NeuroRehabilitation最新文献

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.

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).