Background: Visuospatial function is a core domain of functional cognition in stroke. Post-stroke cognitive impairment disrupts rehabilitation practice, highlighting the importance of characterizing patients with higher-order visuospatial dysfunction to inform personalized rehabilitation strategies. Although neuroimaging offers insights into disease-related mechanisms, its clinical application remains limited.
Aim: The aim of this paper was to investigate whether the residual resting-state functional connectivity supports higher-order visuospatial function after stroke and whether changes in connectivity can characterize patients with visuospatial dysfunction.
Design: Observational study.
Setting: Inpatient rehabilitation ward at Fujita Health University Hospital in Japan.
Population: Fifty-eight patients with stroke.
Methods: Visuospatial analogical reasoning was assessed using Raven's Colored Progressive Matrices (RCPM). Resting-state functional connectivity was evaluated using functional magnetic resonance imaging (fMRI). Empirical covariance matrices and group-sparse inverse covariance (GSIC) matrices were computed from the fMRI data, with the latter negated to estimate partial correlations representing direct connectivity. Correlations between connectivity measures and RCPM scores were analyzed, alongside data-driven clustering to stratify patients.
Results: No significant correlation was found between empirical covariance connectivity and RCPM scores. However, GSIC-based analysis revealed a significant inverse correlation between connectivity of the posteromedial and the left inferior parietal cortex and RCPM scores. Higher parietal connectivity was associated with lower RCPM performance. Patients in the highest connectivity cluster exhibited severe impairments in visuospatial analogical reasoning, particularly in tasks requiring the integration of discrete figures into spatially related wholes. The lesions in these patients were predominantly localized in the left subcortex.
Conclusions: Medio-lateral parietal connectivity may underlie visuospatial analogical reasoning after stroke.
Clinical rehabilitation impact: Clustering analysis highlighted a distinct pattern of low scores in patients with increased parietal connectivity, suggesting that parietal connectivity changes have the potential for characterizing patients with severe dysfunction.
Introduction: Chronic low back pain (CLBP) is a common disabling condition, inflicting a substantial socioeconomic burden. Given its association with neuroplastic changes, as evidenced by central and peripheral sensitization, neuromodulatory techniques such as transcranial direct current stimulation (tDCS) have emerged as potential treatments. This scoping review aimed to identify and map the existing literature on tDCS studies for CLBP to provide insight into how these studies are conducted, and to address their potential gaps in knowledge.
Evidence acquisition: PubMed, Embase, Web of Science, and Cochrane Library were searched for relevant studies from inception to 23 March 2025. Eligible studies included were those examining tDCS alone or with other interventions in adults with CLBP, regardless of the outcome evaluated and included adults with CLBP. The review was conducted using Arksey and O'Malley's six-stage framework and was guided by the PRISMA for scoping review framework.
Evidence synthesis: Of 134 screened records, 26 studies were included: 23 randomized controlled trials and 3 quasi-experimental studies. Half of the studies (50%) had a low risk of bias while one-third (34.6%) showed a high or serious risk of bias. Outcomes evaluated varied and included clinical, biophysical, biomechanical, and psychosocial measures. There was considerable variability in tDCS treatment protocols across studies. The effectiveness of tDCS was inconsistent, particularly for clinical outcomes, with some studies indicating positive effects while others reported no significant effects.
Conclusions: Overall, this review reveals inconsistent results for tDCS effectiveness in CLBP, likely due to variability in study designs, sample characteristics, treatment protocols, and outcome measures. Future well-designed trials are needed to clarify the therapeutic potential of tDCS for CLBP, particularly in combination with other interventions.
Background: Stroke is a leading cause of death and disability, with up to half of people with stroke developing persistent cognitive deficits. The brief memory and executive test (BMET) was developed to provide a comprehensive cognitive assessment, with a focus on executive function and processing speed. However, the psychometric properties of the BMET have not yet been studied in people with stroke.
Aim: This study aimed to: 1) translate and culturally adapt the BMET into Chinese (Cantonese) (C-BMET); 2) compare the C-BMET scores of people with stroke with those of healthy old adults; 3) examine the internal consistency, test-retest reliability, minimal detectable change (MDC), and standard error of measurement (SEM) of the C-BMET in people with stroke; 4) investigate correlations between C-BMET scores and other cognitive and functional outcomes; and 5) determine the C-BMET cut-off score of C-BMET to differentiate the cognitive functions in people with stroke from that of healthy old adults.
Design: Cross-sectional.
