Journal of NeuroEngineering and Rehabilitation最新文献

Background: Spinal cord injury (SCI) results in devastating motor and sensory deficits below the level of injury. Transcutaneous spinal cord stimulation (tSCS) has emerged as a promising non-invasive neuromodulation technique for improving motor function in individuals with SCI. However, the effectiveness of tSCS for lower limb rehabilitation remains unclear.

Objective: To systematically review the effectiveness of tSCS for improving lower limb motor function, walking ability, spasticity, and functional independence in individuals with SCI.

Methods: We conducted a comprehensive search of PubMed, Web of Science, Embase, Scopus, CINAHL, MEDLINE, Cochrane Library, and Physiotherapy Evidence Database (PEDro) from inception to March 2025. We included randomized controlled trials (RCTs), non-randomized studies, and case series examining tSCS for lower limb rehabilitation in adults with SCI. Two reviewers independently screened studies, extracted data, and assessed risk of bias using appropriate tools (Cochrane RoB 2, ROBINS-I, JBI Critical Appraisal Checklist). We used GRADE to assess certainty of evidence.

Results: From 2042 identified records, 14 studies (n = 183 participants) met inclusion criteria, including 5 RCTs, 4 non-randomized studies, and 5 case series. Due to substantial clinical and methodological heterogeneity, we conducted a narrative synthesis. The single high-quality RCT (Comino-Suárez 2025) showed significant improvements in Lower Extremity Motor Score (LEMS) at follow-up (MD: 3.37, 95% CI: 0.29-6.46) and 10-meter walk test (10MWT) speed (MD: - 37.51 s, 95% CI: - 72.78 to - 2.23), but no significant effects on 6-minute walk test (6MWT) or spasticity. Most studies reported only mild adverse events (skin irritation, tingling). The certainty of evidence was very low for clinical outcomes and moderate for safety.

Conclusions: Current evidence suggests tSCS may improve lower limb motor function and walking speed in SCI, with a favorable safety profile. However, the evidence base has significant limitations including small sample sizes, heterogeneous protocols, and methodological concerns. Well-designed, adequately powered RCTs with standardized protocols are urgently needed.

Background: Aerobic cycle-training counters deconditioning and induces muscle and cardiorespiratory benefits in various neuromuscular disorders. However, its application to Duchenne muscular dystrophy (DMD) is limited due to lack of exercise prescription guidelines, particularly for intensity. A balance between beneficial versus harmful effects of muscle activity must be established given the weakness and concerns of contraction-induced damage inherent to DMD. Previous studies in DMD used motor-assisted cycling applying subjective ratings of perceived exertion to guide exercise intensity, whereas objective parameters such as heart rate (HR) or work performed were not reported. In efforts to develop exercise guidelines for DMD, we designed a motor-assisted cycle-exercise paradigm using closed-loop control of motor effort and individualization of intensity based on HR. Feasibility of this paradigm in DMD was tested in the home setting with remote clinical supervision.

Methods: A closed-loop controller was developed with user-defined saturation points for cadence and baseline motor inputs to ensure safety of cycling and adjustments in level of muscle overload (assistive current). The controller allowed remote, interactive adjustment of current based on HR biofeedback, providing cycling assistance when velocity approached a lower-bound and resistance when the upper-bound was approached. A target intensity of 40-50% HR reserve was individualized for each participant and motor effort was adjusted accordingly by the clinician. Force-sensors were embedded in the pedals for quantification of passive and active power.

Results: Six ambulatory boys with DMD (aged 7.7 ± 0.9 years) completed at least two bouts of cycling exercise (3-10 min per bout) with an average 0.53 ± 0.15 amps assistive current (range 0.3-0.8 amps). HR increased from rest during passive and active cycling (mean 109.2 ± 6.1; 119.2 ± 8.5; 149.7 ± 4.6 bpm respectively), where boys were actively exercising at 45% of HR reserve at an average cycling power of 5.7 ± 1.3 watts (ranging 3-8 watts depending on disease severity).

Conclusion: These results show for the first time that boys with DMD can cycle actively to generate power and raise HR to a prescribed intensity, supporting feasibility of this home-based, remotely-supervised control paradigm. They warrant future study to establish clinical exercise prescription parameters and the potential of aerobic cycling as a rehabilitative strategy in DMD.

Purpose: Extended reality (XR) and telerehabilitation (TR) technologies are increasingly being used into stroke rehabilitation. These technologies have the potential to enhance therapy intensity, motivate users through engaging and interactive environments, and improve access to rehabilitation services in both clinical and home settings. Usability assessment is essential to ensure effective, engaging, and accessible interventions. This scoping review aims to identify tools used to evaluate XR and TR technologies in stroke rehabilitation.

Materials and methods: This scoping review was conducted following the methodological framework of Arksey and O'Malley, further refined by Levac et al. and the Joanna Briggs Institute. A literature search was performed across five databases (MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) using keywords and their variations related to stroke, virtual reality, augmented reality, mixed reality, telerehabilitation, and usability evaluation. Peer-reviewed articles and conference abstracts published up to December 2024 were included if they reported on the usability evaluation of XR or TR technologies in neurological rehabilitation. Two reviewers independently screened studies for eligibility. Relevant data were extracted using a standardized data charting framework.

Results: The search yielded 2,290 articles, of which 111 were included in the review. Twenty-eight tools were identified, encompassing both direct usability assessments and complementary tools addressing related aspects. These tools were grouped into six categories: (1) standardized questionnaires, (2) custom questionnaires, (3) semi-structured interviews, (4) task-based usability testing, (5) modified standardized questionnaires, and (6) think-aloud protocols. The most frequently used tool was the System Usability Scale (SUS), followed by custom questionnaires. Among studies explicitly evaluating usability, 55.9% combined two to six tools to capture multiple facets of usability. Usability was assessed in 67.6% of publications using quantitative methods (e.g., questionnaires), in 4.5% using qualitative methods (e.g., interviews, focus groups), and in 27.9% using mixed methods approaches.

Conclusion: Usability of XR and TR technologies is assessed with a wide variety of tools. Combining tools helps capture different aspects of usability, highlighting the importance of addressing its multifaceted nature in stroke rehabilitation. Future research could develop and validate a framework integrating multiple aspects of usability to ensure both relevance and comparability across studies.