Brain & NeuroRehabilitation最新文献

This clinical practice guideline (CPG) is the second part of the fourth edition of the Korean Stroke Rehabilitation Guidelines, following the first part published in 2023. While, the first part addressed rehabilitation for motor function, while this second part focuses on both motor and sensory rehabilitation. Beginning with the fourth edition, significant methodological advancements have been introduced, transitioning from a consensus-based approach to an evidence-based framework using the Grading of Recommendations Assessment, Development, and Evaluation methodology. The target population encompasses adult stroke patients, both male and female, with ischemic and hemorrhagic stroke types included, while pediatric stroke cases are excluded from consideration. This guideline is primarily intended for physiatrists and specialized therapists who provide rehabilitation services to patients with stroke-related motor impairments and activities of daily living limitations across primary, secondary, and tertiary healthcare facilities. The development team consisted of eighteen stroke rehabilitation specialists and one expert in CPG development methodology. Key questions were formulated based on target population preferences and international stroke rehabilitation guidelines, with subsequent refinement by specialists responsible for each respective topic. Draft recommendations underwent a formal consensus process using the RAND-UCLA Appropriateness Method, followed by further refinement through public hearings and external expert evaluation.

This review presents a clinical framework for motor rehabilitation in patients with Parkinson's disease and atypical parkinsonian syndromes. Its purpose is to provide practical, individualized rehabilitation strategies that consider both disease stage and the clinical characteristics of each syndrome. Motor symptoms such as bradykinesia, rigidity, postural instability, and gait disturbance are major contributors to disability and reduced independence in these populations. Although pharmacological treatment remains fundamental, rehabilitation is crucial for maintaining mobility and preventing falls. This review discusses stage-based approaches, including early education in self-management and compensatory movement strategies, as well as advanced interventions for patients with severe motor dysfunction. Syndrome-specific features are also addressed. For example, patients with progressive supranuclear palsy often exhibit early axial rigidity and postural extension, while those with multiple system atrophy may experience cerebellar ataxia or autonomic dysfunction. In corticobasal degeneration, motor planning deficits and sensory loss may resemble symptoms seen in cortical stroke. Additionally, the review emphasizes the importance of recognizing and managing dystonia, which can further impair motor function and safety. While the primary focus is on motor symptoms, the influence of non-motor features such as cognitive impairment and autonomic instability is also acknowledged in rehabilitation planning. Overall, this review aims to support clinical decision-making through a structured, patient-centered approach to motor rehabilitation in parkinsonism.

Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has emerged as a potential adjunct to conventional rehabilitation though findings remain inconsistent. This study investigated the efficacy of rTMS combined with conventional rehabilitation in improving motor function and spasticity after stroke through a systematic review and meta-analysis. MEDLINE, Embase, and the Cochrane Library were comprehensively searched through February 2022. Sixty-eight randomized controlled trials were included based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias and certainty of evidence were assessed using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation methodology. rTMS significantly improved upper limb motor outcomes including Fugl-Meyer assessment scores (mean difference [MD], 3.04; 95% confidence interval [CI], 1.16 to 4.92; p = 0.002), hand function (standardized MD, 0.28; 95% CI, 0.04 to 0.52; p = 0.02), and grip strength (MD, 3.61; 95% CI, 1.20 to 6.03; p = 0.003), with low-certainty evidence. It also significantly reduced upper limb spasticity (MD, -0.48; 95% CI, -0.64 to -0.33; p < 0.00001), with low-certainty evidence. No significant effects were observed for lower limb motor outcomes, and evidence for lower limb spasticity was insufficient. These findings suggest that rTMS may be considered as an adjunct to to enhance upper limb motor function and reduce spasticity in stroke rehabilitation. However, its use for lower limb recovery should be individualized based on neurological status. Further studies are needed to establish optimal protocols and long-term effects.

