NeuroRehabilitation最新文献

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.

ObjectiveMultiple sclerosis (MS) involves respiratory muscle weakness that can lead to critical complications. Inspiratory muscle training (IMT) is a therapeutic intervention that effectively strengthens the respiratory muscles. This study aimed to investigate the effectiveness of IMT combined with deep diaphragmatic breathing exercises with respect to diaphragm excursion, respiratory muscle strength, and fatigue in subjects with MS.MethodsThirty-six subjects with MS, aged 25-45 years, with mild to moderate disability, were assigned equally to a study and an active control group. The study group (i.e., the IMT group) received IMT combined with deep diaphragm breathing exercises, while the control group received only deep diaphragm breathing exercises. The interventions were provided for 15 min, three days per week, and 8 weeks. The primary outcome measure was diaphragm excursion, and the secondary outcome measures were maximal inspiratory pressure (Pimax), fatigue severity scale (FSS), and pulmonary dysfunction index (PDI).ResultsThe IMT group showed significantly more improvements in diaphragm excursion (p < 0.001), Pimax (p = 0.002), FSS (p < 0.001), and PDI (p < 0.001) than the control group.ConclusionIMT combined with deep diaphragmatic breathing exercises could lead to better improvements in diaphragm excursion, inspiratory muscle strength, fatigue symptoms, and PDI than deep diaphragmatic breathing exercises alone in subjects with MS and mild to moderate disability.

BackgroundStudies on non-invasive brain stimulation (NIBS) for children with cerebral palsy (CP) have yielded inconsistent findings regarding motor skills. This research will evaluate its efficacy through a systematic review.MethodA thorough search was conducted on the PubMed, Cochrane, and ScienceDirect databases, encompassing all trials that examined the impact of NIBS on balance, gait, and motor skills in children with CP. The analysis adhered to PRISMA guidelines.ResultsThe review included 17 trials, 13 assessing NIBS protocols, involving 385 children in the meta-analysis. Pooled analysis showed significant therapeutic effects on gait spatiotemporal outcomes in terms of walking speed (post-transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) multi-session treatment) and gait cadence (post-tDCS multi-session). In addition, tDCS multi-session showed significant therapeutic effects on standing abilities and mobility functions. However, no significant effect of tDCS on balance, step length, stride length, walking endurance, and GMFM-walking functions.ConclusionThis review highlighted the potential benefits of NIBS, particularly tDCS, in improving various motor functions in children with CP, such as walking speed, cadence, and mobility. However, its impact on balance and other gait factors remains inconclusive, indicating the need for further research to optimize NIBS protocols based on updated brain mapping findings.

BackgroundThe Perri Auditory Verbal Learning Test (Perri-AVLT) is a cognitive tool that is used to assess verbal learning and memory. To date, demographically adjusted norms for Perri-AVLT have not been identified for Mexican adults.ObjectivesThis study aimed to 1) estimate the means, standard deviations, and ranges for Perri-AVLT raw scores, 2) develop regression-based norms from healthy participants to enable demographic adjustments for clinical interpretation, and 3) assess test-retest reliability.MethodsThe sample included 430 participants (380 cognitively normal individuals and 50 clinical cases) aged 18-59 years from Mexico (Jalisco, Guanajuato and Mexico City). The participants completed the Perri-AVLT. A multivariate regression-based norming approach was used to evaluate the effects of age, sex, and years of education on test performance.ResultsHealthy participants aged $\le$ 39 years performed significantly better than those aged $\ge$ 40 years did in all the Perri-AVLT trials. Age and years of education were significant predictors of performance, with older age associated with lower scores and more years of education associated with greater word recall on the Perri-AVLT.ConclusionWe provided normative data for the Perri-AVLT after performing regression analyses adjusted for sociodemographic factors. These norms can be used to evaluate verbal learning and memory in early-to-midlife Mexican adults. This information can support neuropsychologists in the context of cognitive assessment, rehabilitation and research.

BackgroundVenous congestion is hypothesized to contribute to hand edema in patients with stroke; however, no studies have specifically investigated decreased venous return in the paretic hand.ObjectiveThis preliminary study explores this relationship by objectively measuring hand edema and venous return.MethodsThis cross-sectional study included patients who had experienced a first-ever stroke and presented with hand edema. Hand edema was measured bilaterally using a volumeter, and venous flow volume in the axillary vein was evaluated bilaterally using an ultrasound device. Hand edema and venous flow volumes were compared between the paretic and non-paretic limbs using a paired t-test.ResultsThirteen male patients with stroke with hand edema were screened. Their median age was 69.3 years, and the median time since stroke onset was 117.5 days. Flow volume in the axillary vein was significantly lower on the paretic side (64.7 [95% confidence interval (CI): 41.8, 87.7] mL/min) than on the non-paretic side (115.9 [95% CI: 74.6, 157.2] mL/min).ConclusionThe findings of this study suggest that venous return may be reduced in patients with stroke with hand edema. Future research should investigate the mechanisms underlying venous return impairment and other potential causes of hand edema.

BackgroundThe atypical upper limb (UL) flexion pattern in children with unilateral cerebral palsy (UCP) debilitates their ability to experience natural weight bearing through arms and hands, leading to restricted mobility and reduced hand functions. The recommended therapeutic strategies to improve hand functions are not standardized, i.e., (varied protocols, treatment schedules, and frequency), though the benefits of UL weight-bearing on hand-opening and prehension skills are well-documented.ObjectiveTo study the efficacy of Static weight bearing (SWB) in Prone on UL with active elbow extension versus modified-constrained induced movement therapy (m-CIMT) on hand functions in children with UCP.MethodsRandomized clinical trial. Subjects (N = 38) were randomized equally (group- 1, SWB, n = 19; and group- 2, m-CIMT, n = 19). Outcome measure- Fine Motor of PDMS-2 (FM_PDMS-2) pre-and post-interventions after 2 weeks.ResultsThe percentage change (post-intervention) for the Grasping and VMI subtests in the SWB group were 37.67% and 14.11%, while for the m-CIMT group were 12.78% and 4.88%, respectively. These changes were highly significant (p 0.000).ConclusionBoth groups, i.e., SWB and m-CIMT, showed significant differences in the percentage change post-intervention. However, the SWB group demonstrated augmented changes over the m-CIMT on both subtests of FM_PDMS-2, hence greater improvement in hand functions following SWB exercises.