NeuroRehabilitation最新文献

BackgroundPost-stroke dysphagia is common but often overlooked, especially in patients aged ≥80 years, significantly impacting functional outcomes and quality of life. Despite advances in reperfusion therapies (RTs) for ischemic stroke, dysphagia remains prevalent among older adults. This study aimed to evaluate clinical characteristics and early functional outcomes of post-stroke dysphagia in older adults treated with RT.MethodsA cross-sectional, prospective study was conducted at Astghik Medical Center, Armenia, including 52 participants aged ≥80 years who received RT between January and December 2022. Dysphagia was assessed using the Gugging Swallowing Screen (GUSS) within 24 h after RT. Clinical outcomes, including mortality, dysphagia severity, and functional recovery, were evaluated at discharge and 3 months post-stroke using the modified Rankin Scale (mRS) and GUSS scores.ResultsOf the 52 participants, 32 (62%) developed dysphagia. Dysphagia was associated with higher NIHSS scores at admission (p = 0.03). The in-hospital mortality rate for those with dysphagia was 15.6%, with a 3-month mortality rate of 37%. Participants with dysphagia showed poorer functional recovery, with 41% achieving mRS scores of 0-2 at 3 months compared to 90% in the non-dysphagia group (p = 0.03). Two participants required nasogastric feeding, and 56.2% needed dietary modifications at discharge.ConclusionsPost-stroke dysphagia is prevalent in patients with ischemic stroke aged ≥80 years, affecting both acute and long-term outcomes. Early screening and multidisciplinary management, including swallowing therapy, are essential for improving functional recovery.

ObjectiveTo determine whether daily air stacking (AS) over 12 weeks improves cough effectiveness and pulmonary volumes in individuals with spinal cord injury (SCI).MethodsThis retrospective study analyzed the records of individuals with SCI who received AS training at the Los Coihues Clinic in Chile. Participants performed AS exercises five days per week for 12 weeks. Pulmonary function was assessed at baseline and after the intervention, including peak cough flow (PCF) in four conditions (spontaneous, with AS, with manually assisted cough [MAC], and combined AS + MAC), vital capacity (VC), maximum insufflation capacity (MIC), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP). Paired t-tests were used to compare pre and post-intervention values, with significance at p < 0.05.ResultsTwenty individuals (19 men; mean age 38.8 ± 13.1 years) with cervical (85%) and thoracic (15%) SCI were included. Significant improvements were observed after 12 weeks in VC (2.41 ± 0.91 vs. 3.01 ± 1.06 L; p = 0.004), MIC (3.80 ± 0.96 vs. 4.48 ± 0.96 L; p = 0.006), MIP (71.2 ± 26.2 vs. 88.9 ± 26.5 cmH₂O; p < 0.001), and PCF in all conditions: spontaneous (p < 0.001), with AS (p = 0.03), with MAC (p = 0.02), and with combined AS + MAC (p = 0.02). No significant change was found in MEP.ConclusionsTwelve weeks of daily AS training significantly improved cough effectiveness and pulmonary function in individuals with SCI. These sustained improvements may enhance airway clearance and respiratory health in this population.

ObjectivesTo systematically review the effects of transcranial magnetic stimulation (TMS) on post-stroke dysphagia, focusing on stimulation mode, frequency, and target region.MethodsThis systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42025631286). We systematically searched PubMed, Cochrane Central, and Embase for RCTs on TMS for post-stroke dysphagia up to December 11, 2024. Meta-analysis was conducted using Stata 16, with heterogeneity assessed via the I² statistic. Subgroup and sensitivity analyses explored sources of heterogeneity. Risk of bias and study quality were evaluated using the Cochrane Risk of Bias 2.0 (RoB 2) tool and the Physiotherapy Evidence Database (PEDro) scale.ResultsThis meta-analysis included 14 RCTs with 882 stroke patients, assessing swallowing function using the Penetration-Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA), Functional Dysphagia Scale (FDS), Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), and Functional Oral Intake Scale (FOIS). The results showed that TMS significantly improved swallowing function across all scales: PAS (MD = -1.32, 95% CI: -1.50 to -1.14, P < 0.001), SSA (MD = -1.97, 95% CI: -2.43 to -1.50, P < 0.001), FEDSS (MD = -0.65, 95% CI: -0.84 to -0.46, P < 0.001), FOIS (MD = 0.92, 95% CI: 0.72 to 1.13, P < 0.001), and FDS (MD = -5.54, 95% CI: -7.48 to -3.60, P < 0.001).ConclusionThis meta-analysis demonstrates that TMS significantly improves swallowing function in stroke patients, with consistent effects across scales, interventions, stimulation modes, and targets. However, variability in protocols and short follow-up periods may limit the generalizability of the findings.

