Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100464
Ava Hughes BSc , Mahdis Hashemi MD , Laura Schatz BSc , Daniel Gatenby BSc , Paul Winston MD
Cryoneurolysis is a minimally invasive procedure that induces secondary axonotmesis while preserving the nerve’s supportive structures, offering an alternative approach to managing spasticity in multiple sclerosis (MS)—a condition affecting up to 90% of patients with MS and often leading to contractures, pain, and reduced mobility. In this case report, a 48-year-old woman with progressive MS who previously experienced side effects and limited benefits from prior botulinum toxin-A injections underwent ultrasound-guided percutaneous cryoneurolysis on targeted nerves to spastic muscles identified using the response to diagnostic nerve blocks. Range of motion and spasticity were assessed using the Modified Ashworth Scale, Modified Tardieu Scale, and numerical pain ratings. The patient demonstrated marked, sustained improvements in range of motion (shoulder flexion, abduction, and external rotation and elbow extension up to 11mo and knee flexion up to 7mo) and a reduction in spasticity (at 11mo for shoulder and elbow, 4mo for knee). The patient then experienced a progressive MS crisis, and a second treatment was offered at 1 year. There were additional gains after the second round of cryoneurolysis. The procedure showed 15-fold annual cost savings in their jurisdiction compared with botulinum toxin-A, underscoring the potential economic benefits of cryoneurolysis. These findings suggest that cryoneurolysis is a promising treatment for upper and lower limb spasticity in MS, providing significant, sustained improvements in range of motion, pain, and spasticity. Further research with larger cohorts is needed to confirm the long-term efficacy, broader applicability, and fully substantiate the cost-effectiveness of this emerging treatment modality.
{"title":"Cryoneurolysis for Managing Spasticity in Multiple Sclerosis: A Case Report Demonstrating Sustained Functional Gains and Cost-Effectiveness","authors":"Ava Hughes BSc , Mahdis Hashemi MD , Laura Schatz BSc , Daniel Gatenby BSc , Paul Winston MD","doi":"10.1016/j.arrct.2025.100464","DOIUrl":"10.1016/j.arrct.2025.100464","url":null,"abstract":"<div><div>Cryoneurolysis is a minimally invasive procedure that induces secondary axonotmesis while preserving the nerve’s supportive structures, offering an alternative approach to managing spasticity in multiple sclerosis (MS)—a condition affecting up to 90% of patients with MS and often leading to contractures, pain, and reduced mobility. In this case report, a 48-year-old woman with progressive MS who previously experienced side effects and limited benefits from prior botulinum toxin-A injections underwent ultrasound-guided percutaneous cryoneurolysis on targeted nerves to spastic muscles identified using the response to diagnostic nerve blocks. Range of motion and spasticity were assessed using the Modified Ashworth Scale, Modified Tardieu Scale, and numerical pain ratings. The patient demonstrated marked, sustained improvements in range of motion (shoulder flexion, abduction, and external rotation and elbow extension up to 11mo and knee flexion up to 7mo) and a reduction in spasticity (at 11mo for shoulder and elbow, 4mo for knee). The patient then experienced a progressive MS crisis, and a second treatment was offered at 1 year. There were additional gains after the second round of cryoneurolysis. The procedure showed 15-fold annual cost savings in their jurisdiction compared with botulinum toxin-A, underscoring the potential economic benefits of cryoneurolysis. These findings suggest that cryoneurolysis is a promising treatment for upper and lower limb spasticity in MS, providing significant, sustained improvements in range of motion, pain, and spasticity. Further research with larger cohorts is needed to confirm the long-term efficacy, broader applicability, and fully substantiate the cost-effectiveness of this emerging treatment modality.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100464"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100427
Kimberly Kontson PhD , Bin Wang PhD , Nicole Leung BA , John M. Miguelez CP, FAAOP(D) , Lauren Trent MOT, OTR/L
Objective
To provide evidence for test–retest reliability, interrater reliability, and convergent validity of the targeted Box and Block Test (tBBT) in the upper limb prosthesis user population.
Design
An observational study was designed to assess various psychometric properties of the novel outcome measure. Participants completed the tBBT across 2 distinct testing sessions to assess test–retest reliability, which was quantified using the intraclass correlation coefficient (ICC) (3,k) and Pearson's correlation coefficient. Multiple raters scored the tBBT to assess interrater reliability, which was quantified using the ICC(2,k) and Pearson's correlation coefficient. Convergent validity was assessed by computing the Pearson's correlation coefficient between specific subtasks of the Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL) and the tBBT.
Setting
Clinic.
Participants
A convenience sample of 20 transradial, unilateral upper limb prosthesis users.
Interventions
Not applicable.
Main Outcome Measures
tBBT, Box and Block Test (BBT), and CAPPFUL.
Results
Interrater reliability for completion time and identification of unsuccessful transports were found to be excellent for the tBBT with ICC values of 0.97-0.99. Similarly, test–retest reliability was found to be good to excellent with ICC values >0.84. There were strong correlations between the scores obtained by different sessions and the scores given by different raters, with correlation coefficients exceeding 0.75. Moderate to strong correlations were found between the tBBT and BBT and subtasks of the CAPPFUL.
Conclusions
The tBBT is a valid and reliable measure to assess the functional performance of individuals using an upper limb prosthetic device. This novel measure offers benefits of ease and speed of implementation; assessment of repetitive, ecologically representative movements; and quantification of performance using both speed and accuracy.
