Clinical Rehabilitation最新文献

ObjectiveTo explore how task and stimuli influence response accuracy in assessing functional communication in adults emerging from a Prolonged Disorder of Consciousness (PDOC).SettingSpecialist post-acute brain injury assessment centre.SubjectsTwelve adults (7 male; 5 female) emerging from PDOC, recruited consecutively between June 2021 and August 2023.MethodsA prospective study exploring the impact of task and stimuli on response accuracy. Yes/no questions and spoken word-to-referent (colour/object) matching tasks were presented. Stimuli were controlled for psycholinguistic variables to reduce linguistic confounds in the assessment of consciousness. Accuracy was compared to a standard measure (visually based situational yes/no questions from the Coma Recovery Scale-Revised).ResultsResponses were most accurate for word-to-referent matching tasks compared to yes/no questions (t(23) = -6.49, P < 0.001, d = 1.33), with greater accuracy to colour than object stimuli (t(23) = 2.79, P = 0.01, d = 0.57). Participants also responded with greater accuracy to word-to-referent matching and yes/no questions involving colours and objects compared to the Coma Recovery Scale-Revised situational yes/no questions.ConclusionTask influences accuracy of responses in assessing return of consciousness. The advantage of colours over objects can be attributed to simpler visual processing and higher lexical frequency of these words. The current standard situational yes/no tasks from the Coma Recovery Scale-Revised resulted in lowest scores and should not be relied upon as the only measure of functional communication.

ObjectiveTo synthesize research about clinical reasoning and decision-making among therapists in inpatient rehabilitation facilities about how they organize care and use their treatment time.Data sourcesPubMed, CINAHL, and PsycINFO were searched for relevant empirical studies published prior to January 13, 2026.Review methodsScoping review. The review process was organized using Covidence. Included studies featured descriptions of clinical decisions explained by occupational therapists, physical therapists, and speech therapists in inpatient rehabilitation facilities. Two reviewers coded the extracted themes through inductive analysis using Dedoose.ResultsOf 1239 articles identified through the search process, 51 met inclusion criteria. We identified six factors across studies that contributed to therapists' clinical decision-making including: (1) consideration of non-medical circumstances (with sub-themes of understanding the patient's perspective, presence of families and caregivers, and assessment of patient resources); (2) collaboration and roles within care teams; (3) within-session communication techniques; (4) knowledge-base and the influence of experience; (5) medical and safety considerations; and (6) balancing institutional priorities within treatment. We created a concept map showing connections across these six factors.ConclusionThe process of making decisions about therapy time and organization of care within inpatient rehabilitation settings is complex and requires integration of multiple factors. Therapists usually prefer familiar approaches to complex or time-intensive ones, and local culture shapes decision-making norms. Future research may examine how these factors relate to patient outcomes and implementation of practice changes such as introduction of new evidence-based treatments or assessment tools.

ObjectiveUnilateral cerebral palsy causes motor impairments affecting upper and lower limbs; compromising balance and gait. Although therapeutic exercise is commonly used, heterogeneity in interventions and outcomes hinders interpretation. This systematic review evaluated the effects of exercise programs on balance and gait in children and adolescents with unilateral cerebral palsy.Data SourcesSearches were conducted in PubMed, Cochrane CENTRAL, PEDro, SPORTDiscus, and Scopus from inception to January 2026. Reference lists of eligible studies were also screened.MethodsRandomized controlled trials including participants aged 2-18 years with unilateral cerebral palsy, assessing exercise programs targeting balance or gait were eligible. Independent reviewer pairs conducted screening, data extraction, and risk-of-bias assessments, resolving disagreements with a third reviewer. Standardized mean differences (SMD) were pooled using a random-effects model. Subgroup, sensitivity, and meta-regression analyses were performed. Certainty of evidence was rated with GRADE.ResultsThirteen trials were included. Exercise programs produced a significant moderate effect on balance (SMD = 0.61; 95% CI: 0.38 to 0.83; I² = 0.003%). The pooled effect on gait was moderate (SMD = 0.51; 95% CI: -0.22 to 1.23) but not significant, with high heterogeneity (I² = 91.1%). Subgroup analyses suggested larger effects with non-plyometric training for balance and with plyometric training for gait. Meta-regression indicated a positive dose-response relationship for balance.ConclusionTherapeutic exercise programs improve balance in youths with unilateral cerebral palsy with evidence of a dose-response effect. Effects on gait remain uncertain. Structured balance-focused interventions should be integrated into rehabilitation programs.

