NeuroRehabilitation最新文献

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.

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.

BackgroundLower limb spasticity (LLS), as part of the upper motor neuron syndrome, can adversely affect function, gait, and quality of life (QOL). A multidisciplinary team (MDT) approach is recommended however, the effects of a coordinated MDT clinic on LLS and ambulation in a mixed neurological population has not been investigated.ObjectivesThis study evaluated: i) clinical and service outcomes of a pragmatic outpatient MDT spasticity service; and ii) patient service satisfaction.MethodsIn this prospective pre-post observational study, 37 participants from a mixed neurological population with LLS received an individualised treatment protocol. Gait speed (10-metre walk test), dynamic balance (Timed-Up and Go), Quality of Life (AQoL-8D), and spasticity-related lower limb function (Leg Activity Measure) were assessed at admission and discharge. Patient satisfaction surveys were completed. Wait times for orthotics were monitored.ResultsSignificant differences were observed in gait speed (median (IQR) 0.30 (0.16-0.39) seconds, p ≤ .001), dynamic balance (median (IQR) 3.87 (2.02-8.59) seconds, p ≤ .001), and lower limb function (median (IQR) 9.00 (-4.00-26.00), p = 0.006) following intervention. QOL improved (median (IQR) -0.70 (-8.5-2.10), however this change did not reach statistical significance (p = 0.206). Over 85% of participants reported service satisfaction. Orthotic wait times reduced, with 64.7% assessed and 52.9% fitted within two weeks of referral.ConclusionAn individualised LLS treatment protocol delivered by a collaborative MDT can improve gait speed, dynamic balance, and lower limb function in a mixed neurological population, while also reducing orthotic wait times. Further research is recommended to explore potential QOL interventions for individuals with LLS.

PurposeThis study aimed to investigate the effects of rhythmic auditory stimulation (RAS) gait training combined with real-time vibrotactile feedback (VF) on muscle activation and gait performance in patients with stroke and to compare its effectiveness with that of RAS gait training alone.MethodsTwenty-two patients with stroke who met the inclusion criteria were randomly assigned to either the RAS combined with real-time VF (RVT) or RAS only (RT) groups. Both groups received gait training for 30 min per session, five times per week for 4 weeks. Muscle activation was assessed using surface electromyography, and gait parameters were evaluated using the GAITRite^® analysis system before and after the intervention.ResultsWithin-group comparisons revealed significant post-intervention improvements in the activation of the vastus medialis and tibialis anterior (TA) muscles of the affected side during the stance phase and the TA during the swing phase in both groups (p < .05). Additionally, the RVT group demonstrated significant improvements in gait velocity, cadence, stance time, single-support phase, stride length, and step time differential on the affected side (p < .05). However, no statistically significant differences were observed between the two groups across all outcome variables.ConclusionAlthough no statistically significant differences were found between the two groups, this study suggests that combining RAS gait training with real-time VF may have the potential to improve muscle activation and gait ability in individuals with stroke.Clinical Trial RegistrationThe study was registered in Clinical Research information Service (Registration number: KCT0010212; date: 19 February 2025), https://cris.nih.go.kr/cris/index/index.do.

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.

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.

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.

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.