NeuroRehabilitation最新文献

ObjectiveIndividuals with stroke frequently experience limitations in activities of daily living, and compensation-based approaches have the potential to enhance functional adaptation. This study aimed to develop and evaluate the feasibility and preliminary effects of a novel intervention, Compensation-Based Problem-Solving Therapy (CBPST), on participation and activities of daily living in individuals with stroke.MethodsCBPST was developed by trained occupational therapists, emphasizing in Occupational Adaptation Model and compensatory strategies. The CBPST was delivered individually in five sessions weekly (during four week and approximately 40 min)and including identifying the problem, developing strategies, selecting strategy and implementing and evaluating the selected strategy. Participants were randomly assigned to intervention or control group. This study involved 50 individuals with stroke assigned to either an intervention (n = 24 and mean age 54.58 ± 7.86) or control group (n = 26 and mean age 54.56 ± 7.09). Outcomes were assessed at baseline and immediately post-intervention using the Functional Independence Measure (FIM), Lawton-Brody Instrumental Activities of Daily Living (Lawton-Brody IADL), Frenchay Activity Indeks (FAI) and the Canadian Occupational Performance Measure (COPM). Statistical analyses included Wilcoxon signed-rank, Mann-Whitney U tests and effect sizes.ResultsBoth groups showed significant improvements (p < 0.05) in participation and activities of daily living. Effect size estimates in the intervention group indicated moderate to large clinical effects across outcome measures (COPM performance and satisfaction: 0.62; FIM: 0.62; Lawton-Brody IADL: 0.53; FAI: 0.55), supporting the preliminary efficacy of CBPST.ConclusionCBPST appears to be a feasible and promising approach to enhance adaptive participation after stroke by integrating problem-solving and compensatory strategies. Larger studies are warranted to confirm its clinical effectiveness.

BackgroundThe upper extremity functional recovery remains a major challenge for specialists during post stroke rehabilitation, pertaining to adoption of various compensatory strategies by patients leading to motor redundancy and persistent functional limitations.ObjectivesThe study aimed to evaluate the effectiveness of Patient Tailored-Modified Constraint Induced Movement Therapy (mCIMT) combined with Trunk Restraint (TR) on Upper Extremity motor ability, balance, and health-related quality of life (HR-QOL) in chronic stroke survivors.MethodsIn this patient-blinded trial, 34 voluntary patients with chronic hemiplegia (>6 months post-stroke), aged 45-65 years, with Mini-Mental State Examination (MMSE) scores > 24 having and spasticity graded 1 or 1 + on Modified Ashworth Scale (MAS), were recruited and randomly allocated (1:1) to experimental or control groups. The experimental group received 60 min of Conventional Physical Therapy (CPT) plus 120 min of mCIMT with TR, while the control group received CPT treatment alone, three sessions per week for six consecutive weeks. Outcomes were assessed pre- and post-intervention using the Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), and Stroke Specific Quality of Life Scale (SS-QOL).ResultsBoth groups demonstrated significant improvements from baseline to post-intervention (p < 0.01) across all outcome measures. However, the experimental group exhibited significantly greater gains in functional ability, as reflected by SS-QOL scores (p < 0.005), compared to the control group.ConclusionEighteen sessions of mCIMT along with TR, delivered over six weeks in combination with CPT, demonstrated significant improvements in all outcomes (WMFT, BBS, and SS-QOL) among chronic stroke patients and is as beneficial to individual rehabilitation as conventional therapy alone.Trial registry name and URL: ClinicalTrails.gov (Registration ID: NCT06692569).