{"title":"Test–retest Reliability, Interrater Reliability, and Convergent Validity of the Targeted Box and Block Test in an Upper Extremity Prosthesis User Population","authors":"Kimberly Kontson PhD , Bin Wang PhD , Nicole Leung BA , John M. Miguelez CP, FAAOP(D) , Lauren Trent MOT, OTR/L","doi":"10.1016/j.arrct.2025.100427","DOIUrl":"10.1016/j.arrct.2025.100427","url":null,"abstract":"<div><h3>Objective</h3><div>To provide evidence for test–retest reliability, interrater reliability, and convergent validity of the targeted Box and Block Test (tBBT) in the upper limb prosthesis user population.</div></div><div><h3>Design</h3><div>An observational study was designed to assess various psychometric properties of the novel outcome measure. Participants completed the tBBT across 2 distinct testing sessions to assess test–retest reliability, which was quantified using the intraclass correlation coefficient (ICC) (3,k) and Pearson's correlation coefficient. Multiple raters scored the tBBT to assess interrater reliability, which was quantified using the ICC(2,k) and Pearson's correlation coefficient. Convergent validity was assessed by computing the Pearson's correlation coefficient between specific subtasks of the Capacity Assessment of Prosthesis Performance for the Upper Limb (CAPPFUL) and the tBBT.</div></div><div><h3>Setting</h3><div>Clinic.</div></div><div><h3>Participants</h3><div>A convenience sample of 20 transradial, unilateral upper limb prosthesis users.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>tBBT, Box and Block Test (BBT), and CAPPFUL.</div></div><div><h3>Results</h3><div>Interrater reliability for completion time and identification of unsuccessful transports were found to be excellent for the tBBT with ICC values of 0.97-0.99. Similarly, test–retest reliability was found to be good to excellent with ICC values >0.84. There were strong correlations between the scores obtained by different sessions and the scores given by different raters, with correlation coefficients exceeding 0.75. Moderate to strong correlations were found between the tBBT and BBT and subtasks of the CAPPFUL.</div></div><div><h3>Conclusions</h3><div>The tBBT is a valid and reliable measure to assess the functional performance of individuals using an upper limb prosthetic device. This novel measure offers benefits of ease and speed of implementation; assessment of repetitive, ecologically representative movements; and quantification of performance using both speed and accuracy.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100427"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To investigate the safety and effectiveness of early cardiopulmonary rehabilitation (ECR) combined with melatonin supplementation on functional capacity and sleep quality during hospitalization in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).
Design
Single-blinded randomized controlled trial.
Setting
Cardiology inpatient unit where patients were hospitalized after PCI.
Participants
Forty-eight male patients (N=48) with AMI followed by PCI (mean age of 57.1±8.7y) were included and randomized into 3 groups: MELEX (ECR combined with 4 mg of exogenous melatonin), EX (ECR with placebo), and CON (control group with placebo).
Interventions
Patients in the MELEX and EX groups participated in ECR, consisting of walking, passive and active range of motion, moderate-intensity strengthening exercises, and breathing exercises. The MELEX group received a daily 4 mg dose of melatonin, while the EX and CON groups received a placebo. Participants in CON group received usual care without engaging in ECR.
Main Outcomes Measures
Functional capacity was evaluated by the 6-minute walking test (6mwt). Sleep quality was assessed by the Spiegel questionnaire. Rating of perceived exertion was evaluated using the Borg Scale. Assessments were conducted on the first day after PCI and at hospital discharge.
Results
The 6mwt distance was better in the MELEX group than in the other groups exceeding the minimal clinically important differences (P<.001). Sleep quality was improved more in MELEX than EX and CON groups (P<.001). A strong-graded correlation was found between the 6mwt and Spiegel Score (r=0.730; P<.001). No adverse cardiac events related to ECR or melatonin supplementation were recorded during hospitalization.
Conclusions
ECR combined with a daily 4 mg of melatonin supplementation was safe and effective in improving functional capacity and sleep quality in patients with AMI during hospitalization after PCI.
{"title":"Effectiveness of Early Cardiorespiratory Rehabilitation Combined With Melatonin Supplementation During the Inpatient Period After Acute Myocardial Infarction: a Pilot Study","authors":"Mohamed Ali Hbaieb MSc , Salma Charfeddine MD , Tarak Driss PhD , Laurent Bosquet PhD , Benoit Dugué PhD , Leila Abid MD , Omar Hammouda PhD","doi":"10.1016/j.arrct.2025.100454","DOIUrl":"10.1016/j.arrct.2025.100454","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the safety and effectiveness of early cardiopulmonary rehabilitation (ECR) combined with melatonin supplementation on functional capacity and sleep quality during hospitalization in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI).</div></div><div><h3>Design</h3><div>Single-blinded randomized controlled trial.</div></div><div><h3>Setting</h3><div>Cardiology inpatient unit where patients were hospitalized after PCI.</div></div><div><h3>Participants</h3><div>Forty-eight male patients (N=48) with AMI followed by PCI (mean age of 57.1±8.7y) were included and randomized into 3 groups: MELEX (ECR combined with 4 mg of exogenous melatonin), EX (ECR with placebo), and CON (control group with placebo).</div></div><div><h3>Interventions</h3><div>Patients in the MELEX and EX groups participated in ECR, consisting of walking, passive and active range of motion, moderate-intensity strengthening exercises, and breathing exercises. The MELEX group received a daily 4 mg dose of melatonin, while the EX and CON groups received a placebo. Participants in CON group received usual care without engaging in ECR.</div></div><div><h3>Main Outcomes Measures</h3><div>Functional capacity was evaluated by the 6-minute walking test (6mwt). Sleep quality was assessed by the Spiegel questionnaire. Rating of perceived exertion was evaluated using the Borg Scale. Assessments were conducted on the first day after PCI and at hospital discharge.</div></div><div><h3>Results</h3><div>The 6mwt distance was better in the MELEX group than in the other groups exceeding the minimal clinically important differences (<em>P</em><.001). Sleep quality was improved more in MELEX than EX and CON groups (<em>P</em><.001). A strong-graded correlation was found between the 6mwt and Spiegel Score (<em>r</em>=0.730; <em>P</em><.001). No adverse cardiac events related to ECR or melatonin supplementation were recorded during hospitalization.</div></div><div><h3>Conclusions</h3><div>ECR combined with a daily 4 mg of melatonin supplementation was safe and effective in improving functional capacity and sleep quality in patients with AMI during hospitalization after PCI.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100454"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100468
Katherine L. McCauley PhD , Tracey Wallace MS, CCC-SLP , Timothy P. Moran PhD , Javier Palacios BS , Dina Forehand MS, CCM , Jacquelyn Breitenstein MS, CTRS, CCM , Shannon C. Miller MD , Russell K. Gore MD
Objective
To explore initial outcomes (treatment entry and completion and staff feedback) for an interdisciplinary military traumatic brain injury (TBI) treatment program with individualized support for co-occurring substance use (SU).
