NeuroRehabilitation最新文献

BackgroundPhysical exercise is crucial for reducing disability and enhancing function after stroke. However, therapists regret lacking time within therapy sessions to perform exercises. Implementing unsupervised interventions could be a valuable strategy to support daily exercise in chronic stroke patients.ObjectivesThis scoping review maps the modalities of unsupervised home-based rehabilitation interventions for chronic post-stroke patients.MethodsA scoping review of randomized controlled trials (RCTs) published in English or French since 2020 was conducted. The review examined exercise modalities-frequency, intensity, time, and type-along with materials and devices used, outcomes assessed, participant interactions, and strategies for adherence monitoring. Databases searched included Medline, Google Scholar, the Cochrane Library, and Pedro. Studies were included if they involved unsupervised home-based exercise therapy for patients at least 6 months post-stroke. Study quality was evaluated using the PEDro scale.ResultsSix RCTs with a total of 135 participants were included. Exercise sessions varied from 3 days per week to daily, with low- to moderate-intensity and durations of 20 to 75 min. Interventions targeted balance, mobility, and core stability, and were delivered via mHealth apps (n = 2), video-guided programs (n = 1), or boxing-based exercise (n = 1). Two studies incorporated physiological monitoring, and balance and walking capacity were the most common outcomes. To support adherence, most programs provided regular therapist support, except in mHealth app interventions. Caregivers were involved in three studies.DiscussionThe review reveals diverse approaches in exercise modalities, technological integration, and adherence strategies, indicating that further research is needed to determine the overall effectiveness of these unsupervised home-based interventions.

BackgroundParkinson's disease (PD) is a neurological disorder that significantly impacts individuals, their families, and the healthcare system. Alongside drug therapies and surgical interventions, exercise has shown potential in improving motor and non-motor symptoms. This study explored perspectives of individuals with PD, care partners, and program providers regarding a community-based exercise program for PD.MethodsIndividuals with PD (Hoehn & Yahr stages I-III), on a stable medication regime, who participated in a PD-specific community-based exercise program twice weekly for at least 12 weeks, along with care partners and program providers were recruited. In-depth interviews were conducted with individuals with PD (n = 17), care partners (n = 7), and program providers (n = 3) from January to May 2024. Data were analyzed using an interpretative phenomenology analysis and mapped onto a behavior-change model. Two patient advisors and care partners assisted in data analysis and interpretation.ResultsParticipants highlighted the PD-specific nature of the program and group exercise benefits as key motivators. Pre-program challenges included difficulties obtaining a diagnosis, adapting to non-motor symptoms, medication side effects, and finding motivation. Post-program outcomes included symptom improvement, mutual motivation, community support, and reduced self-consciousness, prompting the recommendation of greater community awareness. Barriers to participation included transportation difficulties and cost. These findings suggest addressing barriers is essential to enhance accessibility and program benefits.ConclusionsThe PD-specific exercise program was perceived as beneficial to overall health and wellness, providing physical, emotional, and social benefits. A lack of awareness about the significance of exercise in PD remains a critical challenge.

PurposePhysiotherapy (PT) is an essential part of care for improving function and increasing community participation in children with cerebral palsy (CP). Combining animal-assisted intervention (AAI) with PT (AA-PT) offers a unique approach, potentially boosting motivation and participation in ambulatory children with CP. This case series piloted AA-PT integrating a rehabilitation dog for children with CP, to enhance walking and balance training.MethodsFour ambulatory children with CP (7-16 y.o.a, GMFCS I-II, 3 girls, 1 boy) participated in an 8-week individualized AA-PT intervention. Assessments at baseline (0 weeks), pre-intervention (8 weeks), post-intervention (16 weeks), and follow-up (24 weeks) included Kids Mini BESTest, timed up and go (TUG), dual task cost (DTC), and spatiotemporal parameters. The AA-PT included weekly 60-min sessions integrating a rehabilitation dog in walking and balance training. Visual analog scales (VAS) assessed perceived comfort, safety, enjoyment, and confidence while walking with and without the rehabilitation dog.ResultsIndividual-responder analysis showed improvements in Kids Mini BESTest scores, reduced DTC, and increased walking speed for all. Children reported higher enjoyment, confidence, safety, and comfort when walking with the rehabilitation dog.ConclusionAA-PT integrating a rehabilitation dog may enhance balance, dual-task cost, walking speed, and confidence in ambulatory children with CP.

