NeuroRehabilitation最新文献

BackgroundEffective engagement and motivation during balance training can be achieved through using technology such as virtual reality and promotes positive adaptation and neural plasticity.ObjectiveThe aim of the study was to explore the effect of gamified balance training using virtual reality on postural control in children with spastic diplegic cerebral palsy.MethodsFifty children with spastic diplegic cerebral palsy from both genders with ages ranged from six to twelve years old participated in this study. The participants were allocated randomly into two groups (n = 25). The control group (A); received conventional physical therapy programs based on neurodevelopmental technique including balance and gait training exercises, while the study group (B); received conventional physical therapy programs based on neurodevelopmental technique including balance and gait training exercises in addition to virtual reality balance training. All children were examined clinically pre- and post-treatment using HUMAC balance and tilt system to asses Limit of Stability (LOS), Center of Pressure (COP), and the Modified Clinical Test of Sensory Integration of Balance (mCTSIB).ResultsThere were significant improvements of all measured variables in both control and study groups with significant difference between groups in favor to the study group (p < 0.05).ConclusionGamified balance training using virtual reality has a beneficial effect on improving postural control in children with spastic diplegic cerebral palsy.

BackgroundAround 80% of stroke survivors experience upper-limb impairment during the acute phase, with 55% to 75% still affected after 6 months, hindering their daily activities. Consequently, upper-limb rehabilitation has become essential in post-stroke management, leading to innovative therapeutic methods. Despite the variety of available techniques, Mirror Therapy stands out as a feasible and cost-effective option alongside conventional physical therapy. This study aims to assess the impact of Mirror Therapy on improving motor and timed functional abilities of the upper extremities in chronic stroke patients in Saudi Arabia.MethodologyThis study was a prospective, randomized controlled trial, which was conducted at 3 Ministry of Health hospitals in Saudi Arabia with 38 chronic stroke patients randomly assigned into two treatment arms, experimental group (n = 19) and control group (n = 19). The study was registered in clinicaltrails.gov with the registration ID NCT06698380. The experimental group received 45 min of training three days a week for six weeks. The Fugl-Meyer Assessment Upper Extremity (FMA-UE) and Wolf Motor Function S Test (WMFT) were used as outcome measures. Pre- and post-intervention measurements were obtained.ResultsThe participants' average age was 54.97 ± 7.11 years, with an average height of 165.66 ± 11.21 cm, weight of 78.92 ± 18.96 kg, and BMI of 28.71 ± 6.19 kg/m². Among them, the majority of participants were male (68.4%), with ischemic strokes being the most prevalent type (73.7%). The FMA-US and WMFT scores showed significant improvement in the experimental group (p < 0.001) when compared to the control group.ConclusionMirror Therapy significantly enhances motor ability and timed functional activities in the upper extremity of chronic stroke patients.

BackgroundConventional stroke rehabilitation often suffers from low engagement and insufficient practice, whereas non-immersive game-based rehabilitation therapy (NI-GRT) offers a low-cost, accessible approach that may enhance motivation and recovery.ObjectiveThis systematic review aimed to evaluate the effects, modality-specific differences, and clinical feasibility of NI-GRT for lower extremity rehabilitation in stroke patients.MethodsLiterature searches (January 2020-March 2025) were conducted in PubMed, Wiley Online Library, Embase, and the Cochrane Library (PROSPERO, CRD420251125369). Eligible studies included adults with stroke receiving NI-GRT for lower extremity function. References were managed in EndNote 20, and extracted data organized in Microsoft Excel. Extracted variables included study, participant, and intervention characteristics, comparators, outcomes, adherence, and adverse events. Methodological quality was appraised using the Arbesman hierarchy, with risk of bias assessed by RoB 2 for randomized controlled trials (RCTs) and ROBINS-I for non-randomized trials (non-RCTs). Owing to heterogeneity in study design, protocols, measurement tools, and intervention durations, results were narratively synthesized, with subgroup analyses by severity, phase, modality, and training dose.ResultsSeven studies (3 RCTs, 1 non-RCT, 2 single-group, 1 case series) were included. Interventions encompassed advanced technologies, motion-sensor systems, commercial exergaming consoles, and non-digital board-game therapy, with training doses ranging from 10-26 h and adherence rates of 85-100%. Across modalities, NI-GRT consistently improved lower-extremity motor function, balance, and mobility, with several studies demonstrating large effect sizes or exceeding minimal clinically important differences. Benefits were observed across severity levels (severe to mild-moderate) and stroke phases (subacute and chronic). Moderate training exposure (13-20 h) yielded the most consistent gains. Reported adverse events were rare, and interventions were generally well tolerated.ConclusionsNI-GRT appears to be a safe, acceptable, and effective intervention for improving lower extremity function after stroke, with both advanced and low-cost modalities demonstrating therapeutic potential. While current evidence remains limited (with small sample sizes, variable study designs, and some inconsistency and imprecision), these findings provide a foundation for broader clinical application and highlight the need for large-scale trials to confirm efficacy and cost-effectiveness.

