European journal of physical and rehabilitation medicine最新文献

Background: Fatigability, defined as the activity-induced decline in performance, is common in people with multiple sclerosis (PwMS), particularly among those with progressive courses of the disease. There is a pressing need to focus on this population to identify the most appropriate rehabilitation strategies, tailored to individual characteristics, including their susceptibility to fatigability. A key objective is to develop new interventions that maximize therapeutic effectiveness while simultaneously reducing task-related fatigability.

Aim: This study investigated whether motor imagery training (MIT) could enhance motor learning and cortical plasticity without causing fatigability in progressive PwMS.

Design: Randomized cross-over study.

Setting: Outpatient clinics.

Population: PwMS and healthy individuals.

Methods: The study consisted of two experiments. Experiment 1 - Motor Training (MT): Both healthy individuals and people with multiple sclerosis (PwMS) performed motor training involving thumb-to-index opposition movements. The primary outcome was pinch strength. Secondary outcomes included finger-opposition movement rate, motor evoked potential (MEP) amplitude, and motor and cognitive Visual Analogue Scale (VAS) scores assessing fatigability. Experiment 2 investigated the effects of MIT, consisting of kinesthetically imagining thumb-to-index opposition movements, and Active Control using a cross-over design. Both groups (PwMS and healthy individuals) underwent these interventions in a controlled randomized order (using the RAND() function in Excel), with a one-week washout period between sessions to minimize carryover effects. Pinch strength was the primary outcome, while finger-opposition movement rate, MEP amplitude, the score of the trials making test, motor and cognitive VAS scores and the score evaluating MI ability were secondary outcome parameters. All outcome measures were assessed before, immediately after and 60 minutes after the training in both experiments.

Results: MT improved motor performance and increased cortical excitability in healthy individuals, but not in PwMS, where it instead induced fatigability. Conversely, MIT enhanced motor learning and cortical plasticity in both groups without increasing fatigability. Notably, PwMS with lower motor fatigability showed greater motor learning gains.

Conclusions: MIT effectively promoted motor skill improvements and cortical plasticity without causing fatigability in progressive PwMS.

Clinical rehabilitation impact: These findings support MIT as a promising, low-fatigability strategy to complement traditional rehabilitation, helping to enhance motor function in progressive PwMS while minimizing fatigue-related barriers.

Background: Breast Cancer Survivors (BCs) often exhibit impaired mobility, balance deficits, and reduced gait speed at functional tests.

Aim: To assess gait patterns in a population of BCs by comparing spatiotemporal (ST) gait measures with those of healthy subjects.

Design: Cross-sectional study.

Setting: Outpatient rehabilitation services of the Breast Unit and the Motion Analysis Laboratory at the Neurorehabilitation Unit, University Hospital of Pisa, Italy.

Population: Twenty-three BCs (BCs-group), who completed active oncological treatments at least 3 months prior to study enrolment, and 16 age-matched healthy female controls (HC).

Methods: All subjects underwent 3-D gait analysis. ST measures of gait were compared between BCs-group and HC. Intra-patient comparisons were made between the operated and the contralateral side. BCs-group was then stratified into two sub-groups according to time from surgery (<12 months; >12 months) and compared to HC.

Results: Results obtained provide evidence that BCs display an abnormal gait pattern characterized by slower gait velocity (0.66±0.21 vs. 0.89±0.22 m/s, P<0.01), shorter step length (0.48±0.10 vs. 0.54±0.07 m; P<0.05) and stride length (0.90±0.16 vs. 1.07±0.14 m; P<0.01), and increased step width (0.12±0.03 vs. 0.10±0.03 m; P<0.01). Cadence was also reduced (81.12±13.68 vs. 98.78±12.48 steps/min; P<0.01) while time of stance (63.1±3.7 vs. 57.69±3.69%; P<0.01) and double support time (14.53±4.85 vs. 8.39±2.87%; P<0.01) were significantly prolonged. The intrapatient analysis of ST measures between the operated and unoperated side revealed no significant differences, but abnormal step length and step width were found only on the operated side. Altered ST parameters were already detectable within 12 months from breast surgery.

Conclusions: A slower and less stable gait pattern develops early after BC treatments, and it can be detected by assessment of ST measures within 12 months from breast surgery.

Clinical rehabilitation impact: Early tailored rehabilitation may help prevent gait deterioration and reduce fall risk in BCs.

Background: Muscle strength is crucial for predicting functional recovery in stroke patients, yet current assessment methods (manual muscle testing and instrument-based dynamometry) are limited in stroke patients due to interference from abnormal synergistic movements and operational complexity/cost, respectively. No validated tool addresses these constraints while quantifying strength across recovery stages.

Aim: To develop an integrative manual muscle test (iMMT) for measuring muscle function in stroke patients with abnormal synergistic movements and evaluate its psychometric properties.

Design: An observational study.

Setting: Rehabilitation hospital inpatient.

Population: Stroke patients.

