NeuroRehabilitation最新文献

BackgroundEmotional consequences are a major area of interest in the field of acquired brain injury (ABI), yet less studied than the other consequences of ABI, despite particularly deleterious consequences on quality of life.Objectives and methodsThis study assessed the relevance of the French version of Difficulties in Emotion Regulation Scale-16 and developed a model of emotional dysregulation in ABI through four studies.ResultsStudy 1 confirmed the unidimensional structure and internal consistency (Cronbach's α = 0.95) of DERS-16 in non-clinical controls. Study 2 established a cutoff of 33.5 for pathological emotional dysregulation and found significantly higher DERS-16 scores in ABI participants compared to non-clinical controls but lower than in borderline personality disorder (BPD) participants (p < 0.001). Study 3 demonstrated consistency between clinical assessments and DERS-16 results, characterizing emotional dysregulation in ABI. Study 4 showed DERS-16 sensitivity to changes (mean DERS-16 difference of 1.21 [0.42; 2.00] per month, p = 0.003).ConclusionsDERS-16 is a valuable scale for screening and monitoring emotional dysregulation in ABI, highlighting the importance of addressing emotional difficulties in rehabilitation programs. The proposed model highlights organic, cognitive, psychological, environmental, vulnerability factors and general population factors contributing to emotional dysregulation in ABI.

Background/AimsThe aim of the present study was to examine the potential association between a specific gaze behavior, "overstay fixations," observed during the Trail Making Test, and cognitive functional independence after stroke.MethodsThis study was a cross-sectional, observational study. Hospitalized patients with mild stroke (n = 12) and healthy young adults (n = 19) performed the electronic version of Trail Making Test. The number of overstay fixations and the total completion time were measured. In the patients with mild stroke, the total time in conventional Japanese version of Trail Making Test and the cognitive scores in Functional Independence Measure were measured.FindingsThe mild stroke group showed significantly more overstay fixations as task difficulty increased (p = 0.005). A significant correlation existed between the overstay fixations during the electronic version of Trail Making Test part A and the cognitive Functional Independence Measure scores for Comprehension (r = -0.643) and Memory (r = -0.610). Multiple regression revealed that the total time and overstay fixations in the electronic version of the Trail Making Test were more strongly associated with the Comprehension score (R² = 0.850) compared with the total time in the paper-based Trail Making Test (R² = 0.397). Similarly, the Memory score showed stronger associations with the total time and overstay fixations in the electronic version of the Trail Making Test (R² = 0.684) than with the total time in the paper-based version (R² = 0.391).ConclusionsThe overstay fixation was associated with specific domains of cognitive functional independence in patients with mild stroke.

ObjectiveTo investigate the effects of a two-week robot-assisted gait training (RAGT) program on walking performance and brain activation in children with spastic hemiplegic cerebral palsy (CP).DesignSingle-group, pre-post pilot study.MethodsEight children with CP were enrolled; six completed the protocol and provided usable gait and functional MRI (fMRI) data. Participants received 10 RAGT sessions over two weeks. Walking performance (6-min walk test [6MWT], 10-meter walk test [10MWT], GAITRite gait speed and cadence) was assessed at baseline, immediately after the intervention, and at one-month follow-up. Pre- and post-intervention fMRI during a lower-limb motor task quantified activated voxels in motor and cerebellar regions.Results6MWT distance, 10MWT speed, and GAITRite gait speed and cadence improved significantly (all p ≤ 0.009) at post-intervention and follow-up versus baseline. In children with isolated subcortical lesions (n = 4), activated voxels during the lower-limb task increased in the lesioned motor cortex (from 363 to 1,075; p = 0.02), with similar increases in ipsilesional cerebellar hemispheres (p = 0.02), whereas no significant changes were seen in children with additional hydrocephalus (n = 2). Change in cadence correlated positively with change in lesioned motor cortex activation (Spearman's ρ = 0.83, p = 0.03).ConclusionsIn this small cohort, a two-week RAGT program was associated with short-term improvements in walking performance and increased fMRI activation in motor-related regions, particularly in children with subcortical lesions. These preliminary, lesion-type-specific findings suggest neuroplastic responses to RAGT that warrant confirmation in larger controlled studies.