BackgroundThere is no comprehensive clinical practice guideline (CPG) for multiple sclerosis (MS) rehabilitation and symptom management. This study aimed to identify and appraise the quality and scope of topics covered by existing international CPGs to inform development of a future comprehensive guideline.MethodsElectronic databases and grey literature were systematically searched for existing CPGs for MS. Identified guidelines were screened independently by 3 authors for inclusion criteria. Included guidelines were each appraised by 4 reviewers using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) tool. The AGREE-II comprises 23 items organized into 6 domains assessing the quality and reporting of CPGs. Mean AGREE ratings and ranges were calculated for each quality domain. The intra class correlation coefficient (ICC) assessed inter-rater reliability. Individual recommendations were organized into broad topics.Results15 CPGs published between 1998 and 2020 met the inclusion criteria. These derived from USA (n = 8), UK (n = 3), Canada (n = 2), and Europe (n = 2). Standardized scores (and range) of quality ratings for the six domains were: 1. Scope and purpose = 83.2% (range 53.7 -100%); 2. Stakeholder involvement = 64.2% (range 31.9-100%); 3. Rigour of development = 55.7% (range 12-93.8%); 4. Clarity of presentation = 79.6% (range 56.9-100%); 5. Applicability = 34.9% (range 13.9-78.1%); and 6. Editorial independence = 60% (range 0-100%). The highest scoring domains were for Scope and purpose and Clarity of presentation. Applicability was the lowest scoring domain with 12/15 guidelines scoring low in this domain. There was moderate to excellent inter-rater reliability (0.60-0.96 across the 6 domains). Recommendations from the CPGs covered spasticity, fatigue, bowel, bladder, pregnancy, physical activity, cognition, mood, and/or multi-disciplinary care topics.ConclusionExisting CPGs have well-defined objectives and target populations, yet clinical applicability and rigour of development is lower. A comprehensive up-to-date MS clinical practice guideline that provides implementation support is urgently needed.

BackgroundSpinal cord injury (SCI) disrupts neuronal pathways, alters spinal reflexes, and often leads to spasticity-a condition of increased muscle tone and involuntary contractions that interfere with daily function. Spasticity typically emerges progressively after injury; however, its mechanisms remain poorly understood, particularly regarding why it develops in some individuals but not in others. Increased spinal excitability has been implicated, but prospective evidence remains scarce.ObjectiveThis pilot, proof-of-concept study explored whether early electrophysiological markers of spinal excitability, specifically the soleus H-reflex and post-activation depression (PAD), could be linked to the subsequent development of spasticity during intensive functional rehabilitation (IFR).MethodsSeventeen individuals with traumatic SCI were assessed. The Hmax/Mmax ratio and PAD were measured prior to or shortly after IFR admission. At IFR admission and discharge, spasticity (Modified Ashworth Scale and clonus) and motor function (Lower Extremity Motor Score, LEMS) were evaluated. Each lower limb was analyzed separately to account for asymmetry. Correlations between early electrophysiological measures and clinical outcomes were examined.ResultsSpasticity measures tended to increase from IFR admission to discharge, but only LEMS improved significantly, reflecting motor recovery. Several participants did not present spasticity at admission or discharge. A higher Hmax/Mmax ratio and reduced PAD at early IFR were associated with greater clonus at both admission and discharge, whereas no significant associations were found with Ashworth scores. Across injury levels and AIS grades, AIS A participants displayed the lowest Hmax/Mmax ratios and minimal spasticity, while AIS B or D participants with H/M ratios exceeding 0.2 in early IFR developed clonus.ConclusionThese exploratory findings suggest that early signs of spinal hyperexcitability reflect spasticity development, but it does not show that they precedes spasticity development, which would be required to support its prognostic value. Assessment at earlier timepoints, such as in acute care, would be necessary to validate both the Hmax/Mmax ratio and the PAD as predictive measures of spasticity in SCI. While not clinically generalizable due to the small and heterogeneous sample, this proof-of-concept study highlights the feasibility and potential value of H-reflex as early markers of spasticity. Larger, adequately powered studies stratified by injury level and severity are needed to confirm utility and clinical applicability.

BackgroundRehabilitation for children with cerebral palsy (CP) often includes physiotherapy to enhance community participation and quality of life. Animal-assisted services (AAS) are a novel approach in physiotherapy to increase motivation, enjoyment and wellbeing. Our team conducted a study integrating a rehabilitation dog (Loki) into animal-assisted physiotherapy (AA-PT) for children with CP. This study presents the experiences and perspectives of children with CP who worked with Loki.MethodsInterpretive Description approach with reflective thematic analysis was used. Semi-structured interviews were completed at two timepoints: T1) single timepoint walking with Loki; T2) after an 8-week AA-PT intervention with Loki (subset of participants). ResultsAmbulatory children with CP aged 7-16 years (n = 11 (T1); n = 4 (T2)) and their caregiver (n = 11 (T1); n = 4 (T2)) participated. Three themes describing the perceived impact of working with Loki were described: 1) Connection, Relationship and Bonding; 2) Being upheld: physical support and emotional safety; 3) Empowerment Through Participation and Confidence.ConclusionChildren with CP and their caregivers reported immense enjoyment and value in having Loki present as part of the physiotherapy intervention. Centered around an immediate bond formed with Loki, the emotional and physical support children experienced improved willingness to participate in the AA-PT and in community following interactions with Loki.

