NeuroRehabilitation最新文献

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.

BackgroundHydrocephalus is a potentially serious complication of stroke that can lead to long-term neurological impairment. However, population-based evidence on its incidence and time-varying risk remains limited.MethodsA retrospective cohort study was conducted using data from the Korean National Health Insurance Service-National Sample Cohort (2002-2013), including 16,514 patients newly diagnosed with hemorrhagic and ischemic stroke and 82,570 propensity score-matched controls. Stroke and hydrocephalus were defined based on codes set forth by the International Classification of Diseases, 10th Edition. Time-stratified Cox regression was applied owing to the violation of the assumption for proportional hazards.ResultsDuring a mean follow-up of 4.3 years, the incidence rate of hydrocephalus was 1.82 per 1,000 person-years in the stroke cohort, versus 0.11 in the controls (IRR, 17.11; 95% CI, 11.89-24.62). The adjusted hazard ratio (aHR) was highest within three years post-stroke (aHR, 29.53), declining over time but remaining elevated up to nine years. Patients with hemorrhagic stroke had a markedly higher early risk (aHR, 54.93), whereas those with ischemic stroke showed a delayed, biphasic risk pattern. Female and younger patients had higher relative risks despite lower absolute incidence. Risk was also elevated in association with smoking, alcohol use, high cholesterol, abnormal BMI, and higher income levels.ConclusionStroke significantly increases the long-term risk of hydrocephalus, with distinct temporal patterns by stroke subtype. These findings emphasize the need for prolonged monitoring and individualized preventive strategies, especially for high-risk subgroups. Further research is warranted to refine risk prediction and guide post-stroke management.

PurposeTo assess how brain cortical activity and upper limb (UL) muscle activity associated with the imitation of a UL reaching task differ following action observation of normal and aberrant movement conditions.Materials and MethodsIn this cross-sectional study, 17 individuals who had unilateral stroke were asked to watch a UL reaching task performed with normal and aberrant movement patterns shown with prerecorded videos and then imitate normal movement patterns. Electroencephalographic mu-rhythm activity, a measure of the mirror neuron system (MNS), and the electromyographic amplitudes of four paretic UL muscles (percentage maximum voluntary contraction) were measured during action observation and imitation (AOI) of normal and aberrant conditions. Freidman's ANOVA was used to compare the outcomes across the conditions.ResultsEEG analysis revealed statistically significant suppression of mu-rhythm (demonstrating better MNS activity) during the AOI of normal movement than during aberrant movement conditions at the C3 (p = 0.001) and C4 (p = 0.003) electrodes. Furthermore, the amplitude of percentage maximum voluntary contraction for the supraspinatus muscle significantly increased (p = 0.027) during imitation of the task following observation of the normal movement condition.ConclusionAOI of normal movements resulted in better MNS activity and increased supraspinatus muscle activity than did the observation of aberrant movements. These findings support the incorporation of therapist-guided AOI training focused on normal movement patterns and the avoidance of exposure to aberrant models as a low-cost, neurophysiology-driven adjunct in stroke rehabilitation protocols.Trial RegistrationClinical Trials Registry-India (CTRI) identifier: CTRI/2018/04/013466.

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.

BackgroundRobotic therapy (RT) and augmented reality (AR) have each demonstrated benefits for stroke rehabilitation. Despite the potential priming effect of robotics, no study has investigated whether robotic priming of AR provides additive effects compared to AR or conventional therapy.ObjectiveThis study examined the effects of AR with and without robotic priming compared with dose-matched control.MethodsIn this exploratory trial (N = 33), participants were allocated to robotic-primed AR (RT + AR), AR, or conventional therapy (CT). Outcomes were the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Berg Balance Scale (BBS), Chedoke Arm and Hand Activity Inventory (CAHAI), and Stroke Impact Scale (SIS). Patient-reported pain and fatigue were recorded.ResultsAll groups improved in motor recovery and balance immediately after therapy. RT + AR exceeded AR (p = 0.037, η²=0.19) and CT (p = 0.039, η²=0.19) on FMA-UE at post-test and remained superior to CT at follow-up (p = 0.03, η²=0.20). For the BBS, both RT + AR (p = 0.016, η²=0.18) and AR (p = 0.004, η²=0.24) outperformed CT at post-test, and AR retained superiority at follow-up (p = 0.02, η²=0.21). RT + AR surpassed CT on CAHAI (p = 0.046, η²=0.18) and SIS (p = 0.04, η²=0.19) at post-test, with a trend favoring RT + AR on SIS at follow-up (p = 0.06, η²=0.18). No severe adverse responses were observed.ConclusionRobotic priming of AR improved more than AR and CT in motor impairments. AR was beneficial for improving balance. Results of this study should be interpreted with caution and may not be generalized to stroke survivors with different characteristics. There was a lack of multiplicity adjustments in this small exploratory trial. Further research is needed to validate the findings based on larger multicenter trials.