BackgroundDepression is frequently encountered in patients suffering from post-concussive syndrome (PCS) after mild traumatic brain injury (mTBI). Clinical strategies for predicting and managing such depression remain underdeveloped.ObjectiveTo determine whether pre- and post-injury alcohol, tobacco, marijuana, and antidepressant medication use are associated with risk of depression in PCS.MethodsWe conducted a retrospective chart review of 297 patients diagnosed with PCS at a Honolulu neurology clinic between January 2020 and January 2023, analyzing substance and antidepressant use patterns before and after PCS diagnosis and their relationship to post-injury depression risk using PHQ-2 scores.ResultsOf screened patients, 31% were identified as at risk for depression after concussion. Pre-injury tobacco use and marijuana use (both before and after concussion) were significantly associated with greater depression risk. Notably, prior antidepressant use emerged as a strong predictor of depression following concussion, particularly for those who discontinued antidepressants after injury. Patients co-using marijuana and antidepressants had the highest risk.ConclusionsTobacco, marijuana, and exposure to antidepressants prior to concussion, especially discontinuation of these agents, are key risk factors for depression in PCS. These findings emphasize the importance of proactively screening patients with post-concussion syndrome for psychiatric symptoms. Regular assessment of substance use and close monitoring of antidepressant adherence should be integrated into neurorehabilitation care. A coordinated, multidisciplinary approach involving neurology, physiatry, psychiatry, and addiction specialists is essential to identify and address these risk factors early, improving patient outcomes through timely intervention. Future studies should clarify mechanisms and optimal intervention timing.

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.

IntroductionOromandibular dystonia (OMD) is a rare, disabling movement disorder causing involuntary jaw and neck tremors. Traditional treatments, such as botulinum toxin (BTX) injections, can have side effects or limited efficacy. This case report aims to explore the effects of a non-invasive, multimodal intervention, including targeted myofascial release (MFR), on tremor severity, balance, gait, and functional independence in a patient with OMD.Case PresentationThe patient, a 65-year-old female, presented with severe jaw tremors, impaired balance, and functional limitations in daily activities. Her symptoms were assessed pre-intervention using standardized tools, including the Berg Balance Scale (BBS), Tinetti Assessment Tool (TAT), Tremor Rating Grid (TRG), Gait Assessment Instrument (GAIT), Bristol Activities of Daily Living Scale (BADLS), Barthel Index (BI), and Katz Index (KI).InterventionThe patient underwent 12 sessions over 4 weeks of targeted MFR, combined with core stabilization, jaw exercises, and sensory stimulation. Treatment progressed in three phases: tone control and trunk preparation, direct neck and jaw MFR, and functional stabilization with jaw resistance and speech exercises.OutcomesThe intervention led to substantial improvements in tremor severity (TRG: 16→5), balance (BBS: 4→27), gait (GAIT: 6→23), and functional independence (BADLS: 21→11; Barthel: 30→70; Katz: 3→6).ConclusionThis case demonstrates that targeted MFR is a safe, non-invasive intervention that can substantially improve tremor, balance, gait, and functional independence in OMD. These findings highlight the novelty and clinical relevance of the approach and support the need for larger controlled studies.