Setting: Research lab in the Hong Kong Polytechnic University.
Population: People with stroke over 12 months.
Methods: Sixty people with stroke and 27 healthy old adults underwent C-BMET and other cognitive and functional outcomes. To examine the test-retest reliability of the C-BMET, it was re-administered to the stroke group after 7 days.
Results: People with stroke had significantly lower C-BMET subtotal and total scores compared to healthy old adults. The internal consistency, as indicated by Cronbach's α of 0.652, and the test-retest reliability, reflected by an intra-class correlation coefficient of 0.604, were observed, with an MDC of 4.13 and a SEM of 1.49. The C-BMET scores were significantly correlated with other cognitive outcomes but not with functional outcomes. The optimal cut-off score of C-BMET to differentiate the cognitive functions in people with stroke from that of the and healthy old adults was 12.5 (area under the receiver operating characteristic curve = 0.728).
Conclusions: The C-BMET scores were significantly lower in people with stroke compared with healthy old adults. The internal consistency and test-retest reliability of C-BMET scores were investigated. The C-BMET scores were significantly correlated with cognitive outcomes. The optimal C-BMET cut-off score of 12.5 was identified.
Clinical rehabilitation impact: The C-BMET may be considered for assessing the cognitive function, especially executive function and processing speed, of people with stroke.
Background and aim: The aims of this study were to investigate the psychometric property of the Comprehensive Coordination Scale (CCS) in people with stroke.
Design: Cross-sectional design.
Setting: University based neurorehabilitation laboratory.
Population: Sixty-two people with stroke (33 men; mean ages=67.1±6.4 years; 8.8±4.9 years) and 31 healthy older adults (10 men, mean ages=65.9±4.2 years).
Methods: CCS was conducted on the subjects, followed with ARAT, BBS, LOS, MoCA, and SF-12muscle strength test, Fugl-Meyer Assessment of Lower Extremity (FMA-LE) and Upper Extremity (FMA-UE), muscle strength, Montreal Cognitive Assessment (MoCA), Action Research Arm Test (ARAT), Berg Balance Scale (BBS), Limit of Stability (LOS) test and 12-Item Short Form Survey (SF12).
Results: There was a significant difference (P<0.001) of CCS score between people with stroke (mean difference=48.0±13.5) and healthy older adults (mean difference=62.9±12.1). CCS showed excellent test-retest reliability (intraclass correlation coefficient (ICC)=0.953). The CCS-Total Score showed a significant positive correlation with the average muscle strength of affected side (dorsiflexors, plantarflexors, elbow flexor, and elbow extensor), FMA-UE score, FMA-LE Score, BBS Score, ARAT Score, and LOS (EE and ME) (r=0.387-0.857, P<0.007) in this study. The CCS-total score of 62.5 (sensitivity 83.9%; specificity of 83.9%; AUC=0.892, P<0.001) was shown to distinguish the walking performance between people with stroke and healthy older adults.
Conclusions: The CCS is a reliable, valid and objective assessment tool for evaluating the motor coordination in people with stroke. The CCS exhibited good diagnostic power for distinguishing the coordination ability of individuals with stroke from that of healthy older adults.
Clinical rehabilitation impact: Therefore, the CCS is recommended for use in clinical settings to provide a detailed and comprehensive assessment of motor coordination impairment in stroke survivors.
Background: Patients with type 2 diabetes mellitus (T2DM) have enhanced fracture risk despite high bone mineral density (BMD), a phenomenon known as the diabetic bone paradox. Consistently with the paradox, hip fractures occur at higher BMD in women with T2DM than in controls. However, no studies have addressed BMD in women with T2DM who have prevalent vertebral fractures at the time of their first hip fracture.
Aim: The aim of this study was to test the hypothesis that BMD levels could be higher in the hip-fracture women with versus without T2DM in the absence but not in the presence of prevalent vertebral fractures.
Design: This was a cross-sectional study.
Setting: The research took place in a rehabilitation ward.
Population: The study involved women who were undergoing inpatient rehabilitation following a subacute hip fracture.
Methods: We investigated hip-fracture women with and without prevalent vertebral fractures, consecutively admitted to our rehabilitation ward. At a median of 19 days after the hip fracture we assessed femoral BMD by dual-energy X-ray absorptiometry and prevalent vertebral fractures by X-ray examination.