ObjectiveThe aim of this study was to evaluate the combined effect of motor imagery and action observation in context of functional rehabilitation and analyse their impact on different functional parameters.Data SourcesA systematic review and meta-analysis were conducted by means of bibliographic searches in the PubMed, Cochrane, Web of Science, Scopus, CINAHL, and PEDro databases until May 2025.Review MethodsRandomized clinical studies with participants older than 18 years with functional problems or limitations and combining action observation and motor imagery therapies were included. The Cochrane Risk of Bias (RoB) 2.0 tool, Covidence and R platform v4.4.2 were used to assess the quality of the included articles, selection of studies and data analysis, and meta-analysis. The protocol was registered in PROSPERO (No. CRD42024552072).ResultsNine articles were ultimately selected. The health conditions addressed included neurological and ageing-related disorders, as well as trauma. Compared with each therapy alone or with conventional therapies, the combination of motor imagery and action observation demonstrated benefits in lower and upper limb functionality, mobility, gait speed and fear of movement. Treatment protocols used varied in dosage (time and repetitions) and frequency (number of sessions per week).ConclusionsCombination of motor imagery and action observation therapies is beneficial for improving functionality, suggesting its potential value as an effective tool in the treatment of acute and chronic symptoms associated with various pathologies. However, clear standards regarding the dosages of these combined therapies are lacking.

BackgroundInterventions for unilateral neglect have involved various approaches, notably the integration of robotics into clinical practice.ObjectiveThis study examined the effects of Robotic Mirroring Training (RMTr) and Mirror Therapy with Robot (MTh-R) on unilateral neglect, activities of daily living (ADL), and depression, and compared the effectiveness of the two interventions.MethodsThis study was a randomized controlled trial. Twenty-four patients with subacute stroke were randomly assigned to either the RMTr group (n = 12) or the MTh-R group (n = 12). Both groups received 30-min sessions, three times per week for five weeks, using the same robotic glove (SY-HRE12, SYREBO): the mirroring function for the RMTr group and pre-programmed passive movements for the MTh-R group. Unilateral neglect was assessed using the Behavioral Inattention Test-Conventional (BIT-C) and the Korean Catherine Bergego Scale (K-CBS). ADLs were measured with the Korean version of the Modified Barthel Index (K-MBI), and depression was assessed using the Korean Short Form Geriatric Depression Scale (SGDS-K). Pre- and post-intervention scores and between-group differences were analyzed.ResultsBoth groups showed significant improvements in BIT-C and K-CBS scores (p < 0.01). The RMTr group demonstrated statistically significant improvements in K-MBI (p < 0.01) and SGDS-K (p < 0.01), while the MTh-R group showed significant improvements in K-MBI (p < 0.05) and SGDS-K (p < 0.01). These results indicate reduced unilateral neglect, enhanced ADL performance, and decreased depression in both groups. Significant between-group differences were observed in BIT-C (p < 0.01), K-CBS, and SGDS-K (p < 0.05), confirming the greater overall effectiveness of the interventions.ConclusionsWhile both interventions were effective, RMTr demonstrated greater efficacy in reducing unilateral neglect and depression.

BackgroundPost-stroke dysphagia is common but often overlooked, especially in patients aged ≥80 years, significantly impacting functional outcomes and quality of life. Despite advances in reperfusion therapies (RTs) for ischemic stroke, dysphagia remains prevalent among older adults. This study aimed to evaluate clinical characteristics and early functional outcomes of post-stroke dysphagia in older adults treated with RT.MethodsA cross-sectional, prospective study was conducted at Astghik Medical Center, Armenia, including 52 participants aged ≥80 years who received RT between January and December 2022. Dysphagia was assessed using the Gugging Swallowing Screen (GUSS) within 24 h after RT. Clinical outcomes, including mortality, dysphagia severity, and functional recovery, were evaluated at discharge and 3 months post-stroke using the modified Rankin Scale (mRS) and GUSS scores.ResultsOf the 52 participants, 32 (62%) developed dysphagia. Dysphagia was associated with higher NIHSS scores at admission (p = 0.03). The in-hospital mortality rate for those with dysphagia was 15.6%, with a 3-month mortality rate of 37%. Participants with dysphagia showed poorer functional recovery, with 41% achieving mRS scores of 0-2 at 3 months compared to 90% in the non-dysphagia group (p = 0.03). Two participants required nasogastric feeding, and 56.2% needed dietary modifications at discharge.ConclusionsPost-stroke dysphagia is prevalent in patients with ischemic stroke aged ≥80 years, affecting both acute and long-term outcomes. Early screening and multidisciplinary management, including swallowing therapy, are essential for improving functional recovery.