Methods: The iMMT was developed through a multi-stage process. Initial development involved creating essential movement test items and a novel grading system. This was followed by a pretest to assess operability and refinement of content validity via expert panel review (10 physiotherapists). Finally, a pilot test with 104 stroke patients was conducted to optimize the scale's structure using factor analysis and evaluate its psychometric properties.

Results: The final 17-item iMMT (six upper limb, four trunk, seven lower limb items) was developed with dual six-point grading systems for active range of motion in a normal pattern (A-score) and strength within the active range (B-score) respectively, integrated into a C-score (C=A+B). It demonstrated satisfactory content validity (above moderate relevance), excellent internal consistency (α=0.949), high test-retest (ICC: 0.852-0.992) and inter-tester reliability (ICC: 0.829-0.992). The minimum detectable change (MDC95) was 9.69. Factor analysis confirmed the pre-specified body-part factor structure (AVE>0.5, CR>0.7) and revealed two categories of test items based on postural perturbation (69% variance explained). The iMMT showed excellent convergent and criterion validities demonstrating moderate-to-very-strong correlations with the Fugl-Meyer Assessment (r=0.954), Berg Balance Scale (r=0.747), 10-Meter Walk Test (r=0.769-0.810), the Timed Up and Go test (r=-0.767), Modified Barthel Index (r=0.627), and isokinetic measures (r=0.589-0.773). No ceiling/floor effects were observed.

Conclusions: The iMMT is the first muscle strength tool specifically designed to mitigate synergistic movement interference, providing reliable and valid assessment across stroke recovery stages.

Clinical rehabilitation impact: The iMMT provides precise, accessible muscle assessment in hemiplegic patients. This enables identification of specific neuromuscular deficits, thereby guiding targeted strength training and enhancing rehabilitation outcome prediction in clinical practice.

Background: Transcranial magnetic stimulation (TMS) has recently been used to great effect to enhance the motor function and performance of patients with stroke by modifying cerebral cortex excitability. But few studies have directly compared the effectiveness of stimulating the M1 and cerebellar regions in using rTMS to improve lower limb motor function in stroke patients.

Aim: To assess the effectiveness of high-frequency (HF) repetitive TMS (rTMS) applied to the primary motor cortex (M1) versus the cerebellar region for improving lower limb dsyfunction and maintaining balance ability in people suffering from stroke.

Design: Randomized, double-blind, sham controlled clinical trial.

Setting: Department of rehabilitation medicine in a general hospital.

Population: Patients with stroke with first unilateral lesions were enrolled in the study.

Methods: Seventy-one patients were randomly allocated to sham stimulation group, acerebellum group, and M1 group. Each group received rTMS alongside their routine rehabilitation. The M1 group received stimulation to the affected lower limb motor cortex, while the cerebellum group received stimulation to the contralesional cerebellum. The sham stimulation group had a non-stimulating setup. The stimulation parameters were as follows: the stimulation intensity of 80%RMTand frequency of 10 Hz. The stimulation lasted 20 minutes per session, comprising 3 seconds of stimulation followed by a 17-second interval. This equated to 1,800 pulses per day, five times a session for two weeks.

Results: Before the intervention, no significant differences was found in terms of the Fugl-Meyer Assessment for the Lower Extremities (FAM-LE), the Berg Balance Scale (BBS), movement trajectory length, center of movement trajectory area and the Modified Barthel Index (MBI) (P>0.05). Two weeks later, however, the M1 group and cerebellar group demonstrated statistically significant improvements in the FAM-LE, BBS and MBI (P<0.05). The cerebellar and M1 groups outperformed the sham stimulation group in terms of movement trajectory measures (P<0.05), with the cerebellar group achieving the best results.

Conclusions: Both M1 and cerebellar HF stimulation have been shown to play a positive role in the functionality of the lower limbs and the ability of balance in stroke patients, with cerebellar stimulation proving to be especially efficacious in the amelioration of balance.

Clinical rehabilitation impact: M1 and cerebellar can improve stroke patient lower limb function, but cerebellar maybe a more perfect region for improving balance function compare with M1.

Introduction: Pediatric brain injuries frequently result in impaired mobility and functional limitations. Although treadmill-based exoskeletal robotic-assisted gait training (RAGT) may enhance gait performance, the optimal treatment parameters remain undefined. The present study evaluated the effects of treadmill-based exoskeletal RAGT on walking-related outcomes in children with brain injuries and examined the influence of training dosage on therapeutic outcomes.

Evidence acquisition: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six databases (PubMed, Embase, Science Direct, ProQuest, Cochrane Library, and PEDro) were searched for studies published between January 2010 and February 2025. Eligible studies included participants aged 2-18 years with brain injuries who received treadmill-based exoskeletal RAGT. Risk of bias was assessed using the Risk of Bias tool 2.0, Risk of Bias in Nonrandomized Studies of Intervention tool, and PEDro scale. Meta-analyses were conducted to estimate pooled effects and explore dose-response relationships.

