NeuroRehabilitation最新文献

BackgroundPost-stroke lateropulsion with pusher syndrome (LP) severely impacts postural control and daily activities. In Japan, while a knee-ankle-foot orthosis (KAFO) is recommended for LP treatment, a gait exercise assist robot (GEAR) is also used.ObjectiveWe investigated the effectiveness of gait training using a GEAR and KAFO in improving LP.MethodsThirty-six stroke patients with LP were randomly assigned to GEAR or KAFO groups, and received 50-min daily sessions for 2 weeks. Both the GEAR group, using robot assistance, and the KAFO group, with therapist assistance, engaged in gait training with a goal of 30 min per session. Primary outcomes were changes in Burke Lateropulsion Scale (BLS) and Scale for Contraversive Pushing (SCP) scores.ResultsSeventeen participants in each group completed their respective interventions. Both groups showed marked improvements in BLS and SCP scores (all p < 0.001). Although the GEAR group achieved greater walking distances and step counts (p < 0.01 each), overall BLS and SCP improvements did not significantly differ between the groups (p = 0.51 and 0.84, respectively). Both interventions demonstrated comparable LP improvement to previous studies.ConclusionsWe found no significant difference in the treatment effects between the two interventions, indicating both to be effective.

BackgroundThe Activities-specific Balance Confidence (ABC) scale lacks sufficient psychometric evidence for use in patients with subacute stroke.ObjectiveTo investigate the floor and ceiling effects, construct validity, responsiveness, and the minimal important change (MIC) of the ABC scale in patients with subacute stroke.MethodsThe cases of patients with subacute stroke (n = 62) were analyzed for floor/ceiling effects and construct validity at baseline; those of 39 of the patients were analyzed for responsiveness and MIC at baseline and after 4 weeks. Outcome measures included the ABC scale, Mini-Balance Evaluation Systems Test (Mini-BESTest), Timed Up and Go test (TUG), comfortable walking speed (CWS), and maximal walking speed (MWS) measured at both baseline and 4-week follow-up. The MIC was calculated using a ≥ 4-point improvement on the Mini-BESTest as the anchor.ResultsThe ABC scale's total score did not exhibit any floor or ceiling effects. The ABC scale was correlated with the Mini-BESTest (ρ = 0.74), TUG (ρ = -0.56), CWS (ρ = 0.60), and MWS (ρ = 0.64). The correlation of change score between the ABC scale and Mini-BESTest was ρ = 0.39. The MIC for the ABC scale was 15.6% (95%CI: 10.4%-21.1%).ConclusionsThe ABC scale may help assess self-efficacy in patients with subacute stroke.

PurposeThis systematic review aimed to identify barriers and facilitators in post-stroke motor rehabilitation across patient, caregiver, and healthcare professional levels, employing the capability, opportunity, motivation, behavior (COM-B) model and the theoretical domains framework (TDF).Materials and MethodsA systematic search of PubMed, EMBASE, Cochrane Library, Web of Science, and CINAHL, following PRISMA guidelines, covered literature until January 20, 2025. Studies reporting qualitative, quantitative, or mixed-methods data on post-stroke motor rehabilitation barriers and facilitators were included. Quality assessment utilized MMAT 2018.ResultsAnalyzing 48 studies, we found that barriers to post-stroke motor rehabilitation encompassed motor impairments, cognitive issues, resource scarcity, and environmental factors, while facilitators included good physical abilities, resource accessibility, and social support. The COM-B model elucidated the dynamic interplay between capability, opportunity, and motivation, suggesting educational interventions and telerehabilitation as avenues for improvement.ConclusionThis systematic review, guided by the COM-B model, identifies key barriers and facilitators in post-stroke motor rehabilitation. It emphasizes the importance of targeted education, improved telerehabilitation infrastructure, and robust social support systems to address multifaceted challenges.

