NeuroRehabilitation最新文献

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.

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.