ObjectiveTo determine whether daily air stacking (AS) over 12 weeks improves cough effectiveness and pulmonary volumes in individuals with spinal cord injury (SCI).MethodsThis retrospective study analyzed the records of individuals with SCI who received AS training at the Los Coihues Clinic in Chile. Participants performed AS exercises five days per week for 12 weeks. Pulmonary function was assessed at baseline and after the intervention, including peak cough flow (PCF) in four conditions (spontaneous, with AS, with manually assisted cough [MAC], and combined AS + MAC), vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Paired t-tests were used to compare pre and post-intervention values, with significance at p < 0.05.ResultsTwenty individuals (19 men; mean age 38.8 ± 13.1 years) with cervical (85%) and thoracic (15%) SCI were included. Significant improvements were observed after 12 weeks in VC (2.41 ± 0.91 vs. 3.01 ± 1.06 L; p = 0.004), MIC (3.80 ± 0.96 vs. 4.48 ± 0.96 L; p = 0.006), MIP (71.2 ± 26.2 vs. 88.9 ± 26.5 cmH₂O; p < 0.001), and PCF in all conditions: spontaneous (p < 0.001), with AS (p = 0.03), with MAC (p = 0.02), and with combined AS + MAC (p = 0.02). No significant change was found in MEP.ConclusionsTwelve weeks of daily AS training significantly improved cough effectiveness and pulmonary function in individuals with SCI. These sustained improvements may enhance airway clearance and respiratory health in this population.

ObjectivesTo systematically review the effects of transcranial magnetic stimulation (TMS) on post-stroke dysphagia, focusing on stimulation mode, frequency, and target region.MethodsThis systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42025631286). We systematically searched PubMed, Cochrane Central, and Embase for RCTs on TMS for post-stroke dysphagia up to December 11, 2024. Meta-analysis was conducted using Stata 16, with heterogeneity assessed via the I² statistic. Subgroup and sensitivity analyses explored sources of heterogeneity. Risk of bias and study quality were evaluated using the Cochrane Risk of Bias 2.0 (RoB 2) tool and the Physiotherapy Evidence Database (PEDro) scale.ResultsThis meta-analysis included 14 RCTs with 882 stroke patients, assessing swallowing function using the Penetration-Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA), Functional Dysphagia Scale (FDS), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Functional Oral Intake Scale (FOIS). The results showed that TMS significantly improved swallowing function across all scales: PAS (MD = -1.32, 95% CI: -1.50 to -1.14, P < 0.001), SSA (MD = -1.97, 95% CI: -2.43 to -1.50, P < 0.001), FEDSS (MD = -0.65, 95% CI: -0.84 to -0.46, P < 0.001), FOIS (MD = 0.92, 95% CI: 0.72 to 1.13, P < 0.001), and FDS (MD = -5.54, 95% CI: -7.48 to -3.60, P < 0.001).ConclusionThis meta-analysis demonstrates that TMS significantly improves swallowing function in stroke patients, with consistent effects across scales, interventions, stimulation modes, and targets. However, variability in protocols and short follow-up periods may limit the generalizability of the findings.

ObjectiveTo examine the effect of heel elevation using a tilting plate on sit-to-stand performance in Parkinson's disease (PD) patients, evaluate the influence of different tilt angles, and identify clinical factors associated with this effect.MethodsThirty-six PD patients participated in a randomized crossover trial. Half started in a flat position, and half in a heel-elevated position, using three tilting angles. The time to complete five times sit-to-stand tests (FTSST) was measured under flat and heel-elevated conditions.ResultsThe fastest FTSST in the heel-elevated condition was reduced by a median decrease of 2.3 s and a median reduction of 14.0% when compared to the flat condition. Neither tilt angle nor ankle dorsiflexion range of motion was not associated with the reduction in FTSST duration. Multivariable regression analyses revealed that the time of FTSST under the flat condition and the standing subscale in the Unified Parkinson's Disease Rating Scale Part III exhibited significant positive associations with the observed shortening effects of FTSST induced by heel elevation.ConclusionsThe use of a heel-elevation intervention reduces the duration of transitioning from a seated to a standing position among patients with PD, particularly among those with a more pronounced disability. (UMIN000048428, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055160).

BackgroundStroke induced neuromuscular deficits, especially in core muscle strength, impair balance and gait, whereas Pilates exercises known to improve strength and postural control remain insufficiently studied in neurological stroke populations.ObjectiveEvaluated the effects of a 3-week Pilates program on balance control, muscle strength, and walking ability in patients with chronic stroke.MethodsSingle-blind, randomized controlled trial included 20 participants with chronic stroke who aged 45-65 years. Participants were randomly assigned into the experimental or the control groups receiving standard physical therapy. The experimental group, Pilates exercise program, comprised warm-up, 15 mat-based poses emphasizing controlled breathing and muscle engagement, followed by cool-down stretches and walking training, supervised by a physiotherapist for 60 min per day, 3 days per week, for 3 weeks. Time up and go test (TUGT), five time sit to stand (FTSST), and 10-meter walk test (10MWT) were conducted at baseline and after 3 weeks.ResultsAll participants in the Pilates exercise program were able to perform all exercise positions safely and statistically significant improved in balance, muscular strength, and walking ability compared to the control group (P < 0.001). Particularly, the TUGT showed a mean difference of 2.23 s (P < 0.001). In addition, improving in FTSST and 10MWT with a mean difference of 1.72 s and 0.15 m/s (P < 0.001) respectively.ConclusionsThe integration of Pilates methodologies within stroke rehabilitation protocols may functional ability as a safe, efficacious, and readily available complement to conventional therapeutic approaches, thereby facilitating functional rehabilitation.