Results: The study sample included 504 women. One hundred eighty-five of the 504 had no vertebral fractures whereas 319 had at least one spine fracture. The 185 women without vertebral fractures had BMD higher in the presence (N.=29) than in the absence (N.=156) of T2DM (mean T-score difference was 0.67, 95% confidence interval (CI) from 0.31 to 1.03, P<0.001). After adjustment for 8 potential confounders, the odds ratio to have densitometric osteoporosis for a woman without T2DM was 3.21 (95% CI from 1.10 to 9.33, P=0.032). On the contrary, in the 319 women with vertebral fractures T2DM was not associated with BMD.
Conclusions: At the time of an original hip fracture, we found a BMD gap between women with and without T2DM in the absence but not in the presence of prevalent vertebral fractures.
Clinical rehabilitation impact: Adjustments of fracture risk calculation in T2DM have been authoritatively suggested, because high BMD levels may falsely lead to risk underestimation. Our data suggests that no adjustments may be needed for the risk estimation in patients with prevalent vertebral fractures. Further data from longitudinal studies are needed to define the role of both prevalent vertebral fractures and BMD in fracture risk of patients with T2DM.
Background: There is growing awareness that traumatic brain injury (TBI) can have a significant and troublesome impact of a person's self-identity, yet few measurement tools exist to clinically evaluate this.
Aim: The aim of this paper was to develop a patient-reported measure of strength of self-identity after TBI - the Brain Injury Sense of Self Scale (BISOSS).
Design: Measurement development and validation.
Setting: UK and New Zealand communities.
Population: One hundred and thirty-six people with TBI (68.4% [93/136]) male; mean age 47.9 years, SD 13.0 years; mean time post-TBI 11.2 years, SD 11.1 years; 74.3% (101/136) moderate to severe TBI).
Methods: Preliminary measurement items were generated from prior qualitative research, a concept analysis, and cognitive interviewing with survivors of TBI. Administration of the draft BISOSS, the Glasgow Outcome Scale, and the Sense of Coherence Scale to participants - with factor analysis, Rasch analysis, and construct validity testing to refine and test the draft BISOSS.
Results: After iterative refinements using the Rasch model to help guide item adjustments, BISOSS was comprised of three subscales (egocentric self, sociocentric self, and relational self), each which fit the Rasch model and demonstrated unidimensionality, adequate precision, absence of differential item functioning and adequate person separation index. BISOSS scores correlated well with employment status, leisure activities and positive family relationships. Participants' responses supported the notion that problems with self-identity were commonplace after TBI, with 40% of respondents self-reporting such problems.
Conclusions: BISOSS is a valid measure, which conforms to measurement expectations for an interval scale and is in grounded in the language of people with TBI. It is now available as a validated tool for assessing self-identity issues post-TBI. Further work is required to assess whether the scale can change over time or is responsive to interventions targeted at strengthening self-identity.
Clinical rehabilitation impact: Change in self-identity is a commonplace problem following TBI but is seldomly evaluated in clinical practice. BISOSS can be used to explore patient experiences of problems with self-identity after TBI and will help further our understanding of this phenomenon.
Aim: To investigate neck pain prevalence and risk factors pain in China.
Design: Cross-sectional analysis using data from the China Health and Retirement Longitudinal Study.
Setting: Nationwide study conducted in China.
Population: Adults aged 45 years or older.
Methods: The data for the study were from the China Health and Retirement Longitudinal Study. A total of 19816 representative subjects were selected by multi-stage stratified sampling method. Univariable and multivariable logistic regression analyses were conducted to identify potential risk factors for neck pain.
Results: The estimated prevalence of neck pain among Chinese people over 45 was 18.93% (95% CI 18.32-19.55). Neck pain prevalence significantly differed according to sex, with an overall rate of 12.26% in men and 25.04% in women (P<0.001 for sex difference). Risk factors for neck pain included female (odds ratio [OR] 1.83, 95% CI 1.61-2.08), depression (1.23, 1.06-1.42), short sleep time (1.48,1.31-1.68), more than one chronic condition (1.18, 1.04-1.35), headache (4.83, 4.28-5.47), poor health status (2.93, 2.18-3.92), limitation of physical activity (1.37,1.21-1.57) and activity of daily living (1.48, 1.31-1.68). A lower risk of neck pain was associated with age over 75 and illiterate.
Conclusions: The Prevalence of neck pain in China is relatively high. These results may help to develop proper prevention and treatment measures for patients with neck pain.
Clinical rehabilitation impact: Our study provides insights for rehabilitating neck pain in adults aged 45 or older, aiding targeted interventions and preventive measures.
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