BackgroundSpasticity is a stretch reflex disorder, clinically characterized by increase in muscle tone and is often seen in upper motor neuron lesions, which can limit function in daily activities. While botulinum toxin injections are widely used treatment option, nerve blocks may offer complementary or alternative benefits.ObjectiveTo evaluate the indications, techniques, and clinical outcomes of nerve blocks for spasticity management.MethodsA literature search of major databases from July 2000- July 2025, identified studies on diagnostic nerve blocks, therapeutic neurolysis, and cryoneurolysis. Fourteen studies met inclusion criteria. Extracted data included patient characteristics, targeted nerves, agents and volumes, imaging guidance, tone reduction, functional outcomes, predictive value for BoNT, and adverse events. Due to heterogeneity in outcomes and methodologies, results were narratively synthesized.ResultsDiagnostic nerve blocks consistently aided treatment planning; one case-control study showed higher goal attainment (≈70% vs 40%) when diagnostic blocks guided BoNT injections. Phenol or alcohol neurolysis and cryoneurolysis produced meaningful spasticity reduction, typically improving Modified Ashworth Scale scores by 1-2 grades with effects lasting 3-6 months, often longer than BoNT. Across modalities, adverse events were uncommon and generally mild, most often transient pain or dysaesthesia. Publication trends showed increased use of ultrasound guidance and greater interest in diagnostic blocks and cryoneurolysis after 2018.ConclusionNerve Blocks are effective yet underused techniques that can provide rapid and sometimes durable spasticity reduction and support individualized long term rehabilitationplanning. Further standardized, long-term studies are needed to optimize their integration into multimodal spasticity care.

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation therapy used to improve lower extremity motor function in patients with spinal cord injury (SCI). However, its efficacy remains inconsistent.ObjectiveThis meta-analysis aimed to comprehensively assess the effectiveness and safety of rTMS for lower extremity motor function, spasticity, and walking ability in SCI patients.MethodsUp to April 30, 2025, randomized controlled trials (RCTs) were searched by PubMed, Web of Science, MEDLINE, Ovid, and the Cochrane Central Register of Controlled Trials. Primary outcomes were Lower Extremity Motor Score (LEMS) and Lower Modified Ashworth Scale (LMAS); secondary outcomes included Spinal Cord Assessment Tool for Spasticity (SCATS), Hmax/Mmax amplitude ratio (H/M ratio), 10-Meter Walking Test (10 WMT), Walking Index for Spinal Cord Injury-II (WISCI-II), and gait velocity. Subgroup analyses were performed by injury duration.ResultsFifteen RCTs (260 participants) were included. rTMS significantly improved lower extremity strength measured by LEMS (SMD = 0.98, 95% CI = 0.61 to 1.36, P < 0.00001) regardless of injury duration and decrease spasticity measured by LMAS (SMD = -0.46, 95% CI = -0.85 to -0.08, P = 0.02). No significant changes were found for spasticity assessed by SCATS or H/M ratio, or for walking outcomes (10MWT, WISCI-II, gait velocity).ConclusionrTMS effectively enhances muscle strength and reduces spasticity in SCI patients, but its impact on walking ability is limited. Further high-quality trials are needed to confirm these findings.

BackgroundPost-stroke spasticity (PSS) arises from central neural hyperexcitability and maladaptive muscle architectural changes that impair motor function. Interventions targeting both mechanisms is essential to support adaptive neural reorganization.ObjectiveTo investigate the combined effects of extracorporeal shockwave therapy (ESWT) and a neuroplasticity-based training protocol (NBTP) on lower limb spasticity, muscle architecture, and motor function in stroke patients.MethodsThis was a sham-controlled, double-blind, randomized controlled trial. Fifty-four patients with post-stroke spasticity (PSS) were randomly assigned to receive either ESWT combined with a NBTP, or to sham ESWT with NBTP . Participants received six weekly sessions of ESWT (1,500 shocks at 5 Hz, 0.10 mJ/mm²) targeting the gastrocnemius muscle, alongside a 12-week NBTP comprising mirror therapy, resistance and aerobic training, motor imagery, and task-specific activities. Outcome assessments were conducted at baseline, 6^th week, and 12^th week using the Modified Ashworth Scale (MAS), passive range of motion (PROM), and the Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Ultrasonographic evaluations included measurements of muscle thickness (MT), muscle fascicle length (MFL), and pennation angle (PA).ResultsAt the 12th week, the experimental group showed significantly greater improvements than controls in MAS (MD = 0.88; p < 0.001), PROM (MD = -6.72; p < 0.001), and FMA-LE (MD = -1.55; p < 0.001). RMI also improved moderatly (MD = -1.04; p = 0.03). Ultrasonographic parameters improved in both groups, with a significant difference observed only in PA and MT (p < 0.05).ConclusionESWT combined with NBTP yielded superior functional and structural outcomes compared with NBTP, supporting this integrative approach as a clinically relevant post-stroke intervention.Trial registration numberTrial was submitted on http://clinicaltrials.gov (registration no. NCT05405140).

