NeuroRehabilitation最新文献

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.

BackgroundPrimary intracerebral hemorrhage (ICH) carries high mortality and disability risks. Although early mobilization is beneficial, concerns about physiological instability often delay mobilization.ObjectiveTo evaluate whether a structured early mobilization protocol improves functional mobility and reduces adverse events in critically ill ICH patients.MethodThis retrospective pre-post study included 192 patients with ICH (ICH score 0-4) admitted to a dedicated stroke center. In the pre-implementation phase in 2022, patients received standard care. In the post-implementation phase in 2023, a standardized mobility protocol, incorporating time-based stratification, neurological thresholds, and safety criteria to guide activity progression, was introduced. Primary outcomes included the Modified ICU Mobility Scale (MIMS) score at intensive care unit (ICU) discharge and the occurrence of adverse events.ResultsThe post-implementation group (99 patients) showed higher MIMS scores at ICU discharge, with a greater proportion achieving out-of-bed sitting during their ICU stay compared to the pre-implementation group (93 patients). Non-serious adverse events in the former decreased significantly; ICU and hospital lengths of stay were shorter but not statistically significant.ConclusionThe structured pathway enabled safer, earlier mobilization and improved ICU functional outcomes. While mobility benefits were observed, caution is warranted in interpreting non-significant trends in length of stay.

ObjectiveTo evaluate the efficacy of warm acupuncture combined with rehabilitation training on lower-limb motor dysfunction in cerebral infarction (CI) patients.MethodsSixty CI patients with lower-limb motor dysfunction (Feb 2019 to Apr 2021) were enrolled. The control group received rehabilitation training, while the study group received warm acupuncture plus rehabilitation. The outcomes, including Functional Independence Measure (FIM), 10-meter maximum walking speed (MWS), Berg-balance scale (BBS), Barthel index, and Holden walking ability rating scale, were compared.ResultsThe study group showed significantly better results than the control group. After treatment, the study group's FIM and BBS scores were higher at 1-, 4-, and 6-week follow-ups. MWS scores of the study group improved significantly, while the control group showed less improvement. The Holden walking ability rating scale was also more favorable for the study group.ConclusionWarm acupuncture combined with rehabilitation training significantly improves lower-limb motor dysfunction in CI patients, demonstrating superior outcomes compared to rehabilitation alone.