Background: Patients with chronic stroke have difficulty in the simultaneous performance of upper extremity (UE) motor tasks while maintaining balance. The dual-task training (DTT) may help them improve their UE functions, trunk performance, and health-related quality of life. Objective: To compare the effects of DTT with dose equivalent conventional physical therapy (DECPT) on UE functions at baseline, week 2, and week 4 of the intervention in these patients. Methods: Twenty-eight patients with chronic stroke were randomly allocated into a dual-task training group (DTTG) (n = 14) and a dose equivalent control group (DECG) (n = 14). Both groups were trained for 1 h per session, 5 sessions per week for 4 weeks. Variables such as the Streamlined Wolf Motor Function Test for chronic stroke (SWMFT-C), Fugl-Meyer Assessment-Upper extremity (FMA-UE), Trunk Impairment Scale (TIS) and Stroke Impact Scale (SIS) were used to measure. Results: Statistically significant differences in the SWMFT-C functional ability scale and the TIS resulted in the group comparisons, however, no significant differences in other variables. Statistically, there was significant improvement in all post-training assessments when compared to pre-training in both groups. Conclusion: DTT can be used as an updated and effective therapeutic intervention for patients with chronic stroke to improve UE functions.

ObjectivesTo evaluate the effect of robot-assisted gait training (Lokomat) combined with conventional physical therapy (CPT) on gait parameters and overall functional outcomes in female patients with stroke.MethodsA total of 40 female patients with stroke were participated in the study. They were randomly allocated into two groups: Robotic-assisted gait training group (RG; n = 20), and received Lokomat training combined with CPT, and the control group (CG; n = 20), received CPT only. CPT included neurophysiological approaches, functional training, balance exercises, and overground walking. Gait parameters (stride length and cadence), muscle strength (Motricity Index), Timed Up and Go Test (TUG), gait independence (Functional Ambulation Category (FAC), and lower limb muscle tone (Modified Ashworth Scale (MAS) were measured before and after 12-weeks of rehabilitation for both groups.ResultsSignificant improvements in post-treatment were observed in all measures across both groups, except for MAS and TUG, as reductions in muscle tone and walking speed were significant only in the RG. Greater significant improvements in all outcome measures were recorded at RG when compared to the CG.ConclusionRobot-assisted gait training with Lokomat, combined with CPT, was more effective than CPT alone in improving gait parameters, mobility, and walking speed in ambulatory post-stroke female patients.Registry: Clinical Trials.gov (NCT05485727).

BackgroundCalf muscle weakness due to neuromuscular disorders significantly impairs walking efficiency, increases energy expenditure, and limits mobility. Ankle-foot orthoses (AFOs) are commonly prescribed to improve gait biomechanics and functional mobility, but their effectiveness remains uncertain.ObjectiveTo assess the effects of AFOs on walking performance in adults with calf muscle weakness caused by slowly progressive neuromuscular disorders.MethodsA summary of the Cochrane Review by van Duijnhoven et al., with commentary from a rehabilitation perspective.ResultsThe Cochrane review included 10 studies with 186 participants. Low-certainty evidence suggests that carbon AFOs may reduce walking energy cost, increase walking speed, and enhance user satisfaction. Leather AFOs may also contribute to improved walking speed. Polypropylene and elastic AFOs appear to provide minimal to no benefit. The effects of AFOs on perceived walking effort, balance, and long-term use remain inconclusive due to very low-certainty evidence. Although adverse events were predominantly mild, conclusions regarding safety remain limited, as most studies were conducted in laboratory settings without incorporating real-life use of AFOs.ConclusionsThe evidence supporting AFO use in adults with calf muscle weakness remains of low to very low certainty. Future research should focus on individualized AFO prescription, long-term outcomes, and safety monitoring. Additionally, further investigation is needed to clarify the impact of AFO material properties on walking, mobility, and quality of life in individuals with neuromuscular disorders.