Evidence synthesis: Twenty-four studies (N.=837) met the inclusion criteria; twenty were included in this meta-analysis. RAGT significantly increased gait speed (standardized mean difference [SMD]=0.40; 95% confidence interval [CI]=0.04 to 0.76; I²=30%; P=0.003) and Gross Motor Function Measure (GMFM) Dimension D (SMD=1.02; 95% CI=0.23 to 1.81; I²=83%; P=0.001). Improvements in the 6-minute walk test (SMD=0.43; 95% CI=-0.28 to 1.14; I²=76%; P=0.23) and GMFM Dimension E (SMD=0.49; 95% CI=-0.13 to 1.12; I²=77%; P=0.12) were nonsignificant. Subgroup and meta-analyses identified high session frequency, ≥20 total sessions, and initial body weight support ≤50% as factors associated with superior outcomes. By contrast, excessive frequency and high initial body weight support adversely affected GMFM Dimension E scores.

Conclusions: Treadmill-based exoskeletal RAGT with conventional physical therapy improves gait speed and gross motor function in children with brain injuries. These findings provide preliminary guidance for optimizing training dosage. Additional high-quality trials with standardized protocols and extended follow-ups are required to validate these outcomes.

Background: Single-event multilevel surgery is a widely used intervention for improving gait in children with cerebral palsy. While its effects on kinematics and spatiotemporal parameters are well documented, its impact on gait efficiency remains underexplored.

Aim: To evaluate the impact of single-event multilevel surgery on gait efficiency and quality in children with cerebral palsy.

Design: Retrospective study.

Setting: Pediatric Rehabilitation Unit at AUSL-IRCCS, Reggio Emilia, Italy, using pre- and post-surgical gait analysis data collected from 2011 to 2022.

Population: The study included 109 children with cerebral palsy, categorized into a surgical group (81 patients) who underwent single-event multilevel surgery and a non-surgical group (28 patients).

Methods: Single-event multilevel surgery targeted lower limb pathologies using soft tissue and skeletal corrections. Gait efficiency was assessed through maximum knee and hip extension, and push-off power and energy. Gait quality was evaluated using the Gait Profile Score and Gait Variable Scores. Spatiotemporal parameters were also measured.

Results: In the surgical group, maximum knee extension improved by 6.1° (P<0.001) and hip extension by 1.6° (P=0.023). Ankle push-off power (+24.1%) and energy (+19.8%) increased significantly, while knee energy production decreased (-14%). Gait Profile Score improved by -2.8° (P<0.001). Significant gait variable score reductions included knee flexion-extension (-4.0°), ankle plantarflexion-extension (-3.8°), and foot progression angle (-4.0°). Spatiotemporal metrics remained largely unchanged. Correlations revealed a modest inverse relationship between age and push-off power (rho=-0.28, P=0.012) and an association between Gross Motor Function Classification System levels and push-off power (P=0.018). The non-surgical group showed no significant changes in any efficiency or quality metrics.

Conclusions: Single-event multilevel surgery significantly improves gait efficiency and quality in children with cerebral palsy by enhancing joint kinematics and dynamics.

Clinical rehabilitation impact: these findings highlight single-event multilevel surgery's capacity to optimize gait mechanics, prioritizing efficiency and quality improvements over maximal walking performance. This supports its use as a key intervention for improving functional mobility in rehabilitation settings.

Background: The International Classification of Functioning, Disability and Health (ICF) provides a comprehensive framework for evaluating stroke patients across four key domains. However, due to the large number of ICF items and the complexity of its classification system, its practical application is often time-consuming, and requires substantial training for evaluators.

Aim: To generate and validate a decision tree model based on ICF items for assessing upper limb dysfunction after stroke.

Design: A cross-sectional study.

Setting: Rehabilitation department of five hospitals.

Population: This study included stroke patients (including ischemic or hemorrhagic; first-ever or recurrent), who were stratified according to disease phase: acute (1-7 days, 1.94%), subacute (8-180 days, 53.02%), and chronic (>180 days, 41.38%). All patients had CT/MRI-confirmed diagnosis, stable vital signs, and upper limb dysfunction.

Methods: All participants completed the 56 items of the comprehensive ICF Core Set for stroke. The decision tree model of ICF items significantly associated with the Fugl-Meyer Upper Extremity Scale (FM-UE) was constructed by using the R package rpart.

Results: A total of 464 participants after stroke were recruited. Ten ICF items that were strongly correlated with the FM-UE and P<0.05, and the items were "d4400," "d4401," "d4402," "d4403," "d4450," "d4451," "d4452," "d4453," "d4454," "d4455". Finally, the decision tree model included: "d4401: grasping," "d4553: turning or twisting the hands or arms" and "d4551: pushing". The statistical significant accuracy of the model confusion matrix in validation was 0.7381 (P=5.008e-13), and the AUC was 0.8406.

Conclusions: This study identified ICF items highly correlated with the FMA-UE and developed a statistically significant decision tree model for the assessing of upper limb dysfunction after stroke.

Clinical rehabilitation impact: The decision tree model based on key ICF items, substantially reduces evaluation time. It simplifies upper limb dysfunction assessment, enhances ICF application, and provides a simpler and more efficient assessment tool that represents a valuable addition to the clinical tool for stroke rehabilitation.