NeuroRehabilitation最新文献

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.

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.

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.

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.

BackgroundWe aimed to propose Emotional training (ET) as a neurocognitive approach, based on motor imagery by stimulating the patient's perception through different stimuli on the face to treat peripheral paralysis of the facial nerve.MethodsRetrospective, observational, double-centres cohort study of 50 patients diagnosed with peripheral facial nerve palsy. Facial function was assessed through the House-Brackmann scale (HBS, the primary outcome), the Sunnybrook Facial Grading System (FGS, secondary outcome) and the Italian validated version of the Facial Disability Index (It-FDI, secondary outcome) at the beginning and the end of the rehabilitation protocol. An author blinded to the protocols did the data analysis.ResultsAll patients showed improvement at the end of ET (HBS: 2 (p < 0.001); FGS: 57 (p < 0.001); It-FDI: 80 (p = 0.002)), by achieving a slight dysfunction or even normal function compared to baseline (HBS: 4; FGS: 21; It-FDI: 76). A second group of 8 surgical patients treated with an already published protocol served as control. HSB and FGC did not differ between the two groups at baseline and after 20 rehabilitative sections, with similar improvements.ConclusionET provided significant improvements in the symmetry of the face at rest and during voluntary movements, in social function and subjectively perceived well-being. ET is an effective therapeutic proposal for patients suffering from idiopathic or iatrogenic facial nerve palsy.

BackgroundFine motor impairment is common in Huntington's disease (HD). Neurologic Music Therapy (NMT) is the therapeutic application of music for neurorehabilitation. Measured by magnetoencephalography (MEG), the modulation of motor-related oscillations via NMT is associated with restorative motor training. In HD, the impact of NMT on fine motor function and associated neurophysiology have yet to be explored.ObjectiveConduct a proof-of-concept study to determine the feasibility of NMT and MEG evaluation in people with HD.MethodsThree participants with HD and impaired fine motor skills underwent a five-week NMT intervention. Pre- and post-intervention assessments included the Unified HD Rating Scale, the Grooved Pegboard Test, and MEG recording during a cued finger-tapping task.ResultsThere was 100% adherence to the pre and post visit assessments and MEG, and 93% adherence to the NMT intervention. A visual increase in evoked beta/gamma power at cue onset along with an earlier evoked beta response at 500-800 msec post cue were observed in the neuromagnetic data after NMT.ConclusionNMT-based fine motor rehabilitation, and its evaluation with neurophysiological studies, are feasible in HD. More work is needed to determine if this intervention holds potential to influence functional change or spectral patterns of motor cortical activity.

Telerehabilitation, especially through mobile health applications, offers a promising approach to prolong and intensify stroke rehabilitation at a distance. This feasibility study aims to evaluate the usability, adherence and satisfaction of a telerehabilitation application called TeleRe-app for post-stroke individuals. The TeleRe-app uses the REApad platform. It includes self-rehabilitation exercises presented via video and serious games, and therapeutic education. Subjects were asked to use TeleRe-app for 4 weeks, 5 times/week, 30 min/session. Weekly remote monitoring was organised through the TeleRe-app teleconferencing module. Usability and satisfaction were measured using Likert scales and the System Usability Scale (SUS), while adherence was tracked by frequency and duration of use of TeleRe-app. 28 post-stroke individuals participated in the study. The usability of TeleRe-app was excellent (SUS 85%). Satisfaction was high (averaged 8/10). These results were better for outpatients than for inpatients. On average, participants performed telerehabilitation 4 times/week for 16 min/session. Adherence was thus lower than expected, but participants engaged in additional exercise by an average of 70 min/week. TeleRe-app is a valuable adjunct to conventional rehabilitation and warrants further evaluation in clinical trials.ClinicalTrials Registration : NCT06016374.

BackgroundPain is a non-motor symptom (NMS) of Parkinson's disease (PD) present in up to 85% of patients. Fatigue is another highly prevalent NMS. Presence of both is detrimental for the individual's well-being, but their association remains largely unexplored.ObjectivesTo assess the relationship between pain, fatigue, and mediating variables in PD.MethodsFifty-three PD patients with pain participated in a cross-sectional study. Correlation analyses were performed between clinical, self-reported measures of pain (Spanish-King's-Parkinson-Pain-Scale (S-KPPS) and Brief-Pain-Inventory (BPI) and fatigue (Fatigue-Severity-Scale (FSS), Daily-Fatigue-Impact-Scale (DFIS)). Partial correlations were performed considering these confounders: Levodopa-equivalent daily dose (LEDD), years from PD diagnosis, UPDRS-III score, anxiety, depression and kinesiophobia.ResultsFatigue severity (FSS) was positively and moderately correlated with pain interference (BPI; ρ = 0.351, p = 0.045) and symptomatic burden (S-KPPS; ρ = 0.367, p = 0.042), but not intensity (BPI; ρ = 0.122, p = 0.446). DFIS did not correlate with any dimension of pain (p > 0.05). Motor symptoms, anxiety, depression and kinesiophobia changed correlation significance, but LEDD and disease duration didn't.ConclusionA moderate correlation was found between fatigue severity and both pain interference and symptomatic burden, influenced by other non-motor symptoms (NMS) like anxiety and depression. Although anxiety and depression have previously been associated with fatigue, this study adds pain to a tetrad of interrelated NMS prevalent in PD.

ObjectiveThe objectives of this study were to evaluate functional outcomes of cervical motor control, strength and endurance following active transcranial direct current stimulation (tDCS) with exercise therapy (ET) compared to sham tDCS/+ET in patient with cervicogenic headache (CGH),DesignThis was a pilot sham-controlled, participant and assessor blinded, randomized controlled trial.MethodsThirty-two participants with CGH were randomized to active tDCS/+ET or sham tDCS/+ET. Participants completed 6-weeks of daily ET concurrently combined with 3 sessions per week of tDCS. Assessments included: craniocervical flexion test (mmHg), cervical isometric strength (N), cervical flexor and extensor endurance (seconds), and range of motion (degrees) pre-treatment, post-treatment, 6-weeks and 12-weeks post treatment. Linear mixed effect models evaluated group-time interactions at each follow-up while accounting for exercise program adherence and sex.ResultsThere were significant group-time interactions for activation scores on the craniocervical flexion test from pre-treatment to post-treatment (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), 6-weeks (β = 1.571; 95%CI[0.155, 2.988]; p = 0.030), and 12-weeks (β = 1.954; 95%CI[0.465, 3.443]; p = 0.011) favoring the active tDCS/+ET group.ConclusionsActive tDCS/+ET demonstrated significant benefits in deep cervical flexor motor control compared to sham tDCS/+ET that remained improved up to 12 weeks post-treatment. This suggests tDCS/+ET may improve of functional outcomes for patients with CGH.