BackgroundThe Supine-to-Stand Test (SST) evaluates muscle strength, flexibility, and dynamic balance. It may serve as a global measure of functional movement ability in patients with Multiple Sclerosis (pwMS).ObjectiveTo investigate the validity and reliability of the SST in pwMS.MethodsThirty-four pwMS (mean EDSS score: 4.80 ± 1.13) participated in this cross-sectional observational study. Ankle plantar and dorsiflexor muscle strength was measured using a digital hand dynamometer. Manual dexterity, balance, endurance, and functional mobility were assessed using the 9-Hole Peg Test (9HPT), the Berg Balance Scale (BBS), the Six-Minute Walk Test (6MWT), and the Timed Up and Go test (TUG), respectively. The Activity-specific Balance Confidence (ABC) scale was used to identify fear of falling. Quality of life was evaluated using the Multiple Sclerosis Quality of Life-54 (MSQOL-54). Test-retest reliability was determined using the intraclass correlation coefficient (ICC).ResultsThe SST demonstrated excellent test-retest reliability (ICC = 0.984, 95% CI 0.801-0.995). SST performance was moderately correlated with BBS (r = -0.547, p = 0.001), TUG (r = 0.619, p < 0.001), and 6MWT (r = -0.642, p < 0.001). A moderate correlation was found between plantar flexor strength on the dominant side and SST (r = 0.349, p = 0.043), whereas no significant correlation was observed for the non-dominant side or dorsiflexor strength bilaterally (p > 0.05). SST was not correlated with 9HPT bilaterally or MSQOL-54 (p > 0.05).ConclusionsThe SST is a reliable and valid tool for assessing functional movement ability in pwMS. Its significant correlations with established balance and mobility measures suggest that it may contribute to clinical decision-making, particularly in evaluating fall risk and predicting walking independence in patients with moderate disability (EDSS scores 4-6).

BackgroundStroke often results in upper limb motor impairment and activity limitation, however terminology to describe severity levels vary. This hinders data pooling from clinical trials to inform practice. There are no reviews that have synthesized severity levels of stroke-related upper limb motor impairment or activity limitation.ObjectiveTo systematically review published literature on descriptors of severity levels for post-stroke upper limb motor impairment and activity limitation.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched eight major databases. Inclusion criteria: primary research studies, adults post-stroke, severity of upper limb motor impairment and/or activity limitation described. We classified included papers by assessing descriptor precision: 'green' (studies including descriptors that used recommended outcome measures, cut-offs or central tendency and dispersion), 'red' (descriptors only), and 'amber' (remaining studies). Of the 'green' studies, we identified the most commonly reported descriptors and measures, and computed cut-off scores using non-parametric statistics.ResultsFrom 17,273 records, 750 studies were included. The most commonly used severity descriptors were 'mild, and/or moderate, and/or severe,' used in 580 (77%) of studies. For the Fugl-Meyer Assessment (Upper Extremity) (57 studies, 8% of the total number of studies included), 'severe' ranged from 0 to 25, 'moderate' from 26 to 50, and 'mild' from 51 to 66. Limited data from the remaining studies prevented further analysis.ConclusionsOur review highlights a lack of standardization of the operationalization of 'severity' of post-stroke upper limb motor impairment and activity limitation. It provides a foundation for developing a standardized clinical language to describe severity levels to improve research and clinical practice.