BackgroundCarpal tunnel syndrome (CTS) represents the most common focal neuropathy in the upper limb. It occurs due to compression of the median nerve in the carpal tunnel. Various doses of radial extracorporeal shock wave therapy (rESWT) were used in previous studies; however, there is still controversy about the most effective dose of rESWT for treating CTS.ObjectivesTo compare and investigate the effectiveness of different doses of rESWT on the severity of symptoms, function and median nerve conduction velocity in patients with mild-to-moderate CTS.MethodsEighty-three participants (99 affected wrists) were assigned to three groups. Group A received 1000 shocks, Group B received 2000 shocks, and Group C received 1500 shocks. All participants received four sessions of rESWT, once a week over four weeks, in addition to conventional physical therapy. The Boston Carpal Tunnel Questionnaire (BCTQ) was used to investigate the severity of symptoms and functional level. The median nerve sensory conduction velocity and distal motor latency were measured. ANOVA was used for comparison between groups. Statistical significance was set at P < 0.05.ResultsAll groups showed significant improvements (p < 0.001). Group (C) showed the maximal improvement in symptom severity (p < 0.001) and functional level (p < 0.001), as well as the median nerve sensory conduction velocity (p < 0.001) and distal motor latency (p < 0.001).ConclusionThe combination of rESWT (1500 shocks) with the conventional physical therapy effectively reduces symptoms, improves function, nerve conduction velocity and distal motor latency as well in patients with mild-to-moderate CTS.

BackgroundOver-ground walking assistance robots are increasingly being used in stroke rehabilitation; however, their clinical effects remain underexplored.ObjectiveWe investigated the immediate effects, in a single-session design, of an over-ground walking assistance robot with Mecanum wheels (OWAR-MW) on gait and lower limb muscle activity in stroke.MethodsThirty patients with stroke (age: 67.3 years; time since stroke: 12.4 months) participated in a repeated-measures study. Each performed a 20 m straight-line walk using Andago^® and OWAR-MW in random order. Gait was measured using a triaxial accelerometer, and surface electromyography recorded muscle activities of the rectus femoris, biceps femoris, tibialis anterior, gastrocnemius, and gluteus medius on the paretic side.ResultsNo significant differences in gait were observed between robots (all p > .05). However, the OWAR-MW elicited greater muscle activation than the Andago^®. In particular, the gluteus medius (stance: 274.06 vs. 213.00%RVC, p = .048, d = -0.38, 95% CI [-0.745, -0.004]; swing: 354.04 vs. 199.32%RVC, p = .002, d = -0.64, 95% CI [-1.026, -0.239]) and tibialis anterior (stance: 594.23 vs. 423.70%RVC, p = .046, d = -0.38, 95% CI [-0.749, -0.007]; swing: 657.60 vs. 440.94%RVC, p = .027, d = -0.43, 95% CI [-0.796, -0.048]) showed significantly higher activation.ConclusionsThe OWAR-MW provided mobility assistance comparable to the Andago^®, while promoting greater lower limb muscle activation. However, these findings represent single-session physiological responses and should be interpreted as exploratory. Further research involving multi-session training and long-term functional outcomes is required to determine the clinical applicability.

PurposeTo assess the effectiveness of robot-assisted training (RAT) plus acupuncture therapy (AT) on lower limb functional recovery in stroke patients.MethodsThe study protocol was registered with INPLASY (INPLASY2024120107). We searched CNKI, Wanfang, VIP, CBM, PubMed, Embase, Web of Science, and Cochrane Library for RCTs comparing RAT plus AT versus conventional rehabilitation, RAT alone, or AT alone. The risk of bias was assessed using the Cochrane risk-of-bias tool 2.0.ResultsTwenty-one studies (n = 1821) were included. Meta-analyses showed RAT plus AT yielded superior improvements in FMA-LE (MD = 4.02, 95% CI [3.12, 4.93], I² = 89%), FAC (MD = 0.66, 95% CI [0.43, 0.89], I² = 86%), MBI (MD = 9.88, 95% CI [6.43, 13.33], I² = 83%), and BBS (MD = 6.79, 95% CI [5.43, 8.16], I² = 90%). Significant improvements were also observed in gait parameters: step length (MD = 7.42, 95% CI [6.48, 8.36], I² = 12%), step speed (MD = 0.16, 95% CI [0.12, 0.21], I² = 90%), and step width (MD = -2.22, 95% CI [3.96, -0.48], I² = 90%). Sensitivity analyses verified the robustness of these findings.ConclusionRAT plus AT effectively ameliorates post-stroke lower limb dysfunction, demonstrating superior improvements in motor function, gait parameters, and daily living activities compared to monotherapies.