NeuroRehabilitation最新文献

Background: Upper extremity motor impairment is common after stroke. The Hybrid Assistive Limb single-joint type (HAL-SJ), an exoskeletal robot with biosensors, assists voluntary movement by detecting biopotential signals. While there are reports of positive effects, optimal strategies and patient selection criteria remain unclear. Objective: To map the evidence on HAL-SJ use for upper extremity recovery after stroke. Methods: A scoping review was conducted using five databases (search date: September 20, 2025). The studies included stroke patients treated with HAL-SJ and reported motor function outcomes. Reviews, abstracts, and commentaries were excluded. Results: Eight studies met the inclusion criteria. HAL-SJ improved upper limb motor function across recovery phases, with several studies reporting clinically meaningful improvements assessed by measures such as the Fugl-Meyer Assessment and Action Research Arm Test. Effective strategies included combining HAL-SJ with therapies such as botulinum toxin A and occupational therapy, and high-frequency training. Patients with moderate impairment benefited most; early intervention showed potential in severe cases. Conclusion: HAL-SJ shows potential as a rehabilitation tool for stroke-related upper extremity motor impairment. However, all included studies were conducted in Japan, which may limit the generalizability of these findings. Large-scale, multicenter studies are needed to establish optimal intervention protocols.

BackgroundHemiplegia resulting from a stroke frequently causes considerable difficulties in hand function. Virtual reality (VR) therapy has evolved as an innovative and engaging method to facilitate sensorimotor rehabilitation.ObjectiveThis meta-analysis assessed the efficacy of VR-based therapies on hand function in post-stroke hemiplegic patients. The study evaluated the impact of treatment duration, type of VR (immersive, semi-immersive, non-immersive), and stroke stage (subacute versus chronic) on outcomes.MethodsA comprehensive search of six databases until September 2024 identified randomized controlled trials (RCTs) that compared VR therapy with conventional rehabilitation or sham control. The primary outcomes consisted of validated, hand-specific performance metrics, including the Fugl-Meyer upper extremity subscale, Action Research Arm Test, Box and Block Test, Jebsen-Taylor Hand Function Test and Box and Block Test.ResultsTwenty-five RCTs involving 844 participants were evaluated. VR therapy significantly enhanced hand function (SMD = 0.68; 95% CI: 0.41-0.95; p < 0.00001), while there was considerable heterogeneity (I² = 71%). Subgroup analysis indicated that semi-immersive VR had the most significant benefit (SMD = 1.03), whereas interventions with a cumulative training duration beyond 12 h, along with those administered to subacute patients, demonstrated greater effect size in hand function relative to shorter interventions (pooled SMD for >12 h = 0.94; 95% CI: 0.66-1.23).ConclusionThis meta-analysis suggests that semi-immersive VR therapy improves hand function in post-stroke patients, especially when the total cumulative treatment duration exceeds 12 h. Future research should determine the principal treatment elements, establish uniform dosing methods, and evaluate long-term results, including activities of daily living and quality of life.

IntroductionSpeaking valves (SVs) restore phonation and may support airway protection in people with a tracheostomy, yet tolerance varies widely in neurological rehabilitation. We aimed to identify clinical factors associated with SV use and duration in a neurological rehabilitation setting.MethodsWe retrospectively analyzed 117 adults with neurological conditions and tracheostomy admitted to a rehabilitation center. Two internally validated multivariable models were developed: logistic regression for SV use (yes/no) and a quasi-Poisson regression for target daytime SV duration (hours/day), using routinely available bedside clinical variables.ResultsOf 117 patients, 64 (54.7%) used an SV during hospitalization. In the multivariable logistic model, higher level of consciousness (eMCS vs VS/MCS; OR 6.26, 95% CI 1.53-23.14), a positive blue dye test (OR 0.05, 95% CI 0.01-0.30), and endotracheal suction requirement (vs spontaneous cough; OR 0.07, 95% CI 0.003-0.879) were independently associated with SV use. Model performance was strong (AUC 0.856; accuracy 79.5%). Among SV users, longer daytime duration for SV use was associated with younger age, greater inspiratory and expiratory muscle strength, higher consciousness level, mild dysphagia, spontaneous cough, and neuromuscular or spinal cord injury diagnoses. In contrast, moderate-to-abundant secretions were associated with fewer hours.ConclusionIn a single-center neurological rehabilitation cohort, SV adoption and sustained tolerance were associated with bedside indicators of neurological responsiveness, secretion management, swallowing safety, and respiratory muscle strength. Findings should be interpreted as predictive associations and warrant external validation in contemporary multicenter cohorts.

