NeuroRehabilitation最新文献

BackgroundBalance impairments, stemming from disruptions in motor, and cognitive systems, are key contributors to fall risk.ObjectiveThis study aimed to identify balance tasks associated with fall risk within 6 months of discharge in inpatients with subacute stroke.MethodsThis prospective cohort study included patients with subacute stroke who completed the Mini-Balance Evaluation Systems Test (Mini-BESTest), Fugl-Meyer Assessment for the Lower Extremities, and Mini-Mental State Examination before discharge. Falls were self-reported via telephone survey six months post-discharge. Logistic regression was used to identify significant predictors, with sensitivity analyses to evaluate robustness.ResultsAmong 50 patients, 30% experienced falls within six months. Regression analysis identified stand on one leg (OR = 4.70, 95% CI 1.31-16.85, p = 0.018), compensatory stepping correction of backward (OR = 3.48, 95% CI 1.36-8.92, p = 0.009) and lateral (OR = 3.00, 95% CI 1.02-8.84, p = 0.046) as significant balance tasks associated with fall risk. Forward compensatory stepping corrections were associated with increasing age, whereas standing with eyes closed and walking with head turned horizontally were associated with fall risk in interaction with motor paresis and cognitive integration.ConclusionsOne leg standing and compensatory stepping correction of backward and lateral were significant balance tasks related to fall risk.

BackgroundA wide range of virtual reality (VR) applications are currently used in rehabilitation to support people with multiple sclerosis (pwMS) in improving limb function, balance, postural control, gait training, and cognitive abilities. Despite its widespread use, there is a lack of systematic evaluation for the effectiveness of VR in the rehabilitation.ObjectiveCommentary on the systematic review by De Keersmaecker et al. (2025) which assessed the effects of VR interventions on lower limb and gait function, and balance and postural control in pwMS.MethodsThis review conducted a comprehensive search of the health science databases for (quasi-) randomized controlled trials (RCTs) that assessed virtual reality (VR) interventions in adult pwMS.ResultsThe review included 33 RCTs with a total of 1,294 participants. VR interventions varied across studies, including immersive and non-immersive approaches targeting motor and cognitive rehabilitation. Compared to no intervention, VR demonstrated a moderate positive effect on upper limb function and quality of life, suggesting that it could be a viable rehabilitation tool for improving motor performance and patient well-being. Compared with conventional therapy, VR interventions were more effective in improving balance and postural control. However, for other rehabilitation outcomes, such as gait function, cognitive function, and fatigue management, VR did not show significant differences compared to conventional therapy.ConclusionsVR can be a useful adjunct to traditional rehabilitation, but it may not be superior in all aspects of MS rehabilitation, unambiguous evidence regarding the effect of virtual reality training in multiple sclerosis is still missing. The authors emphasized the need for further research, particularly high-quality, large-scale RCTs, to strengthen the evidence base for VR in MS rehabilitation.

Background and objectivesTo translate and adapt the Multiple Sclerosis Quality of Life-29 into Arabic (MSQOL-29-Ar) and assess its psychometric properties in people with multiple sclerosis (MS).MethodsGenerally, 101 Arabic-speaking adults with MS aged 21 to 60 were recruited. Construct validity was tested by correlating MSQOL-29-Ar with the Arabic Functional Assessment of Multiple Sclerosis (FAMS-AR) and Multiple Sclerosis International Quality of Life (MusiQOL). Known-group validity was assessed by correlating the scale's Physical Health Composite (PHC) and Mental Health Composite (MHC) scores with the demographic and clinical data. Test-retest reliability, internal consistency, standard error of measurement (SEM), minimal detectable change (MDC₉₅), limit of agreement (LOA), responsiveness, and floor/ceiling effects were also investigated.ResultsPHC and MHC scores correlated strongly with FAMS-ARA (r = 0.76 and 0.70, respectively).PHC scores were associated with age, employment, and MS chronicity, while MHC scores correlated with the Expanded Disability Status Scale. Internal consistency was acceptable (PHC α = 0.80; MHC α = 0.90), with excellent test-retest reliability (PHC r = 0.76; MHC r = 0.90). SEM (1.4-1.6) and MDC₉₅ (4.3-3) were low. Responsiveness analysis indicated moderate accuracy (AUC = 0.70-0.75) with on-floor/ceiling effects.ConclusionMSQOL-29-Ar is valid and reliable for assessing HQOL in people with MS, making it suitable for clinical and rehabilitation settings.