Design
A quality improvement effort was undertaken to develop an integrated model of care for TBI with support for service members and veterans (SM/Vs) with co-occurring SU. We describe treatment entry and completion outcomes, along with staff feedback, collected over 26 months of program implementation.
Setting
An intensive outpatient program (IOP) for SM/Vs with TBI, administered by a not-for-profit hospital
Participants
Three hundred and sixty-four (N=364) SM/Vs applying for TBI treatment (85.2% men, 28.3% active service, median age of 41 (interquartile range, ±12)).
Interventions
An Integrated Care Model for TBI + SU was developed and flexibly applied to support client needs, including modifications to assessment, intervention, and follow-up support related to SU.
Main Outcome Measures
We report on instances of noncompletion because of SU, percentage of admission denials because of SU, demographic and clinical predictors of entering care, and qualitative feedback from treating clinicians.
Results
Over 26 months, 188 individuals entered care, and just 7 who entered the IOP did not complete, with 1 of these instances because of SU. Clinician attitudes indicate optimism about the Integrated Care Model. Predictors of entering care, analyzed using logistic regression with recursive feature elimination, included multiple demographic (sex, race, location, service status) and clinical (SU and psychiatric history, brain injury symptom severity) characteristics.
Conclusions
An interdisciplinary TBI treatment environment holds promise as a setting for incorporating SU-related support to enhance entry and completion for more SM/Vs.
{"title":"Exploring Integration of Support for Co-Occurring Substance Use-Related Needs in Interdisciplinary Traumatic Brain Injury Treatment for Military Service Members and Veterans","authors":"Katherine L. McCauley PhD , Tracey Wallace MS, CCC-SLP , Timothy P. Moran PhD , Javier Palacios BS , Dina Forehand MS, CCM , Jacquelyn Breitenstein MS, CTRS, CCM , Shannon C. Miller MD , Russell K. Gore MD","doi":"10.1016/j.arrct.2025.100468","DOIUrl":"10.1016/j.arrct.2025.100468","url":null,"abstract":"<div><h3>Objective</h3><div>To explore initial outcomes (treatment entry and completion and staff feedback) for an interdisciplinary military traumatic brain injury (TBI) treatment program with individualized support for co-occurring substance use (SU).</div></div><div><h3>Design</h3><div>A quality improvement effort was undertaken to develop an integrated model of care for TBI with support for service members and veterans (SM/Vs) with co-occurring SU. We describe treatment entry and completion outcomes, along with staff feedback, collected over 26 months of program implementation.</div></div><div><h3>Setting</h3><div>An intensive outpatient program (IOP) for SM/Vs with TBI, administered by a not-for-profit hospital</div></div><div><h3>Participants</h3><div>Three hundred and sixty-four (N=364) SM/Vs applying for TBI treatment (85.2% men, 28.3% active service, median age of 41 (interquartile range, ±12)).</div></div><div><h3>Interventions</h3><div>An Integrated Care Model for TBI + SU was developed and flexibly applied to support client needs, including modifications to assessment, intervention, and follow-up support related to SU.</div></div><div><h3>Main Outcome Measures</h3><div>We report on instances of noncompletion because of SU, percentage of admission denials because of SU, demographic and clinical predictors of entering care, and qualitative feedback from treating clinicians.</div></div><div><h3>Results</h3><div>Over 26 months, 188 individuals entered care, and just 7 who entered the IOP did not complete, with 1 of these instances because of SU. Clinician attitudes indicate optimism about the Integrated Care Model. Predictors of entering care, analyzed using logistic regression with recursive feature elimination, included multiple demographic (sex, race, location, service status) and clinical (SU and psychiatric history, brain injury symptom severity) characteristics.</div></div><div><h3>Conclusions</h3><div>An interdisciplinary TBI treatment environment holds promise as a setting for incorporating SU-related support to enhance entry and completion for more SM/Vs.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100468"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100462
Jane T. Hein PT , Sarah Redmond PhD , Lina Daus DPT , Monica Heinemann MOT , Jon Tilburt MD , Andrea Cheville MD, MSCE
Objective
To explore barriers and facilitators experienced by therapists (physical therapists/assistants and occupational therapists/assistants) supporting the implementation of the electronic health record (EHR)-based Healing After Surgery (HAS) initiative, which used clinical decision support (CDS) elements to support therapists in providing perioperative education and support to patients for the use of evidence-based nonpharmacological pain care (NPPC) techniques as part of a health system-wide clinical trial.
Design
A cross-sectional web-based survey.
Setting
Three academic and 3 community-based hospitals from the same health system.
Participants
Therapists (N=236) who delivered the EHR-based HAS initiative.
Interventions
Not applicable.
Main Outcome Measures
Barriers and facilitators that therapists experienced implementing the EHR-based HAS initiative.
Results
We received survey responses from therapists (34.6% response rate). Using a numerical rating scale (1=not at all, 10=a great deal), therapists reported the highest agreement to questions regarding understanding the goal of the initiative (mean ± SD, 7.3±2.4) and alignment of the initiative with therapy practice (mean ± SD, 7.2±2.4), followed by alignment with patient needs (mean ± SD, 6.7±2.4). Ratings were slightly lower for understanding of their role (mean ± SD, 6.5±2.3), leadership support (mean ± SD, 6.3±2.4), and adequacy of training (mean ± SD, 6.2±2.4). Therapists rated the helpfulness of CDS elements at the midpoint of the scale, with mean ratings ranging from 5.0 to 5.1. Only 27% of therapists felt equipped to educate patients on all NPPC techniques.