ObjectivesTo compare between the effects of plyometric exercises versus Wii on upper extremity functions in children with unilateral cerebral palsy (UCP).MethodForty-two children with UCP, ranging in age from 8 to 12 years were allocated to receive plyometric exercises (PLYO -group) or Wii training (Wii-group) for 45 min. both groups received selected occupational therapy programs for 30 min twice a week over 3-month. The intervention was delivered on non-consecutive days. The quality of upper extremity skills test (QUEST), Test of arm selective control (TASC) and pneumatic squeeze bulb dynamometer were used to assess upper extremity function, SMC and HGS, respectively.ResultsOverall, 42 children (21 in the PLYO-group, 21 in the Wii-group) completed data collection and treatment. With-in group comparison showed significant improvement in both groups while post-treatment comparisons revealed a significant difference from mean difference in upper extremity function is 9.55 (8.71:10.39), SMC is 2.05 (1.47: 2.63) and HGS is 2.86 (2.20: 3.53) (p < 0.05; 95% Confidence interval) in favor of the PLYO-group.ConclusionsPlyometric exercises are significantly more effective than Wii training in improving upper extremity function and strength in children with UCP.

BackgroundWhile there is strong evidence for botulinum toxin-A (BoNT-A) in post-stroke spasticity, there is a paucity of data in multiple sclerosis and other conditions in real-world settings.ObjectiveDocument the use of BoNT-A in the management of spasticity, with focus on the treatment of spasticity due to stroke and multiple sclerosis.MethodsThis noninterventional, retrospective study included all adults treated for upper and/or lower limb spasticity (any etiology) at three centers in Italy who received ≥3 BoNT-A injection cycles between 2008 and 2018.ResultsInjection data from 149 patients were analyzed (n = 67 post-stroke, n = 47 MS, n = 35 other etiologies). The median treatment duration was 54.9 months in the post-stroke population and 41.9 months in the MS population. Total doses for the commercially available BoNT-A formulations were typically lower than approved for use in spasticity; we also observed clinically relevant differences in the muscle patterns treated between the MS and post-stroke indications. Regardless of etiology, most patients were satisfied with treatment.ConclusionsThis retrospective study provides a snapshot of spasticity management for patients referred for BoNT-A treatment. Most patients were satisfied with their treatment over several cycles and the data support the effectiveness of BoNT-A for focal spasticity regardless of etiology.

BackgroundThe vestibular system is crucial for maintaining the body's orientation and postural control, as well as for coordinating movements.ObjectiveThis study investigated the effects of vestibular rehabilitation (VR) in sitting position on trunk control, balance, and gait in subacute stroke patients.MethodsPatients were divided into an experimental group (VR, n = 11) and a control group (neurodevelopmental rehabilitation, n = 12). The trunk impairment scale (TIS) measured trunk control, while the modified functional reaching test (mFRT) assessed dynamic balance using Balancia software. The BTS G-Walk was used to measure gait and pelvic movement.ResultsIn the experimental group, significant increases were observed in TIS total score, sitting balance, and coordination (p < 0.05). The mFRT and the maximum distance of the center of gravity increased on the affected and unaffected side, as well as forward (p < 0.05). Additionally, cadence, velocity, and gait symmetry significantly improved during gait (p < 0.05).ConclusionThe VR in the sitting position effectively improved trunk control, balance, and gait quality in patients with subacute stroke. Therefore, this suggests that VR should be incorporated into rehabilitation protocols to enhance functional outcomes and recovery in these patients.

BackgroundCurrent gait rehabilitation strategies for stroke survivors have limitations. Virtual reality-integrated treadmill training shows promise by enhancing neuroplasticity and motor learning, but its comparative efficacy remains unclear.ObjectivesThis review evaluates the effectiveness of VR-integrated treadmill training on gait performance, balance, and functional outcomes in stroke survivors, addressing benefits and limitations.MethodsFollowing PRISMA guidelines, randomized controlled trials comparing Virtual reality-treadmill and conventional rehabilitation were analyzed. Outcomes included gait speed, balance, and participation. Methodological quality was assessed using the RoB 2 tool.ResultsTen RCTs involving 266 participants were included. Virtual reality interventions significantly improved gait speed, stride length, and balance compared to conventional training. Interactive Virtual reality systems demonstrated superior benefits by incorporating task-specific and feedback-driven elements. However, improvements in quality of life and participation were inconsistent. Most studies spanned 4-8 weeks, limiting long-term conclusions.ConclusionVirtual reality-treadmill training improves gait and neuroplastic recovery but shows inconclusive effects on quality of life and participation. Future research should focus on longer interventions and translating gains to real-world activities, supporting Virtual reality as a complement to traditional rehabilitation.