ObjectiveTo examine the effect of heel elevation using a tilting plate on sit-to-stand performance in Parkinson's disease (PD) patients, evaluate the influence of different tilt angles, and identify clinical factors associated with this effect.MethodsThirty-six PD patients participated in a randomized crossover trial. Half started in a flat position, and half in a heel-elevated position, using three tilting angles. The time to complete five times sit-to-stand tests (FTSST) was measured under flat and heel-elevated conditions.ResultsThe fastest FTSST in the heel-elevated condition was reduced by a median decrease of 2.3 s and a median reduction of 14.0% when compared to the flat condition. Neither tilt angle nor ankle dorsiflexion range of motion was not associated with the reduction in FTSST duration. Multivariable regression analyses revealed that the time of FTSST under the flat condition and the standing subscale in the Unified Parkinson's Disease Rating Scale Part III exhibited significant positive associations with the observed shortening effects of FTSST induced by heel elevation.ConclusionsThe use of a heel-elevation intervention reduces the duration of transitioning from a seated to a standing position among patients with PD, particularly among those with a more pronounced disability. (UMIN000048428, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000055160).

ObjectiveThis study aimed to investigate the association between cognitive reserve (CR), measured using the Cognitive Reserve Index questionnaire (CRIq), and activities of daily living (ADL) outcomes among patients with stroke during the subacute phase, focusing on sex-related differences in CR and their impact on ADL recovery.ResultsNinety-six stroke patients admitted to a rehabilitation ward were included, with demographic and clinical data collected from medical records. No significant sex differences in baseline characteristics were observed. Based on CRIq scores, 70.8% of patients were classified at a medium CR level, with no significant sex difference in composite CRIq scores. However, men scored higher in CRI-Working Activity (CRI-WA), whereas women scored higher in CRI-Leisure Time (CRI-LT). Least Absolute Shrinkage and Selection Operator (LASSO) regression revealed that better functional outcomes at discharge were associated with younger age, higher cognitive reserve, greater initial ADL function, and better motor ability. Additionally, a significant interaction between sex and cognitive reserve indicated a sex-specific effect on ADL recovery. In sex-stratified analyses, CRIq was a significant predictor of Modified Barthel Index (MBI) at discharge in men, along with age, MBI at admission, and Fugl-Meyer Assessment for Upper Extremity (FMA-UE). Conversely, CRIq was not predictive in women, while FMA-LE and MBI at admission were significant predictors.ConclusionCR is an independent predictor of ADL outcomes, particularly in men, suggesting a sex-specific effect during the subacute phase of stroke. These findings underscore the importance of CR in recovery and support the need for more personalized rehabilitation strategies.

BackgroundStroke induced neuromuscular deficits, especially in core muscle strength, impair balance and gait, whereas Pilates exercises known to improve strength and postural control remain insufficiently studied in neurological stroke populations.ObjectiveEvaluated the effects of a 3-week Pilates program on balance control, muscle strength, and walking ability in patients with chronic stroke.MethodsSingle-blind, randomized controlled trial included 20 participants with chronic stroke who aged 45-65 years. Participants were randomly assigned into the experimental or the control groups receiving standard physical therapy. The experimental group, Pilates exercise program, comprised warm-up, 15 mat-based poses emphasizing controlled breathing and muscle engagement, followed by cool-down stretches and walking training, supervised by a physiotherapist for 60 min per day, 3 days per week, for 3 weeks. Time up and go test (TUGT), five time sit to stand (FTSST), and 10-meter walk test (10MWT) were conducted at baseline and after 3 weeks.ResultsAll participants in the Pilates exercise program were able to perform all exercise positions safely and statistically significant improved in balance, muscular strength, and walking ability compared to the control group (P < 0.001). Particularly, the TUGT showed a mean difference of 2.23 s (P < 0.001). In addition, improving in FTSST and 10MWT with a mean difference of 1.72 s and 0.15 m/s (P < 0.001) respectively.ConclusionsThe integration of Pilates methodologies within stroke rehabilitation protocols may functional ability as a safe, efficacious, and readily available complement to conventional therapeutic approaches, thereby facilitating functional rehabilitation.