Conclusions
The EHR-based HAS initiative was perceived to align with standard therapy care. However, many therapists did not feel equipped to support all NPPC techniques. Similar future efforts should address additional training needs and CDS refinement.
{"title":"Evaluating Physical and Occupational Therapists’ and Assistants’ Experiences Implementing an Electronic Health Record-Based Intervention to Support Perioperative Patients’ Use of Nonpharmacological Pain Management Techniques","authors":"Jane T. Hein PT , Sarah Redmond PhD , Lina Daus DPT , Monica Heinemann MOT , Jon Tilburt MD , Andrea Cheville MD, MSCE","doi":"10.1016/j.arrct.2025.100462","DOIUrl":"10.1016/j.arrct.2025.100462","url":null,"abstract":"<div><h3>Objective</h3><div>To explore barriers and facilitators experienced by therapists (physical therapists/assistants and occupational therapists/assistants) supporting the implementation of the electronic health record (EHR)-based Healing After Surgery (HAS) initiative, which used clinical decision support (CDS) elements to support therapists in providing perioperative education and support to patients for the use of evidence-based nonpharmacological pain care (NPPC) techniques as part of a health system-wide clinical trial.</div></div><div><h3>Design</h3><div>A cross-sectional web-based survey.</div></div><div><h3>Setting</h3><div>Three academic and 3 community-based hospitals from the same health system.</div></div><div><h3>Participants</h3><div>Therapists (N=236) who delivered the EHR-based HAS initiative.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Barriers and facilitators that therapists experienced implementing the EHR-based HAS initiative.</div></div><div><h3>Results</h3><div>We received survey responses from therapists (34.6% response rate). Using a numerical rating scale (1=not at all, 10=a great deal), therapists reported the highest agreement to questions regarding understanding the goal of the initiative (mean ± SD, 7.3±2.4) and alignment of the initiative with therapy practice (mean ± SD, 7.2±2.4), followed by alignment with patient needs (mean ± SD, 6.7±2.4). Ratings were slightly lower for understanding of their role (mean ± SD, 6.5±2.3), leadership support (mean ± SD, 6.3±2.4), and adequacy of training (mean ± SD, 6.2±2.4). Therapists rated the helpfulness of CDS elements at the midpoint of the scale, with mean ratings ranging from 5.0 to 5.1. Only 27% of therapists felt equipped to educate patients on all NPPC techniques.</div></div><div><h3>Conclusions</h3><div>The EHR-based HAS initiative was perceived to align with standard therapy care. However, many therapists did not feel equipped to support all NPPC techniques. Similar future efforts should address additional training needs and CDS refinement.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100462"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100480
Rosemay A. Remigio-Baker PhD, MPH , Lars D. Hungerford PhD , Donald Marion MD , Grace L. Reveles RN , Angela G. Basham MPH , Keith Stuessi MD , Juan Lopez BA , Jason M. Bailie PhD
Objective
To evaluate the associations between resilience and emotional symptoms among service members (SMs) with mild traumatic brain injury (mTBI) and determine whether these relationships vary by the number of lifetime mTBI.
Design
Cross-sectional.
Setting
Southwestern US military interdisciplinary traumatic brain injury (TBI) facility
Participants
N=230 SMs being treated for mTBI (92.2% of men, with a mean age of 33.8 years [SD, 8.8] and 13.5 years in active duty [SD, 8.3], and a median of 64.9 months from injury to intake).
Interventions
Not applicable; however, overall resilience (categorized as low, moderate, and high) and 5 themes (meaning-making and restoration, active coping, cognitive flexibility, spirituality, and self-efficacy) were measured using the Response to Stressful Experiences Scale.
Main Outcome Measures
Clinically elevated posttraumatic stress (PTS) and depressive symptoms were measured using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Ediction (score≥33) and the 8-item Patient Health Questionnaire (score≥15), respectively. The number of lifetime mTBI (single vs multiple) was ascertained using the Ohio State University TBI Identification Method and evaluated as an interaction term.
Results
SMs with higher (vs lower) overall resilience levels were significantly less likely to have clinically elevated PTS and depressive symptoms at pretreatment. These associations did not vary by the number of lifetime mTBIs. By resilience themes, higher levels were associated with a lower likelihood of clinically elevated PTS and depressive symptoms at pretreatment, but for active coping and cognitive flexibility, the relationship with depressive symptoms was only significant among those with a single mTBI. No significant results were found at posttreatment.
Conclusions
The findings may be helpful to inform expectations of recovery and optimal management of symptoms. Future longitudinal studies are needed to evaluate the effect of resilience on mental health issues and why it may not be beneficial in the presence of multiple mTBIs.