BackgroundHealth literacy, which enables patients to effectively navigate the healthcare system, is associated with improved patient outcomes. Patients with traumatic brain injury (TBI) may be uniquely susceptible to gaps in health literacy and access to care, particularly for those of vulnerable socioeconomic status.MethodsUsing the National Institutes of Health's (NIH) All of Us Research Program, we analyzed survey responses among matched participants with and without TBI (N = 2,330 and N = 11,562, respectively) via nearest-neighbor propensity score matching. Chi-squared tests compared responses between racial/ethnic and income groups among those with TBI. Multivariable binary and logistic regression compared responses between matched participants with and without TBI.ResultsRespondents with TBI were more likely to report issues related to health literacy and financial barriers to care. Multivariable analyses revealed participants with TBI reported increased difficulty understanding medical forms (OR 1.31, 95% CI 1.18-1.45, P < 0.001) and difficulty affording emergency care (OR 1.55, 95% CI 1.26-1.90, P < 0.001) when compared to those without TBI.ConclusionRespondents with history of TBI, per electronic health records, are more likely to report issues pertaining to health literacy and access to care. Among those with TBI, historically underserved populations are also more likely to report issues relating to health literacy and financial barriers to care, though TBI did not consistently modify the effects of race/ethnicity or income. Multidisciplinary efforts to address these limitations are necessary.

BackgroundCurrent practice guidelines recommend 70-85% age-predicted heart rate (HR) max attainment and high walking dosages for ambulatory persons with chronic stroke. The evidence to support target heart rate attainment and walking dosage on gait speed for persons post stroke with severe balance impairments has been limited during inpatient rehabilitation.ObjectivesTo examine the relationship between 70% HR max attainment, walking distance (≥304.8 meters), and minimum detectable changes (MDC) in gait speed for persons post stroke who have severe balance impairment on admission to inpatient rehabilitation.MethodsRetrospective observational cohort study examining 70% HR max heart rate attainment during locomotor training for 244 persons post stroke with severe balance impairment (BERG Balance Scale ≤ 6/56) during inpatient rehabilitation and its association with the minimum detectable change (MDC) for the 10-meter walk test (10 MWT).Results164/244 persons post stroke achieved 70% HR max and this was significantly associated with MDC in gait speed (odds ratio 2.64, CI: 1.41-5.08). Preserved sitting balance (BERG Balance Scale 4-6/56) on admission was positively associated with meaningful gait speed changes (odds ratio 1.36, CI: 1.15-1.64). Walking distance was not positively associated with gait speed.ConclusionTwo-thirds of persons post stroke with severe balance impairment on admission to inpatient rehabilitation were able to achieve target heart rate. When this heart rate is achieved, meaningful changes in gait speed are likely to occur. Additionally, persons post stroke with preserved sitting balance are more likely to achieve meaningful improvements in gait speed.

BackgroundPostural control in children with non-progressive brain injury (NPBI), such as cerebral palsy, is often impaired due to deficits in vestibular and somatosensory integration. While static balance has been studied, few have assessed how these children perceive anterior-posterior dynamic tilt and how this sensory dependance differs from children with typically developing (TD).ObjectiveThis study aimed to examine how visual input and foot pressure influence anterior-posterior dynamic balance perception in children with NPBI, aiming to predict their consequences for postural control strategies and to characterize their sensory-motor integration compared to children with TD.MethodsThirteen children with NPBI and fifteen children with TD performed ascending and descending tilt tasks on an anterior-posterior dynamic tilt table under visual input (VI) and visual blocking (VB) conditions. Stopping angles and perception errors were recorded. Static balance was assessed using foot pressure distribution and vestibular sway on a force plate. Wilcoxon signed-rank and Mann-Whitney U tests compared conditions, and Spearman's rank correlation examined associations among variables.ResultsChildren with NPBI showed significant differences between VI and VB across dynamic tasks (p < 0.05), while children with TD differed only in ascending trials. Vestibular sway was unaffected by vision. Between-group comparisons revealed greater errors during descending tasks and reduced heel pressure in children with NPBI. Higher forefoot pressure correlated with increased sway, and lower heel pressure with greater postural displacement.ConclusionChildren with NPBI rely more on visual input for anterior-posterior dynamic balance, especially during posterior tilt. The findings support interventions promoting sensory reweighting and heel contact to improve stability.