BackgroundNeurological disorders are the leading cause of global disability. To enhance neurorehabilitation effectiveness, it is essential to consider contextual factors that influence patient outcomes and the overall experience.ObjectiveThis study aimed to examine the integration of contextual factors into neurorehabilitation practice among physical therapists, focusing on their frequency of use, associated beliefs, ethical considerations, and communication strategies.MethodsA cross-sectional web-based survey was disseminated to a convenience sample of physical therapy professionals via various online platforms. The survey collected demographic data and information regarding the integration of contextual factors into neurorehabilitation practice.ResultsA total of 369 physical therapists completed the survey. Respondents reported moderate use of contextual factors (43%), with verbal communication (85%), positive attitude (82%), and physical contact (75%) the most frequently employed factors. The strongest beliefs about the influence of contextual factors on therapeutic outcomes were linked to verbal communication and optimistic behavior. No significant correlations were found between respondents' characteristics and the use of contextual factors.ConclusionPhysical therapists recognize the importance of contextual factors such as verbal communication, positive attitudes, and a professional approach in neurorehabilitation. Enhanced training is recommended to further integrate these factors into neurorehabilitation practice and optimize patient outcomes.

BackgroundPediatric dysphagia poses risks to feeding safety, nutrition, and overall health, especially in those with developmental or neurological disorders. While various treatments exist, including therapeutic, medical, and surgical options, oral sensorimotor stimulation (OSMS) and neuromuscular electrical stimulation (NMES) are commonly used non-invasive interventions. However, their relative effectiveness remains uncertain, with limited evidence on their advantages in managing specific types of dysphagia.ObjectiveThis prospective cohort study aimed to compare the effectiveness of NMES and OSMS in managing pediatric dysphagia.MethodsThis study recruited pediatric dysphagia patients for a two-month rehabilitation program, with either NMES or OSMS with pre- and post-intervention evaluations using video-fluoroscopic swallow studies, Modified Barium Swallow Impairment Profile (MBSImP) scores, and the 8-point Penetration-Aspiration Scale (PAS).ResultsA total of 26 children participated in the study. NMES significantly reduced MBSImP scores in both oral and pharyngeal impairments, and PAS. OSMS showed significant improvement in MBSImP scores, particularly in oral impairment.ConclusionsThe study suggests NMES benefits oropharyngeal dysphagia and reduces penetration and aspiration, while OSMS is effective for improving oral dysphagia.

BackgroundAchieving community ambulation is a critical milestone in post-stroke rehabilitation, particularly for patients who can ambulate indoors with supervision (Functional Ambulation Category [FAC] 3). However, objective criteria to predict the transition to limited community ambulation (FAC 4) during the subacute phase remain inadequately defined.ObjectiveTo examine the discriminative and predictive validity of selected functional performance tests for identifying the potential to achieve limited community ambulation in stroke patients with supervised indoor walking ability.MethodsThis retrospective study included 52 subacute stroke patients with FAC 3-level ambulation. Participants completed a battery of functional assessments categorized into gait speed, endurance, balance, and activities of daily living (ADL)- including the 10-Meter Walk Test (10mWT), 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Four Square Step Test (FSST), Activities-specific Balance Confidence Scale (ABC), Modified Barthel Index (MBI), among others. Receiver operating characteristic (ROC) curve analysis and logistic regression were employed to determine optimal cutoff values and significant predictors for achieving FAC 4.ResultsThe 6MWT (cutoff: 99.35 m; AUC = 0.980) and 10mWT (cutoff: 0.315 m/s; AUC = 0.953) demonstrated the highest predictive accuracy. Logistic regression identified 6MWT (OR = 1.156, p = .029) and FSST (OR = 0.838, p = .040) as significant predictors. BBS, ABC, and MBI showed moderate discriminative power.ConclusionThe 6MWT and 10mWT are valid and clinically useful tools for predicting limited community ambulation in subacute stroke patients. Early incorporation of endurance and dynamic balance measures may support individualized rehabilitation planning.