{"title":"Resiliency and Mental Health Symptoms Among Active Duty Service Members With a History of Mild Traumatic Brain Injury","authors":"Rosemay A. Remigio-Baker PhD, MPH , Lars D. Hungerford PhD , Donald Marion MD , Grace L. Reveles RN , Angela G. Basham MPH , Keith Stuessi MD , Juan Lopez BA , Jason M. Bailie PhD","doi":"10.1016/j.arrct.2025.100480","DOIUrl":"10.1016/j.arrct.2025.100480","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the associations between resilience and emotional symptoms among service members (SMs) with mild traumatic brain injury (mTBI) and determine whether these relationships vary by the number of lifetime mTBI.</div></div><div><h3>Design</h3><div>Cross-sectional.</div></div><div><h3>Setting</h3><div>Southwestern US military interdisciplinary traumatic brain injury (TBI) facility</div></div><div><h3>Participants</h3><div>N=230 SMs being treated for mTBI (92.2% of men, with a mean age of 33.8 years [SD, 8.8] and 13.5 years in active duty [SD, 8.3], and a median of 64.9 months from injury to intake).</div></div><div><h3>Interventions</h3><div>Not applicable; however, overall resilience (categorized as low, moderate, and high) and 5 themes (meaning-making and restoration, active coping, cognitive flexibility, spirituality, and self-efficacy) were measured using the Response to Stressful Experiences Scale.</div></div><div><h3>Main Outcome Measures</h3><div>Clinically elevated posttraumatic stress (PTS) and depressive symptoms were measured using the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Ediction (score≥33) and the 8-item Patient Health Questionnaire (score≥15), respectively. The number of lifetime mTBI (single vs multiple) was ascertained using the Ohio State University TBI Identification Method and evaluated as an interaction term.</div></div><div><h3>Results</h3><div>SMs with higher (vs lower) overall resilience levels were significantly less likely to have clinically elevated PTS and depressive symptoms at pretreatment. These associations did not vary by the number of lifetime mTBIs. By resilience themes, higher levels were associated with a lower likelihood of clinically elevated PTS and depressive symptoms at pretreatment, but for active coping and cognitive flexibility, the relationship with depressive symptoms was only significant among those with a single mTBI. No significant results were found at posttreatment.</div></div><div><h3>Conclusions</h3><div>The findings may be helpful to inform expectations of recovery and optimal management of symptoms. Future longitudinal studies are needed to evaluate the effect of resilience on mental health issues and why it may not be beneficial in the presence of multiple mTBIs.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100480"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100484
Felipe González-Seguel PT, MS , Evan Haezebrouck PT, DPT , Lindsey E. Fresenko PT, PhD , Carla M. Sevin MD , Stacey Slone MS , Ashley Montgomery-Yates MD , Anna G. Kalema MD , Lori Ginoza PT , Clarisa Martinez PT, DPT, MS , Michelle Biehl MD , Soibhan R. Kelley MD , Joshua K. Johnson PT, DPT, PhD , Matthew F. Mart MD, MSc , Kirby P. Mayer PT, DPT, PhD
Objective
To examine the occurrence of physical and cognitive impairments among survivors of critical coronavirus disease of 2019 (COVID-19) who attend an intensive care unit (ICU) recovery clinic and describe their utilization of community-based rehabilitation (physical and occupational therapy).
Design
Retrospective, observational cohort study and multisite practice analysis.
Setting
ICU recovery clinics at 4 academic medical centers.
Participants
Adults (median age 56 [interquartile range, {IQR}, 47–64] years, 60% female) surviving acute respiratory failure caused by COVID-19 who required advanced respiratory support.
Main outcome measures
Six-minute walk test (6MWT) and Montreal Cognitive Assessment (MoCA).
Results
Patients attended the ICU recovery clinic (n=163) in a median of 43 (IQR, 30-60) days after discharge. Ninety-four patients (58%) participated in at least 1 community-based rehabilitation session, 52 (32%) never participated, and 17 (10%) did not have data available. Patients walked a median [IQR] of 282 [150-390] meters on the 6MWT, and the median Short Physical Performance Battery (SPPB) score was 8 [4-11] with 63% of patients classified as physically frail (score ≤9/12). The median MoCA score was 26 [22-27], with 37% at least mild cognitive impairment (score of ≤26). Among patients who were driving before ICU admission, 44% had not returned to driving after hospitalization, and an additional 21% reported driving with new limitations. Patients who participated in at least 1 community-based rehabilitation session had longer ICU lengths of stay as well as worse performance on the 6MWT and SPPB at discharge compared with individuals not receiving postdischarge rehabilitation (P<.001).
Conclusions
Survivors of acute respiratory failure caused by critical COVID-19 who attended an ICU recovery clinic are at high risk of physical and/or cognitive impairments. Two-thirds of survivors participated in physical or occupational therapy at home or an outpatient center after hospital discharge. Patients with longer lengths of stay and more physical impairments at discharge are more likely to participate in community-based rehabilitation interventions.
{"title":"Community-Based Rehabilitation and Patient-Centered Outcomes in Survivors of Critical COVID-19 Attending an Intensive Care Recovery Clinic","authors":"Felipe González-Seguel PT, MS , Evan Haezebrouck PT, DPT , Lindsey E. Fresenko PT, PhD , Carla M. Sevin MD , Stacey Slone MS , Ashley Montgomery-Yates MD , Anna G. Kalema MD , Lori Ginoza PT , Clarisa Martinez PT, DPT, MS , Michelle Biehl MD , Soibhan R. Kelley MD , Joshua K. Johnson PT, DPT, PhD , Matthew F. Mart MD, MSc , Kirby P. Mayer PT, DPT, PhD","doi":"10.1016/j.arrct.2025.100484","DOIUrl":"10.1016/j.arrct.2025.100484","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the occurrence of physical and cognitive impairments among survivors of critical coronavirus disease of 2019 (COVID-19) who attend an intensive care unit (ICU) recovery clinic and describe their utilization of community-based rehabilitation (physical and occupational therapy).</div></div><div><h3>Design</h3><div>Retrospective, observational cohort study and multisite practice analysis.</div></div><div><h3>Setting</h3><div>ICU recovery clinics at 4 academic medical centers.</div></div><div><h3>Participants</h3><div>Adults (median age 56 [interquartile range, {IQR}, 47–64] years, 60% female) surviving acute respiratory failure caused by COVID-19 who required advanced respiratory support.</div></div><div><h3>Main outcome measures</h3><div>Six-minute walk test (6MWT) and Montreal Cognitive Assessment (MoCA).</div></div><div><h3>Results</h3><div>Patients attended the ICU recovery clinic (n=163) in a median of 43 (IQR, 30-60) days after discharge. Ninety-four patients (58%) participated in at least 1 community-based rehabilitation session, 52 (32%) never participated, and 17 (10%) did not have data available. Patients walked a median [IQR] of 282 [150-390] meters on the 6MWT, and the median Short Physical Performance Battery (SPPB) score was 8 [4-11] with 63% of patients classified as physically frail (score ≤9/12). The median MoCA score was 26 [22-27], with 37% at least mild cognitive impairment (score of ≤26). Among patients who were driving before ICU admission, 44% had not returned to driving after hospitalization, and an additional 21% reported driving with new limitations. Patients who participated in at least 1 community-based rehabilitation session had longer ICU lengths of stay as well as worse performance on the 6MWT and SPPB at discharge compared with individuals not receiving postdischarge rehabilitation (<em>P</em><.001).</div></div><div><h3>Conclusions</h3><div>Survivors of acute respiratory failure caused by critical COVID-19 who attended an ICU recovery clinic are at high risk of physical and/or cognitive impairments. Two-thirds of survivors participated in physical or occupational therapy at home or an outpatient center after hospital discharge. Patients with longer lengths of stay and more physical impairments at discharge are more likely to participate in community-based rehabilitation interventions.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100484"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100491
Veronica T. Rowe PhD, OTR/L , Emily A. Wilcox MHS, OTR/L , Charlotte A. Chatto PT, PhD , Ryan M. Carrick PhD, MHS, OTR/L
Objective
To determine the effect of a multifaceted task-oriented training intervention delivered through telerehabilitation (Remote Task-Oriented Training and Evaluation [reTOTE]) on stroke survivors’ activity, performance, quality of life, and confidence.