Music therapy (MT) is implemented in healthcare settings for a range of symptoms and conditions. This systematic review provides an update of the available evidence by searching a combination of keywords related to MT, traumatic brain injury (TBI), and posttraumatic stress disorder (PTSD) across four databases (PubMed, PsycINFO, PTSDpubs, Scopus) from inception to February 2025. We included randomized controlled trials, controlled clinical trials, quasi-experimental, cohort, observational, and pre-post longitudinal studies with at least 20 participants. Eligible participants were adults with TBI and/or PTSD, including participants with both diagnosed and subclinical conditions. We included studies that either examined the impact of MT (i.e., music interventions facilitated by board-certified music therapists [MT-BCs]) or used music for therapeutic purposes (i.e., music interventions facilitated by non-MT-BCs) either as the sole intervention or combined with other treatment modalities. Of the 446 studies screened, six studies met the eligibility criteria. For both TBI and PTSD, two studies on music therapy and one study that examined music instruction were included. Methodological weaknesses and imprecision of effect size estimates precluded making any strong conclusions. The current evidence is too inconclusive to generalize findings widely, however, there is potential use of MT for treating symptoms due to TBI and PTSD in the context of interdisciplinary neurorehabilitation. Advancing the clinical implementation of MT for these populations will hinge on future research that has more detailed descriptions of MT interventions, standardizing MT protocols, using common clinical outcome measures across studies, and incorporating widely used and validated measures of TBI and PTSD. [250 words].

BackgroundRobot-assisted gait training (RAGT) is a promising intervention for patients with stroke. However, its effectiveness in improving gait speed in ambulatory patients with stroke who have moderate-to-severe motor paralysis remains unclear.ObjectiveTo determine whether high-speed RAGT, which facilitates faster gait training by increasing step length via swing assistance to the paretic lower limb, improves gait speed more effectively than conventional treadmill training in ambulatory patients with stroke who have moderate-to-severe hemiplegia.MethodsFive subacute patients with stroke (Functional Ambulation Categories ≥ 2; Fugl-Meyer Assessment lower limb motor score ≤ 22) participated in a multiple AB single-case experimental design. Period A involved conventional treadmill training, while Period B incorporated high-speed RAGT using the Welwalk WW-1000, which combines a treadmill and a robotic device attached to the paretic lower limb. In high-speed RAGT, maximum swing assistance was applied to increase step length and facilitate faster gait. Each participant completed two 5-min training sessions across eight days per period. The primary outcomes were comfortable and maximum gait speeds.ResultsNo training-related adverse events occurred. During training, high-speed RAGT enabled gait speeds approximately 1.6 times higher than conventional treadmill training. Tau-U effect sizes ranged from -0.16 to 0.98 for comfortable gait speed and 0.08-0.97 for maximum gait speed. Meta-analysis showed Tau values of 0.67 (comfortable) and 0.77 (maximum), indicating large changes.ConclusionsThis preliminary study suggested that high-speed RAGT is feasible and may improve gait speed. Given the study's nonrandomized, unblinded design and small sample size, larger randomized trials are warranted.

BackgroundHippotherapy uses horse movement to promote physical and psychosocial rehabilitation and may benefit children with cerebral palsy (CP). Standardised instruments such as the Activity Scale for Kids-Performance (ASK^©), the Gross Motor Function Classification System (GMFCS) and the Gross Motor Function Measure (GMFM) are needed to quantify effects on motor function.ObjectivesTo systematically review the effects of hippotherapy on gross motor skills in children with CP. Although autism spectrum disorder (ASD) was included in the search strategy, no eligible ASD studies were identified.MethodsFollowing PRISMA guidelines, six databases (PubMed, EMBASE, Web of Science, SCOPUS, Cochrane and SciELO) were searched for English, Portuguese or Spanish studies employing ASK^©, GMFCS or GMFM. Two reviewers independently screened records, extracted data and assessed risk of bias.ResultsTwenty-five studies (602 participants, mean age 7.1 years, 3-14) met inclusion criteria; all involved CP, none ASD. Interventions lasted 8-24 weeks (1-3 sessions/week). Two ASK^© studies showed significant motor gains (Hedges g = 0.48-0.62). GMFM was used in 22 studies; 20 reported clinically relevant improvements, particularly in dimensions D (standing) and E (walking, running, jumping). The sole GMFCS study reported no change in classification. Methodological quality was moderate, limited by small samples and lack of blinding.ConclusionHippotherapy improves gross motor function in CP, best demonstrated with GMFM. Evidence for ASD is absent, highlighting a research gap. Broader application of ASK^© and GMFCS is still needed to better define benefits across neurodevelopmental disorders.