ObjectiveTo explore the roles, experiences and support needs of relatives of individuals who have undergone major lower extremity amputation during the early post-amputation period (0-2 years).DesignQualitative study using focus group interviews and a Research-Driven Photo Elicitation approach.SettingA 5-day psychosocial residential rehabilitation program for individuals with lower extremity amputation.ParticipantsThirty-three relatives of individuals with a major lower extremity amputation recruited through participating patients.InterventionParticipation in focus group interviews informed by photo elicitation to facilitate reflection and discussion of caregiving experiences.Main MeasuresData were analysed using Reflexive Thematic Analysis to identify patterns and themes related to relatives' roles and needs.ResultsOne overarching theme, The Road to a New Normal, described relatives' adaptive processes following amputation. Three subthemes were identified: (a) a gradual realisation of the long-term emotional and practical consequences of amputation; (b) challenges in supporting patients' emotional reactions, including grief and altered identity; and (c) shifting relationship dynamics, where relatives assumed caregiving roles while striving to maintain their original relational identity. Many relatives adopted a shared 'we-perspective', emphasising joint adaptation and coping.ConclusionsRelatives play a central role in post-amputation rehabilitation, and the findings highlight the complexity of relatives' adaptation following amputation. Their experiences highlight the importance of systematically involving relatives in rehabilitation through support for dyadic coping, emotional preparedness and shared goal setting to enhance outcomes for both patients and caregivers.

ObjectiveTo evaluate prehabilitation interventions evaluated in randomised controlled trials for people undergoing lumbar spinal stenosis surgery and determine which individual intervention components are associated with successful interventions.Data sourcesEnglish language papers from 2011 until December 2025 from PubMed, Cumulative Index of Nursing and Allied Health, Scopus and Web of Science.Review methodsWe searched for randomised controlled trials comparing prehabilitation to other non-active interventions for people undergoing surgery for lumbar spinal stenosis. Two authors independently screened, selected and performed quality assessments of the studies. Relevant study details were extracted, tabulated and synthesised using intervention component analysis.ResultsNine papers describing five randomised control trials involving 466 participants and 28 outcomes measured pre- and/or post-surgery were found. Overall, the interventions consisted of 47 individual components. Fifteen of these components (including psychological/behavioural approaches, and cardiovascular, strength and trunk/core exercise) featured in successful interventions that resulted in greater improvement in 16 outcomes (including back pain, disability, walking and hospital stay) in prehabilitation compared to usual care participants. The results of further evaluation of individual outcomes at each time point was inconsistent and unreliable.PROSPERO registration numberCRD42025645253, https://www.crd.york.ac.uk/PROSPERO/view/CRD42025645253ConclusionOnly five small trials of low-to-moderate quality report common outcomes at similar timepoints. There is high uncertainty regarding the importance of individual intervention components in successful prehabilitation interventions for people undergoing lumbar spinal stenosis surgery.

ObjectiveAustralian and New Zealand Guidelines for the Physiotherapy Management of People with Spinal Cord Injury recommend the use of inspiratory muscle training for people with spinal cord injury and respiratory muscle weakness. The aim of this study was to evaluate if tailored implementation strategies increased provision of inspiratory muscle training by physiotherapists.DesignA pre-post implementation study with baseline, post and follow-up measures.SettingThree spinal units in Sydney, Australia.ParticipantsTwenty-one physiotherapist-participants and 68 patient-participants across three spinal units.InterventionTailored, evidence-based, multi-faceted implementation strategies to improve physiotherapists' provision of inspiratory muscle training, delivered over a 6-week period (the implementation phase).Main measuresPhysiotherapists' provision of inspiratory muscle training was measured via a standardised audit tool. Medical records were audited at baseline, immediately after the implementation phase and then two months later to determine whether patients had been provided inspiratory muscle training.ResultsNinety-four medical records were audited of 68 patient-participants over the study period. Data at baseline indicated that inspiratory muscle training was only provided to 20% of eligible patient-participants. This improved to 91% immediately post the 6-week implementation phase but reduced to 72% two months later.ConclusionsTailored, evidence-based implementation strategies increased the provision of inspiratory muscle training by physiotherapists. These strategies can be adapted to different health care settings to improve physiotherapists' provision of inspiratory muscle training for the respiratory management of people with spinal cord injury.The study was prospectively registered with the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au/. ACTRN: 12623001106628).

ObjectiveTo examine the effects of the Wim Hof Method (WHM), with cold exposure (WHM-C) and without (WHM-NC), on mental and physical health in individuals with chronic spinal cord injury (SCI).DesignRandomized-controlled trial.SettingRehabilitation center.ParticipantsSixty-two adults with chronic SCI (37% tetraplegia, 41% motor complete) were randomized into three groups: WHM-C, WHM-NC, and usual care (UC).InterventionThe intervention groups participated in a 7-week program involving weekly supervised sessions and daily home practice. WHM-NC included breathing exercises and mindset training, while WHM-C also incorporated cold exposure. UC participants received no intervention.Main measuresThe primary outcome was the Mental Health Inventory (MHI-5) score. Secondary outcomes included inflammatory and metabolic markers, pulmonary function, body composition, sleep quality, spasticity, chronic pain, and psychological stress.ResultsWHM-NC had eight dropouts, mostly due to motivation or unrelated medical issues, while WHM-C and UC had one dropout each. No significant differences in MHI-5 scores were observed between groups. However, WHM-C participants reported reduced pain interference in daily activities compared to UC (p=0.027). WHM-C also showed improvements in inspiratory parameters FIV1 (+27%, p=0.02) and PIF (+23%, p=0.02) and a significant reduction in fasting glucose concentration (-6%, p=0.006) compared to UC.ConclusionsWhile 44% of WHM-NC dropped out, WHM-C appears to be a feasible, effective intervention for improving aspects of physical health and pain perception in a broad group of individuals with chronic SCI, although no significant mental health benefits were observed.