Design
Cohort study with repeated measures at pre- and post-reTOTE intervention and 1-month follow-up.
Setting
Virtual through telerehabilitation.
Participants
Twelve (N=12) stroke survivors.
Interventions
The reTOTE intervention was individualized for each participant during 8 sessions designed with evidence-based components of constraint-induced movement therapy, principles of experience-dependent plasticity, and use of the Cognitive Orientation to daily Occupational Performance approach.
Main Outcome Measures
Motor Activity Log, Canadian Occupational Performance Measure, Stroke Impact Scale, and the Activities-specific Balance Confidence Scale.
Results
The results demonstrated an increase in performance of functional abilities in stroke survivors’ lives immediately and at 1-month follow-up after completing reTOTE compared with preintervention.
Conclusions
This study indicates the importance of using an evidence-based, individualized, task-oriented therapeutic intervention for stroke survivors and the feasibility of remote delivery through telerehabilitation. Implementation of reTOTE may allow for access to rehabilitation that could improve meaningful therapeutic outcomes for stroke survivors.
目的探讨通过远程康复提供的多面向任务的训练干预（Remote task-oriented training and Evaluation [reTOTE]）对脑卒中幸存者活动、表现、生活质量和信心的影响。设计队列研究，在retote干预前后进行重复测量，随访1个月。SettingVirtual通过远程康复。参与者12名（N=12）中风幸存者。干预措施：在8个疗程中，对每个参与者进行个性化的远程干预，设计了基于证据的约束诱导运动疗法成分、经验依赖可塑性原则，并使用了日常职业表现的认知取向方法。主要结果测量：运动活动记录、加拿大职业表现测量、中风影响量表和特定活动平衡信心量表。结果结果表明，与干预前相比，完成远程康复治疗后立即和1个月随访时中风幸存者的功能能力表现有所提高。结论本研究提示对脑卒中幸存者采用循证、个性化、任务导向的治疗干预的重要性，以及通过远程康复进行远程交付的可行性。远程遥控的实施可能会使中风幸存者获得康复，从而改善有意义的治疗结果。
{"title":"Remotely Delivered Task-Oriented Training and Evaluation (reTOTE) for Stroke Rehabilitation","authors":"Veronica T. Rowe PhD, OTR/L , Emily A. Wilcox MHS, OTR/L , Charlotte A. Chatto PT, PhD , Ryan M. Carrick PhD, MHS, OTR/L","doi":"10.1016/j.arrct.2025.100491","DOIUrl":"10.1016/j.arrct.2025.100491","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the effect of a multifaceted task-oriented training intervention delivered through telerehabilitation (Remote Task-Oriented Training and Evaluation [reTOTE]) on stroke survivors’ activity, performance, quality of life, and confidence.</div></div><div><h3>Design</h3><div>Cohort study with repeated measures at pre- and post-reTOTE intervention and 1-month follow-up.</div></div><div><h3>Setting</h3><div>Virtual through telerehabilitation.</div></div><div><h3>Participants</h3><div>Twelve (N=12) stroke survivors.</div></div><div><h3>Interventions</h3><div>The reTOTE intervention was individualized for each participant during 8 sessions designed with evidence-based components of constraint-induced movement therapy, principles of experience-dependent plasticity, and use of the Cognitive Orientation to daily Occupational Performance approach.</div></div><div><h3>Main Outcome Measures</h3><div>Motor Activity Log, Canadian Occupational Performance Measure, Stroke Impact Scale, and the Activities-specific Balance Confidence Scale.</div></div><div><h3>Results</h3><div>The results demonstrated an increase in performance of functional abilities in stroke survivors’ lives immediately and at 1-month follow-up after completing reTOTE compared with preintervention.</div></div><div><h3>Conclusions</h3><div>This study indicates the importance of using an evidence-based, individualized, task-oriented therapeutic intervention for stroke survivors and the feasibility of remote delivery through telerehabilitation. Implementation of reTOTE may allow for access to rehabilitation that could improve meaningful therapeutic outcomes for stroke survivors.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100491"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145009900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100478
Andrea Calderone MSc , Svonko Galasso PhD , Alessandro Marco De Nunzio PhD , Antonio Leo PhD , Tina Balletta PhD , Angelo Quartarone PhD , Rocco Salvatore Calabrò PhD
Objective
To consolidate evidence on the efficacy of muscle vibration therapy for neurorehabilitation, providing health care practitioners with insights for enhancing treatment protocols and guiding future research.
