NeuroRehabilitation最新文献

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).

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.

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.

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.

BackgroundChildren with hemiparetic cerebral palsy (Hemi-CP) often face challenges in strength and function, limiting participation in daily activities. While plyometric exercise (Plyo-Ex) has shown promise in improving neuromuscular performance in other populations, its applications in pediatric neurorehabilitation remains understudies.ObjectiveTo assess whether a 12-week Plyo-Ex program could elicit meaningful improvement in muscle strength and upper extremity function in children with Hemi-CP.MethodsA prospective, randomized controlled trial involving 58 children with Hemi-CP was conducted. Participants were assigned to either a Plyo-Ex group or a control group receiving standard exercise approaches. The Plyo-Ex group completed supervised upper-extremity-oriented Ply-o-Ex program (∼45 min, twice weekly for 12 weeks), with at least 48 h between sessions. Measurements at the baseline and post-treatment included muscle strength (shoulder flexors, external rotators, abductors, elbow extensors, and wrist extensors), unilateral upper extremity function (movement quality, spontaneity, dynamic segmental alignment, and grasp-release capability), and bimanual hand function.ResultsCompared to the control group, the Plyo-Ex group demonstrated significant moderate-to-large increases in muscle strength across all tested muscle (all P < 0.05; η²p = 0.07-0.18). Improvements were also seen in unilateral upper extremity function [quality of function (P = 0.006, η²p = 0.13), spontaneity (P = 0.003, η²p = 0.14), dynamic segmental alignment (P = 0.018, η²p = 0.10), and grasp-release capability (P = 0.033, η²p = 0.08)] as well as the bimanual hand function (P = 0.004, η²p = 0.14).ConclusionsEvidence from this trial indicates that Plyo-Ex may serve as a viable intervention to enhance upper extremity strength and function in children with Hemi-CP. Rehabilitation professionals may consider adopting this modality as part of a comprehensive, evidence-based therapeutic plan.Trial RegistrationClinicalTrial.gov (Identifier: NCT06980246).

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.

BackgroundIndividuals with neurologic impairment, such as brain injury, are more likely to have autonomic dysfunction, including POTS, but often experience a lack of treatment options and access to quality care.ObjectiveExamine the feasibility and outcomes of a group-based multimodal rehabilitation training program.MethodsNineteen females, ages 18-53 (M = 28.6) completed the outpatient training program. The intervention included eight 50-min weekly sessions using an interdisciplinary, multimodal approach, including education, movement, and mindful self-compassion. Participants completed demographic and medical history and assessment for baseline orthostatic intolerance. At pre-training, post-training, and follow-up, participants completed the Modified Fatigue Impact Scale (MFIS), Lower Extremity Functional Scale (LEFS), Rand 36-Item Health Survey 1.0 (RAND-36), Trail Making Test (A and B) (TMT-A, TMT-B), 10-Meter Walk Test (10MWT), and grip strength testing.ResultsAt baseline, participants were significantly below norms in daily function (p < 0.001), grip strength (p ≤ 0.001) gait speed (p < 0.001), fatigue (p < 0.001), and quality of life (p < 0.001). Between pre-training and follow-up, participants showed significant improvement across function in daily life tasks (p < 0.01); grip strength in the dominant (p < 0.01) and non-dominant (p < 0.01) hands; gait speed (p < 0.05); levels of fatigue (p < 0.05); cognitive performance (p < 0.05); and quality of life (p < 0.05).ConclusionIndividuals with POTS face functional challenges that can be significantly and objectively improved through multimodal rehabilitation. There is a need for provider education and further research to optimize care and quality of life for individuals with POTS.

BackgroundNeurological disorders such as stroke, cerebral palsy, Parkinson's disease, and multiple sclerosis frequently cause sensorimotor impairments, limiting independence and quality of life. Pressure garments (PGs), originally designed for burn and vascular conditions, have gained interest in neurorehabilitation for enhancing proprioceptive input and neuromuscular modulation. However, their scope and effectiveness remain unclear.ObjectiveTo map current literature on the application of PGs in neurological disorders and evaluate their effects on sensorimotor function.MethodsA scoping review was conducted following the Arksey and O'Malley framework and PRISMA-ScR guidelines. Five databases and grey literature were searched up to February 2025. Included studies involved PGs used in neurological conditions and reported at least one sensory or motor outcome.ResultsTwenty-three studies were included, covering stroke (n = 7), cerebral palsy (n = 12), multiple sclerosis (n = 3), and Parkinson's disease (n = 1). PGs showed potential benefits in improving proprioception, motor control, and postural stability, especially in stroke and cerebral palsy. However, evidence for spasticity reduction and long-term outcomes was inconsistent. Studies varied in garment type, intervention protocols, and outcome measures, with common methodological limitations.ConclusionPGs may serve as useful adjuncts in neurorehabilitation to enhance sensorimotor function. However, further high-quality studies with standardized protocols are needed to clarify their clinical utility.RegistrationOSF https://doi.org/10.17605/OSF.IO/H9B27.

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.

ObjectiveIn this randomized controlled trial (RCT), we evaluated the efficacy of a progressive speed increase in robot-assisted gait training (RAGT) on balance and gait performance in chronic stroke patients.MethodsIn total, 20 patients with chronic stroke were randomly assigned to a progressive speed increase (n = 10) or a constant speed (n = 10) RAGT group. Both groups underwent 12 training sessions over 4 weeks (3 sessions per week). Outcome measures, including postural sway, limits of stability, the Berg Balance Scale score, and 6-min walk test (6MWT) performance, were assessed before and after the intervention. Within-group differences were analyzed using paired t-tests, whereas independent t-tests were employed to analyze between-group differences (α = 0.05).ResultsBoth groups demonstrated significant improvements in all measured outcomes (p < 0.05). However, the experimental group showed significantly greater gains in 6MWT distance (mean between-group difference: 8.55 m; Cohen's d = 1.33) and walking speed (Cohen's d = 1.45) compared to the control group (p < 0.05). No significant between-group differences were observed in balance outcomes (p > 0.05).ConclusionsProgressive speed increase in RAGT is an effective intervention for enhancing walking distance and speed in chronic stroke patients. However, the observed improvements did not exceed the minimal clinically important difference (MCID), and future studies should assess long-term clinical significance.