ObjectiveTechnology-based interventions may enhance self-directed or caregiver-assisted activity during inpatient stroke rehabilitation, yet effective implementation strategies for technology-based tools remain unclear. This scoping review synthesises existing evidence on acceptability, feasibility and effectiveness of technology-based interventions in inpatient stroke rehabilitation, and maps barriers and enablers to implementation through the Capability, Opportunity, Motivation and Behaviour model.Data sourcesComprehensive searches of MEDLINE, Embase, CINAHL and Google Scholar were conducted through to December 2025.Review methodsStudies involving adult stroke survivors using self-directed technology-based interventions during inpatient rehabilitation were included. Arksey and O'Malley's scoping review framework guided data extraction. Analysis focused on acceptability, feasibility, effectiveness and behaviour change strategies.ResultsEighteen high-moderate quality studies (20 papers) from 13 countries, involving 1081 participants, were included (10 pilot randomised controlled trials, 6 feasibility studies, 1 non-randomised and 1 observational study). Interventions were upper limb exergaming or robotics devices (n = 4) and tablet/smartphone applications with exercise videos (n = 14). Acceptability, feasibility and effectiveness outcomes were reported in 12 studies (63%), with rates of recruitment, safety and retention being reported in eight (67%), eight (67%) and six (50%) studies, respectively. All studies reported on at least one construct relating to barriers or enablers. Key enablers were caregiver involvement and additional support for more impaired individuals. Common barriers were stroke-related impairments and reduced staffing.ConclusionThis review offers an integrated overview of the acceptability, feasibility and effectiveness of technology-based interventions in inpatient stroke rehabilitation, with identified strategies to support clinicians with implementation. Further research is needed on long-term outcomes.

ObjectiveThe Brain Injury associated Visual Impairment - Impact Questionnaire (BIVI-IQ) was developed to measure the impact of post-brain injury visual impairment. Communication and cognitive impairments are common brain injury sequelae and a barrier to completing standard patient reported outcome measures. The objective of this study was to develop and refine an easy-read version in order to meet recommendations to promote self-reporting.DesignEasy-read version development involved stakeholder input at several meetings. An iterative refinement process was used, involving a cognitive interview, until no new issues were identified.ParticipantsStroke survivors with visual impairment and/or aphasia and relevant healthcare professional were involved in the development stage. The clinical study recruited 12 stroke survivors with visual impairment.Main measuresParticipants completed the easy-read and standard versions. The researcher documented observations and time taken. Analysis assessed association and agreement between the two versions.ResultsDevelopment considered the structure, image selection and key words. Four iterations were used before five consecutive participants reported no new issues. Image amendments involved replacing four, revising four and adding three across eight of the 13 items. A preference for the easy-read version was reported by 45.5% completing both questionnaires (n = 11). A significant, strong positive correlation was found between the easy-read and standard version total scores. Weighted Kappa found significant agreement between 12 items.ConclusionsThe easy-read version, using images to support the question wording, will increase accessibility for brain injury survivors with communication and/or cognitive difficulties. It is acceptable and further evaluation of this version is now required.

ObjectiveThis meta-analysis aimed to evaluate effects of physical exercises on gross and fine motor skills in children and adolescents with attention deficit hyperactivity disorder (ADHD), and to explore the influencing factors and dose-response relationships for optimizing exercise parameters.Data sourcesSix electronic databases were searched from inception to 20 June 2025, with an updated search performed on 27 January 2026.MethodsThe effect sizes were estimated using Hedge's g within three-level random-effects modeling frameworks. Subgroup analyses were performed to examine potential moderators, while restricted cubic splines were employed to characterize dose-response relationships.ResultsTwenty-one studies with 850 participants were included. Physical exercises showed moderate positive effects on both gross motor skills (Hedge's g = 0.62, 95% CI: 0.48-0.76) and fine motor skills (Hedge's g = 0.72, 95% CI: 0.54-0.90). Significant improvements were observed in subcomponents of gross motor skills (locomotion, object control, body coordination, and strength) and fine motor skills (manual dexterity, hand-eye coordination, and handwriting). Moderator analyses indicated that longer session durations (>45 min) and higher frequencies (≥3 sessions/week) were associated with greater benefits. Fine motor skills (∼1350 min) appeared to require greater cumulative exercise exposure than gross motor skills (∼810 min) to achieve substantial gains.ConclusionPhysical exercise is an effective intervention for improving motor skills in children and adolescents with ADHD. However, the effectiveness of interventions appears to be moderated by motor subcomponents and dose parameters. Tailored programs, specific motor skill targets and dose parameters, should be integrated into clinical and educational practices to maximize outcomes.