0.033, η ² p = 0.08)] as well as the bimanual hand function ( P = 0.004, η ² p = 0.14). Conclusions: Evidence from this trial indicates that Plyo-Ex may serve as a viable intervention to enhance upper extremity strength and function in children with Hemi-CP. Rehabilitation professionals may consider adopting this modality as part of a comprehensive, evidence-based therapeutic plan. Trial Registration: ClinicalTrial.gov (Identifier: NCT06980246)

Objective: Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity and has unclear aetiology. Vitamin D deficiency may contribute to AIS through its impact on bone metabolism. This study examined the correlation between vitamin D levels and idiopathic scoliosis development in an adolescent patient population. Methods: The study involved 130 patients (aged 7 to 18 years) diagnosed with AIS at a Physiotherapy and Rehabilitation Centre in Qena, Egypt, between May 2021 and October 2022. Patients’ clinical and demographic data were extracted from medical records, including age, gender, height, weight, serum vitamin D level, and Cobb angle. Scoliosis was identified when the Cobb angle was ≥ 10°. Results: Patients’ mean age was 13.1 ± 2.75 years, vitamin D level was 10.3 ng/ml ± 4.76, and weight was 47.4 kg ± 9.63. In the patient group, the mean Cobb angle was 16.8 ± 5.79°, with a 95 % confidence interval (CI) of 15.8–17.8. Vitamin D levels correlated positively with age (r = 0.45, p < 0.001) and weight (r = 0.51, p < 0.001). However, only a weak positive correlation was found between vitamin D and the Cobb angle (r = 0.11, p = 0.18). Conclusions: Vitamin D deficiency may contribute to AIS pathogenesis by affecting calcium and phosphorus metabolism in bone. As a result, we recommend testing vitamin D levels in those with AIS. Although there was only a positive weak correlation (not significant) between vitamin D levels and Cobb angle, vitamin D deficiency/insufficiency should be examined in AIS patients.