BackgroundUnilateral spatial neglect (USN) is a common post-stroke deficit that adversely affects activities of daily living and functional independence. Despite advancements in stroke rehabilitation research, USN-specific rehabilitation studies remain relatively limited, contributing to a gap in evidence-based clinical practice.ObjectiveTo characterize randomized controlled trials (RCTs) evaluating post-stroke USN rehabilitation interventions and to provide an overview of the intervention types studied and gaps in the current literature.MethodsSystematic searches of MEDLINE, Embase, Scopus, CINAHL, and PsycINFO were conducted from inception to December 31, 2024. The methodological quality of included RCTs was assessed using the PEDro scale.ResultsA total of 123 RCTs were included, collectively enrolling 3,419 participants. The annual number of trials has remained stable in recent years. The mean sample size was 27.8, and the majority of RCTs (60.2%) were conducted in the subacute phase post-stroke. A total of 44 unique types of intervention were examined across the 123 RCTs. Top-down interventions were evaluated in 49 RCTs (39.8%), while bottom-up therapies were examined in 82 RCTs (66.6%), and pharmacological interventions were used in only 6 studies (4.9%).ConclusionsFuture RCTs on neglect should recruit larger sample sizes, evaluate the efficacy of combined interventions, and implement time-sensitive treatment strategies to maximize gains in the earlier post stroke phase. Additionally, RCTs are needed to specifically address the impact of treatment timing on outcomes, and the long-term effects.

BackgroundPost-stroke depression is common yet frequently underdiagnosed, substantially hindering rehabilitation engagement and functional recovery. Understanding its impact from the clinician's perspective is critical to optimizing care.ObjectiveThis study aimed to explore how post-stroke depression affects patient autonomy and rehabilitation processes from the viewpoint of occupational, physical, and speech therapists.MethodsAn observational mixed-methods study was conducted via an online survey of 111 neurorehabilitation therapists. Quantitative data were analyzed descriptively; qualitative responses from open-ended questions underwent thematic analysis.ResultsTherapists reported that post-stroke depression profoundly influences rehabilitation through: (1) reduced patient motivation and collaboration; (2) the consequent need for adapted therapeutic strategies (e.g., modified goal-setting and relational approaches); (3) significant professional challenges in patient engagement; and (4) an increased emotional burden on therapists. Consequently, interventions are routinely modified, requiring more time, interdisciplinary coordination, and psychological support.ConclusionsThis study underscores that post-stroke depression necessitates a fundamentally adapted, team-based rehabilitation approach tailored to motivational deficits. The findings highlight the importance of early screening, therapist training in motivational and relational skills, and structured support for clinicians to improve both patient outcomes and therapist well-being.

IntroductionStroke is a leading cause of disability worldwide. This study uses Machine Learning models to investigate factors influencing modified Rankin Scale scores at discharge and three months post-discharge.MethodsData from 116 stroke patients were analyzed using four predictive models: Logistic Regression, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGB). Shapley Additive Explanations (SHAP) were also employed to interpret factor significance.Results and discussionThe XGB model achieved an Area Under the Curve of 79% at discharge and 87% three months post-discharge. SHAP analysis revealed changing factor significance over time. The National Institutes of Health Stroke Scale was most critical at discharge, while post-discharge destination became more significant at three months. Age, time metrics, thrombolysis therapy, and management of long-term health issues also proved influential.ConclusionsFindings highlight the complex, evolving nature of stroke recovery. The shift in factor importance from clinical interventions to broader health management issues emphasizes the need for time-sensitive, multifaceted approaches to stroke care. This study contributes to understanding stroke recovery by identifying key influencing factors and demonstrating the value of SHAP for model interpretation. The insights gained have practical implications for rehabilitation practices. By identifying evolving predictors of recovery, the proposed framework may support early stratification of rehabilitation needs, assist clinicians in tailoring rehabilitation intensity and modality, and inform discharge destination decisions.