BackgroundWith the development of modern biomedical engineering, bio-signal feedback-based robots, such as electromyography (EMG)-based and brain-computer interface (BCI)-based rehabilitation robot, have emerged beyond conventional designs. However, their comparative effectiveness for improving upper limb function in stroke patients remains unassessed.ObjectiveTo evaluate the comparative effectiveness and ranking of the conventional rehabilitation robot and bio-signal feedback-based rehabilitation robot in improving upper limb function in stroke patients.MethodsPubMed, EMBASE, Cochrane Library, CINAHL, PEDro, EI, IEEEXplore, ClinicalTrials.gov, ICTRP, and ISRCTN Registry were searched for randomized controlled trials (RCTs) from their inception to December 25, 2024. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2.0) and evidence certainty with the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Network meta-analyses were performed using a random-effects model within a frequentist framework.Results59 RCTs with 3,387 participants were included. Based on the surface under the cumulative ranking curve (SUCRA), the BCI-based rehabilitation robot demonstrated the highest overall effects (SUCRA: 99.9%), short-term effects (SUCRA: 99.4%), and long-term effects (SUCRA: 85.1%), though its long-term effects were not significant (mean difference: 2.21; 95% confidence interval: -0.79, 5.21). The EMG-based rehabilitation robot outperformed the conventional rehabilitation robot in short-term interventions (SUCRA: 59.8% vs. 40.3%), but it did not have the same advantage in long-term interventions (SUCRA: 27.1% vs. 66.8%).ConclusionsThe BCI-based rehabilitation robot might be the best choice for improving upper limb function in stroke patients. Future studies should focus on the intervention time for the EMG-based rehabilitation robot.

BackgroundThis study investigates the use of Vicon^® motion capture as a convergent measure of goal attainment in children with cerebral palsy (CP) undergoing Contemporary Neuro-Developmental Treatment (NDT).ObjectivesUsing Goal Attainment Scaling (GAS) as the primary outcome measure, the study examines how motion capture data can quantify biomechanical changes related to individualized therapy goals.MethodsThis descriptive study used data from eight children aged 2-15 years with varying classifications of CP. The intervention group underwent six days of intensive NDT, while the control group participated in structured activities before crossing over to receive NDT. Vicon motion capture quantified kinematic parameters for each participant's goals, providing objective data to complement GAS outcomes.AssessmentResults demonstrated that motion capture could effectively identify and measure functional changes, aligning with GAS goals. Of the eight subjects, six children had GAS scores indicating progress toward or beyond their targeted goalsConclusionThese findings highlight the potential of motion capture to enhance the precision of functional performance assessments in pediatric rehabilitation and inform the refinement of goal-setting practices. Despite technical challenges and the need for advanced expertise, motion capture offers a valuable tool for capturing individualized therapy outcomes and advancing evidence-based practices in CP interventions.

BackgroundThe role of sensory pathways in gait recovery remains unclear. We hypothesized that preservation of the somatosensory pathway may play a key role in gait recovery in patients with stroke and severe motor pathway impairment.ObjectiveThis study aimed to investigate the impact of preserving the somatosensory pathway, spinothalamic tract (STT), and superior thalamic radiation (STR) on gait recovery in patients with chronic stroke and severe damage to motor pathways.MethodsThis retrospective cross-sectional study included 85 patients and investigated the association between functional ambulation categories and the integrity of sensory pathways, as represented by fractional anisotropy values. Diffusion tensor imaging was performed to assess the integrity of the corticospinal tract (CST), cortico-ponto-cerebellar tract, STT, and STR 6 months after stroke.ResultsMultivariable logistic regression analysis revealed that severe damage to the CST with the STT preserved yielded an odds ratio of 8.49 (p = 0.030) for functional gait, compared to when both tracts were damaged.ConclusionsSomatosensory pathways may play a critical role in gait recovery for patients with chronic stroke and severe motor tract damage. Preserving the somatosensory pathway could facilitate gait recovery in patients with severe motor pathway damage, offering valuable insights for future stroke rehabilitation strategies.

BackgroundDorsal scapular nerve (DSN) entrapment commonly causes an inconvenient pain in the peri-scapular area and arm.ObjectiveTo assess the efficacy of adding scapulothoracic stabilization exercises (StSE) to DSN blockade on pain intensity, upper extremity disability, DSN conductivity and fatigue severity in people with DSN entrapment.MethodsIn this randomized controlled trial, 60 patients with chronic DSN entrapment, were assigned to control (n = 30) and intervention (n = 30) groups. Both groups received DSN blockade injection and only the intervention group received an additional StSE for six successive weeks. The primary outcome measures included the Numeric Pain Rating Scale (NPRS) and the Disability of Arm, Shoulder and Hand Questionnaire (DASH), while the secondary measures were the motor distal latency (MDL) of DSN and the Fatigue Assessment scale (FAS), which were all tested pre-and post-treatment.ResultsPost-treatment, both groups showed significant changes in all measures. On comparing groups, the results revealed a significant difference in favor to the intervention group observed in the NPRS, DASH and FAS (p < 0.001).ConclusionAdding the StSE alongside DSN blockade could reduce patient's scapular pain, decrease the upper extremity's disability and fatigue severity in people with DSN entrapment.