BackgroundPost-stroke, damage to the prefrontal cortex (PFC) disrupts the neural circuits involved in motor control and sensorimotor integration, which contributes to impaired ankle sensorimotor function.ObjectiveApply functional near-infrared spectroscopy (fNIRS) post-stroke to investigate, 1) whether PFC activation differed among active and passive dorsiflexion/plantarflexion and somatosensory stimulation of the paretic ankle, 2) differences between hemispheres, and 3) interhemispheric asymmetry and functional outcomes.MethodsIn nine participants, bilateral hemodynamic responses of the PFC were collected with fNIRS during active and passive dorsiflexion/plantarflexion and somatosensory stimulation. Sensorimotor function and interhemispheric asymmetry were assessed using the Fugl-Meyer Lower Extremity (FMLE) assessment and laterality index.ResultsAcross the three tasks, no differences in PFC activation were found within or between hemispheres. There was a potential relationship between interhemispheric asymmetry with the sensory and motor portions of the FMLE, suggesting that greater asymmetry during passive and somatosensory stimulation tasks may be associated with poorer functional outcomes.ConclusionsOur results highlight that ankle sensorimotor functions may not generate different levels of PFC activation in a single hemisphere. The imbalance of PFC activation between the hemispheres from somatosensory and motor input may relate to clinical somatosensory function, which could be a useful measure of recovery.

BackgroundEvidence to guide multiple sclerosis (MS) rehabilitation and symptomatic care has grown, yet suboptimal access to care persists and uptake of evidence-based information is limited in practice. The movement of evidence into routine clinical care is not a spontaneous or linear process. Effective knowledge mobilization strategies may enhance equitable access to evidenced-based comprehensive MS care.MethodsTo guide the development of a MS rehabilitation knowledge mobilization strategy with priorities and action items a Canadian summit was hosted to engage key stakeholders in identifying and discussing current MS rehabilitation and symptomatic care evidence and needs. This multifaceted summit included workshops, breakout groups, presentations, brainstorming, and consensus-building.ResultsForty-three key stakeholders participated. Varied disciplines, Canadian geographical regions, and content expertise were represented. This included early/mid/late-career researchers, healthcare providers, and people with MS. The summit process identified 18 key need statements. Participants individually rated the identified need statements on feasibility and importance, and the relationships in terms of timeliness and impact were discussed. The three top priorities were identified and focused on for action planning. Developing a best-practice guideline for MS rehabilitation was unanimously identified as the critical first step to improve access to care. Support for healthcare providers and establishing a network to support this knowledge mobilization work were the next two priorities. Priority topic areas for knowledge mobilization were fatigue, mobility, cognition, mood and emotion, and rehabilitation across the MS disease course.ConclusionKnowledge mobilization priorities and key topic areas for MS rehabilitation have been identified using a collaborative process. The lessons learned from this summit will inform advocacy efforts for improved access to evidence-based comprehensive care and opportunities to support moving a sustainable MS rehabilitation knowledge mobilization agenda forward. Creating a formalized Canadian MS Rehab Knowledge Mobilization Network was an outcome of the summit, and our network will collaboratively support advancing and re-evaluating this agenda.

BackgroundBalance impairments and fatigue are common after stroke and impact physical therapy assessments and treatments. Reasons are multifactorial and include motor dysfunction and changes to cortical activation poststroke. The prefrontal cortex (PFC) is involved in motor control; yet, limited research has explored cortical activation during common physical therapy balance tasks or the link with fatigue.ObjectivesDuring standing balance tasks, the objective was to determine whether PFC activation levels: (1) change between tasks, (2) are asymmetric, and (3) are associated with fatigue.MethodsPatients with hemiparesis were recruited from an inpatient stroke unit and functional near-infrared spectroscopy was applied bilaterally over the PFC to measure cortical activation during balance tasks. Fatigue was assessed using the Fatigue Severity Scale (FSS).ResultsNine participants were included. PFC activation during semi-tandem stance showed greater amplitude than during double-leg stance, indicating more cortical activation. Bilateral PFC activation was observed during both tasks. Participants with greater fatigue (higher FSS score) showed more activation in the ipsilesional PFC than the contralesional PFC.ConclusionPFC activation may occur when performing more challenging balance postures, potentially indicating compensatory activation, and may be linked with greater fatigue.