BackgroundThe upper extremity functional recovery remains a major challenge for specialists during post stroke rehabilitation, pertaining to adoption of various compensatory strategies by patients leading to motor redundancy and persistent functional limitations.ObjectivesThe study aimed to evaluate the effectiveness of Patient Tailored-Modified Constraint Induced Movement Therapy (mCIMT) combined with Trunk Restraint (TR) on Upper Extremity motor ability, balance, and health-related quality of life (HR-QOL) in chronic stroke survivors.MethodsIn this patient-blinded trial, 34 voluntary patients with chronic hemiplegia (>6 months post-stroke), aged 45-65 years, with Mini-Mental State Examination (MMSE) scores > 24 having and spasticity graded 1 or 1 + on Modified Ashworth Scale (MAS), were recruited and randomly allocated (1:1) to experimental or control groups. The experimental group received 60 min of Conventional Physical Therapy (CPT) plus 120 min of mCIMT with TR, while the control group received CPT treatment alone, three sessions per week for six consecutive weeks. Outcomes were assessed pre- and post-intervention using the Wolf Motor Function Test (WMFT), Berg Balance Scale (BBS), and Stroke Specific Quality of Life Scale (SS-QOL).ResultsBoth groups demonstrated significant improvements from baseline to post-intervention (p < 0.01) across all outcome measures. However, the experimental group exhibited significantly greater gains in functional ability, as reflected by SS-QOL scores (p < 0.005), compared to the control group.ConclusionEighteen sessions of mCIMT along with TR, delivered over six weeks in combination with CPT, demonstrated significant improvements in all outcomes (WMFT, BBS, and SS-QOL) among chronic stroke patients and is as beneficial to individual rehabilitation as conventional therapy alone.Trial registry name and URL: ClinicalTrails.gov (Registration ID: NCT06692569).

BackgroundRepetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation therapy used to improve lower extremity motor function in patients with spinal cord injury (SCI). However, its efficacy remains inconsistent.ObjectiveThis meta-analysis aimed to comprehensively assess the effectiveness and safety of rTMS for lower extremity motor function, spasticity, and walking ability in SCI patients.MethodsUp to April 30, 2025, randomized controlled trials (RCTs) were searched by PubMed, Web of Science, MEDLINE, Ovid, and the Cochrane Central Register of Controlled Trials. Primary outcomes were Lower Extremity Motor Score (LEMS) and Lower Modified Ashworth Scale (LMAS); secondary outcomes included Spinal Cord Assessment Tool for Spasticity (SCATS), Hmax/Mmax amplitude ratio (H/M ratio), 10-Meter Walking Test (10 WMT), Walking Index for Spinal Cord Injury-II (WISCI-II), and gait velocity. Subgroup analyses were performed by injury duration.ResultsFifteen RCTs (260 participants) were included. rTMS significantly improved lower extremity strength measured by LEMS (SMD = 0.98, 95% CI = 0.61 to 1.36, P < 0.00001) regardless of injury duration and decrease spasticity measured by LMAS (SMD = -0.46, 95% CI = -0.85 to -0.08, P = 0.02). No significant changes were found for spasticity assessed by SCATS or H/M ratio, or for walking outcomes (10MWT, WISCI-II, gait velocity).ConclusionrTMS effectively enhances muscle strength and reduces spasticity in SCI patients, but its impact on walking ability is limited. Further high-quality trials are needed to confirm these findings.

BackgroundPost-stroke spasticity (PSS) arises from central neural hyperexcitability and maladaptive muscle architectural changes that impair motor function. Interventions targeting both mechanisms is essential to support adaptive neural reorganization.ObjectiveTo investigate the combined effects of extracorporeal shockwave therapy (ESWT) and a neuroplasticity-based training protocol (NBTP) on lower limb spasticity, muscle architecture, and motor function in stroke patients.MethodsThis was a sham-controlled, double-blind, randomized controlled trial. Fifty-four patients with post-stroke spasticity (PSS) were randomly assigned to receive either ESWT combined with a NBTP, or to sham ESWT with NBTP . Participants received six weekly sessions of ESWT (1,500 shocks at 5 Hz, 0.10 mJ/mm²) targeting the gastrocnemius muscle, alongside a 12-week NBTP comprising mirror therapy, resistance and aerobic training, motor imagery, and task-specific activities. Outcome assessments were conducted at baseline, 6^th week, and 12^th week using the Modified Ashworth Scale (MAS), passive range of motion (PROM), and the Fugl-Meyer Assessment-Lower Extremity (FMA-LE). Ultrasonographic evaluations included measurements of muscle thickness (MT), muscle fascicle length (MFL), and pennation angle (PA).ResultsAt the 12th week, the experimental group showed significantly greater improvements than controls in MAS (MD = 0.88; p < 0.001), PROM (MD = -6.72; p < 0.001), and FMA-LE (MD = -1.55; p < 0.001). RMI also improved moderatly (MD = -1.04; p = 0.03). Ultrasonographic parameters improved in both groups, with a significant difference observed only in PA and MT (p < 0.05).ConclusionESWT combined with NBTP yielded superior functional and structural outcomes compared with NBTP, supporting this integrative approach as a clinically relevant post-stroke intervention.Trial registration numberTrial was submitted on http://clinicaltrials.gov (registration no. NCT05405140).

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).