Data Sources
Studies were identified from an online search of PubMed, Web of Science, and Embase databases, with a search time range of 2014-2024.
Study Selection
A total of 26 studies involving 787 individuals were included in this systematic review, including diverse neurologic conditions and intervention protocols.
Data Extraction
Keywords, Boolean operators, and controlled vocabulary were combined and tested in a gradual and iterative manner to achieve the highest possible sensitivity and specificity. The PRISMA flowchart was used to depict the process of selecting relevant studies.
Data Synthesis
Research on segmental and local muscle vibration in upper limb rehabilitation for poststroke patients is promising, as it can improve motor function, decrease spasticity, and enhance muscle control. Whole-body vibration interventions also show advantages in lower limb spasticity and balance, with specific studies adducing better results when paired with task-specific training. Vibration therapy has shown promising outcomes for alleviating pain, managing spasticity, and improving motor function in various neurologic conditions such as SCI and cerebral palsy, highlighting its potential in treating different neurologic disorders.
Conclusions
This review emphasizes the potential of muscle vibration therapy in neurorehabilitation, showing benefits in motor control, spasticity, and functional outcomes, while underscoring the importance of rigorous methods and further extensive research to improve result dependability.
目的巩固肌肉振动治疗神经康复疗效的证据，为医护人员完善治疗方案和指导未来的研究提供参考。研究来源于PubMed、Web of Science和Embase数据库的在线搜索，搜索时间范围为2014-2024年。研究选择本系统综述共纳入26项研究，涉及787名个体，包括不同的神经系统疾病和干预方案。数据提取关键字、布尔运算符和受控词汇以渐进和迭代的方式进行组合和测试，以达到尽可能高的灵敏度和特异性。使用PRISMA流程图来描述选择相关研究的过程。研究局部和局部肌肉振动在脑卒中后患者上肢康复中的应用是有前景的，因为它可以改善运动功能，减少痉挛，增强肌肉控制。全身振动干预在下肢痉挛和平衡方面也显示出优势，具体研究表明，与特定任务训练相结合，效果更好。振动疗法在缓解疼痛、控制痉挛和改善各种神经系统疾病（如脊髓损伤和脑瘫）的运动功能方面显示出有希望的结果，突出了其在治疗不同神经系统疾病方面的潜力。结论本综述强调了肌肉振动疗法在神经康复中的潜力，显示出在运动控制、痉挛和功能结局方面的益处，同时强调了严格方法和进一步广泛研究以提高结果可靠性的重要性。
{"title":"Exploring the Impact of Muscle Vibration Therapy in Neurologic Rehabilitation: A Systematic Review","authors":"Andrea Calderone MSc , Svonko Galasso PhD , Alessandro Marco De Nunzio PhD , Antonio Leo PhD , Tina Balletta PhD , Angelo Quartarone PhD , Rocco Salvatore Calabrò PhD","doi":"10.1016/j.arrct.2025.100478","DOIUrl":"10.1016/j.arrct.2025.100478","url":null,"abstract":"<div><h3>Objective</h3><div>To consolidate evidence on the efficacy of muscle vibration therapy for neurorehabilitation, providing health care practitioners with insights for enhancing treatment protocols and guiding future research.</div></div><div><h3>Data Sources</h3><div>Studies were identified from an online search of PubMed, Web of Science, and Embase databases, with a search time range of 2014-2024.</div></div><div><h3>Study Selection</h3><div>A total of 26 studies involving 787 individuals were included in this systematic review, including diverse neurologic conditions and intervention protocols.</div></div><div><h3>Data Extraction</h3><div>Keywords, Boolean operators, and controlled vocabulary were combined and tested in a gradual and iterative manner to achieve the highest possible sensitivity and specificity. The PRISMA flowchart was used to depict the process of selecting relevant studies.</div></div><div><h3>Data Synthesis</h3><div>Research on segmental and local muscle vibration in upper limb rehabilitation for poststroke patients is promising, as it can improve motor function, decrease spasticity, and enhance muscle control. Whole-body vibration interventions also show advantages in lower limb spasticity and balance, with specific studies adducing better results when paired with task-specific training. Vibration therapy has shown promising outcomes for alleviating pain, managing spasticity, and improving motor function in various neurologic conditions such as SCI and cerebral palsy, highlighting its potential in treating different neurologic disorders.</div></div><div><h3>Conclusions</h3><div>This review emphasizes the potential of muscle vibration therapy in neurorehabilitation, showing benefits in motor control, spasticity, and functional outcomes, while underscoring the importance of rigorous methods and further extensive research to improve result dependability.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100478"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.arrct.2025.100461
Eva Pettemeridou PhD , Maria Loizidou MSc , Jelena Trajkovic PhD , Maria Constantinou PhD , Stefanie De Smet MSc , Chris Baeken PhD , Alexander T. Sack PhD , Steven C.R. Williams PhD , Fofi Constantinidou PhD
Objective
To investigate the structural, functional, and neurophysiological brain changes associated with post-COVID-19 condition (PCC)-related cognitive and psychological issues and evaluate the efficacy of noninvasive brain stimulation (NIBS) and cognitive rehabilitation interventions.
Data Sources
Electronic databases, including Web of Science, PubMed, and Embase, were systematically searched for articles published before February 1, 2025, using terms such as “post-COVID-19 condition,” “cognitive dysfunction,” “brain changes,” “noninvasive brain stimulation,” and “cognitive rehabilitation.” Language was restricted to English, and only studies involving human participants were included.
Study Selection
Studies with human participants aged ≥18 years diagnosed with PCC, employing magnetic resonance imaging, functional magnetic resonance imaging, positron emission tomography, and electroencephalography, and interventions such as NIBS and cognitive rehabilitation were included. Articles were selected through independent review by multiple authors, with consensus resolving discrepancies. Of the 123 studies initially identified, 78 met the inclusion criteria.
