NeuroRehabilitation最新文献

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.

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.

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.