European journal of physical and rehabilitation medicine最新文献

Background: Virtual reality (VR) has been demonstrated as an effective intervention for promoting motor recovery post-stroke. A self-directed game-based VR training can reduce manpower, but its safety and efficacy still need to be evaluated.

Aim: To evaluate the efficacy of a self-directed game-based VR program on upper-limb motor recovery in mild-to-moderate ischemic stroke patients.

Design: Randomized controlled trial.

Setting: Inpatient rehabilitation center.

Population: A total of 84 mild-to-moderate ischemic stroke patients with unilateral upper limb motor impairment were randomly allocated to the VR group (N.=42) and the control group (N.=42).

Methods: All participants underwent a standardized inpatient rehabilitation program. The VR group received an additional 20 minutes of user-centric VR training, while the control group engaged in an additional 20 minutes of conventional upper-limb training as a control training. The treatment plan was implemented for 6 days per week over a 4-week period.

Results: Blinded assessments at baseline (T0), post-intervention (T1) and 6-week follow-up (T2) revealed significant group-time interactions favoring the VR group in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE, P=0.001), elbow extension strength (MMT, P=0.038) and Barthel Index (BI, P=0.002), although no significant differences were observed in MMT scores for shoulder flexion/extension and elbow flexion (P=0.407/P=0.573, P=0.407). Notably, significantly more patients in the VR group achieved the FMA-UE MCID (≥9 points) than controls (44.7% vs. 2.6%, P<0.001), with moderate stroke patients deriving the greatest benefit. Post-intervention usability metrics demonstrated high system acceptability (SUS: 75.07±7.20), minimal simulator sickness (SSQ=3.74 [0.00, 3.74]) and positive exercise motivation (BREQ-2 RAI: 15.79±3.80).

Conclusions: The findings indicate that integrating self-directed VR games into conventional rehabilitation enhances upper-limb functional recovery and independence in mild-to-moderate ischemic stroke patients, with sustained effects at 6 weeks. This facilitated clinically meaningful improvements, particularly in patients with moderate baseline impairment. Although safe and engaging, the program may require targeted approaches for specific joint movements. Further studies should explore long-term outcomes and optimal implementation protocols.

Clinical rehabilitation impact: Self-directed game-based VR games with conventional therapy enhance upper-limb functional recovery and independence in mild-to-moderate stroke patients, offering a scalable solution for inpatient rehabilitation.

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.