Data Extraction
Data on participant demographics, methodologies, neurophysiological changes, and intervention outcomes were extracted by 2 independent reviewers using predefined guidelines. Study quality was assessed using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program tools.
Data Synthesis
Seventy-eight studies with over 5900 participants met the inclusion criteria. Significant cognitive impairments were observed in attention, executive function, and memory (N=78). Key findings included mixed evidence of gray matter (N=16) and white matter volume changes (N=20), cortical thickness alterations (N=9), variations in functional connectivity (N=14), electrophysiology (N=9), and blood flow (N=8). NIBS, including transcranial magnetic stimulation (N=8) and transcranial direct current stimulation (N=2), showed potential benefits for managing depression and cognitive impairments. Although cognitive rehabilitation (N=3) showed promise, it requires further investigation.
Conclusions
This review highlights the complex neurologic underpinnings of PCC and the potential of NIBS and cognitive rehabilitation as interventions. Further research is essential to refine these interventions and establish evidence-based strategies for addressing long-term cognitive and psychological effects of PCC.
目的探讨与新冠肺炎（PCC）后认知和心理问题相关的脑结构、功能和神经生理变化，评价无创脑刺激（NIBS）和认知康复干预的疗效。包括Web of Science、PubMed和Embase在内的电子数据库系统地检索了2025年2月1日之前发表的文章，使用了“后covid -19状况”、“认知功能障碍”、“大脑变化”、“无创脑刺激”和“认知康复”等术语。语言仅限于英语，而且只包括有人类参与者的研究。研究选择纳入年龄≥18岁诊断为PCC的人类受试者，采用磁共振成像、功能磁共振成像、正电子发射断层扫描和脑电图，以及NIBS和认知康复等干预措施。文章是由多位作者通过独立审查选择的，以共识解决差异。在最初确定的123项研究中，78项符合纳入标准。数据提取2名独立审稿人使用预先定义的指南提取参与者人口统计学、方法、神经生理变化和干预结果的数据。使用纽卡斯尔-渥太华量表和关键评估技能计划工具评估研究质量。78项研究超过5900名参与者符合纳入标准。在注意、执行功能和记忆方面观察到显著的认知障碍（N=78）。主要发现包括灰质（N=16）和白质体积变化（N=20）、皮质厚度改变（N=9）、功能连通性变化（N=14）、电生理（N=9）和血流（N=8）的混合证据。NIBS包括经颅磁刺激（N=8）和经颅直流电刺激（N=2），显示出治疗抑郁症和认知障碍的潜在益处。虽然认知康复（N=3）显示出希望，但仍需进一步研究。结论本综述强调了PCC的复杂神经基础以及NIBS和认知康复作为干预措施的潜力。进一步的研究对于完善这些干预措施和建立基于证据的策略来解决PCC的长期认知和心理影响至关重要。
{"title":"Cognitive and Psychological Symptoms in Post-COVID-19 Condition: A Systematic Review of Structural and Functional Neuroimaging, Neurophysiology, and Intervention Studies","authors":"Eva Pettemeridou PhD , Maria Loizidou MSc , Jelena Trajkovic PhD , Maria Constantinou PhD , Stefanie De Smet MSc , Chris Baeken PhD , Alexander T. Sack PhD , Steven C.R. Williams PhD , Fofi Constantinidou PhD","doi":"10.1016/j.arrct.2025.100461","DOIUrl":"10.1016/j.arrct.2025.100461","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the structural, functional, and neurophysiological brain changes associated with post-COVID-19 condition (PCC)-related cognitive and psychological issues and evaluate the efficacy of noninvasive brain stimulation (NIBS) and cognitive rehabilitation interventions.</div></div><div><h3>Data Sources</h3><div>Electronic databases, including Web of Science, PubMed, and Embase, were systematically searched for articles published before February 1, 2025, using terms such as “post-COVID-19 condition,” “cognitive dysfunction,” “brain changes,” “noninvasive brain stimulation,” and “cognitive rehabilitation.” Language was restricted to English, and only studies involving human participants were included.</div></div><div><h3>Study Selection</h3><div>Studies with human participants aged ≥18 years diagnosed with PCC, employing magnetic resonance imaging, functional magnetic resonance imaging, positron emission tomography, and electroencephalography, and interventions such as NIBS and cognitive rehabilitation were included. Articles were selected through independent review by multiple authors, with consensus resolving discrepancies. Of the 123 studies initially identified, 78 met the inclusion criteria.</div></div><div><h3>Data Extraction</h3><div>Data on participant demographics, methodologies, neurophysiological changes, and intervention outcomes were extracted by 2 independent reviewers using predefined guidelines. Study quality was assessed using the Newcastle-Ottawa Scale and Critical Appraisal Skills Program tools.</div></div><div><h3>Data Synthesis</h3><div>Seventy-eight studies with over 5900 participants met the inclusion criteria. Significant cognitive impairments were observed in attention, executive function, and memory (N=78). Key findings included mixed evidence of gray matter (N=16) and white matter volume changes (N=20), cortical thickness alterations (N=9), variations in functional connectivity (N=14), electrophysiology (N=9), and blood flow (N=8). NIBS, including transcranial magnetic stimulation (N=8) and transcranial direct current stimulation (N=2), showed potential benefits for managing depression and cognitive impairments. Although cognitive rehabilitation (N=3) showed promise, it requires further investigation.</div></div><div><h3>Conclusions</h3><div>This review highlights the complex neurologic underpinnings of PCC and the potential of NIBS and cognitive rehabilitation as interventions. Further research is essential to refine these interventions and establish evidence-based strategies for addressing long-term cognitive and psychological effects of PCC.</div></div>","PeriodicalId":72291,"journal":{"name":"Archives of rehabilitation research and clinical translation","volume":"7 3","pages":"Article 100461"},"PeriodicalIF":2.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145011266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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