This systematic review and meta-analysis evaluated the efficacy and safety of methylphenidate in patients with brain disease. A comprehensive search up to November 4, 2024 identified 33 randomized controlled trials involving 1,369 participants with traumatic brain injury (TBI), stroke, Parkinson's disease (PD), Alzheimer's disease (AD), other dementias, and multiple sclerosis. Methylphenidate was administered at 10-80 mg/day or 0.1-1 mg/kg/day for durations ranging from a single dose to 6 months. Data were synthesized using a random-effects model, with study quality evaluated via the Revised Cochrane Risk of Bias Tool. Methylphenidate significantly improved attention (standardized mean difference [SMD], 0.43; 95% confidence interval [CI], 0.03 to 0.84), particularly in TBI. Motor function improved in stroke populations (mean difference [MD], 0.66; 95% CI, 0.13 to 1.18), while activities of daily living (ADL) significantly improved in stroke and AD (SMD, 0.71; 95% CI, 0.37 to 1.06). Apathy was significantly reduced in AD (SMD, -0.60; 95% CI, -0.95 to -0.26), and depression improved across patients with PD, stroke, and TBI (SMD, -0.50; 95% CI, -0.94 to -0.05). No significant effects were observed for consciousness, global cognition, executive function, fatigue, or quality of life. Side effects were mild, with a slight increase in pulse rate (MD, 0.28; 95% CI, 0.10 to 0.47). In summary, methylphenidate improves attention (TBI), motor function (stroke), ADL (stroke, AD), and mood, especially apathy (AD) and depression, with a favorable safety profile. Its effects appear condition-specific, and further research is needed to confirm long-term efficacy and establish standardized protocols.

Trial registration: International Prospective Register of Systematic Reviews Identifier: CRD42024563826.

This retrospective cohort study aimed to identify predictive factors for patients with traumatic brain injury (TBI) requiring short (≤ 14 days) or long (≥ 15 days) rehabilitation length of stays (LOSs).The study was conducted in an acute rehabilitation hospital associated with a community-based tertiary medical center. Patients who were admitted to the acute inpatient rehabilitation unit with TBI between January 2020 and September 2022 were included (n = 197). The mean rehabilitation LOS of the 197 patients was 16.73 ± 9.4 days. A long rehabilitation LOS was associated with a higher rate of urinary tract infection in the rehabilitation facility (p = 0.002), a higher rate of lung infection in the inpatient rehabilitation facility (p = 0.003), unplanned readmission to acute care (p < 0.001), a longer LOS in acute care before admission to rehabilitation (p < 0.001), and a lower Section GG score on admission to rehabilitation (p < 0.001). The logistic regression model revealed having lower Section GG scores on admission to rehabilitation as the only factor predictive of a long rehabilitation LOS (odds ratio, 0.91; p < 0.001). Our study revealed that the Section GG score at admission to inpatient rehabilitation facilities is a predictor of rehabilitation LOS.

This meta-analysis presents an updated comparison between virtual reality (VR) training and conventional training (CT) in post-stroke rehabilitation by incorporating recent studies based on prior meta-analyses. We searched 3 international electronic databases (MEDLINE, Embase, and the Cochrane Library) and a Korean database (KoreaMed) to identify relevant studies. Out of 5,218 studies, 30 randomized controlled trials were selected through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Among these, 21 focused on upper limb training and 14 on lower limb training. A subgroup meta-analysis was conducted based on the VR type. The risk of bias (RoB) was assessed using Cochrane's RoB tool. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) method. The outcomes were categorized into upper limb motor function, fine motor function, and activities of daily living (ADLs) for upper limb training, and lower limb motor function, balance, and gait velocity for lower limb training. A random-effects model for the meta-analysis indicated that VR training showed significant superiority over CT in improving upper limb motor function, ADL, and balance. This study provides low- to moderate-certainty evidence supporting the superiority of VR training over CT. Clinicians and therapists should consider individual rehabilitation needs, goals, patient preferences, and available resources when selecting VR for post-stroke functional recovery.

Improvement in gait after a cerebrospinal fluid (CSF) tap test is a key indicator for shunt surgery in idiopathic normal pressure hydrocephalus (iNPH) patients. However, quantitative analysis of gait requires sophisticated equipment and specialists that limit practical use. Development of Bluetooth-connected sensors offers affordable way to assess gait. We present a case of iNPH patient in whom gait changes were serially assessed using a smart insole before and after intervention, which helped in clinical decision making. A 68-year-old female who showed the triad of iNPH symptoms (gait disturbance, cognitive decline, and urinary frequency) were evaluated. Before and after the CSF tap test, gait was analyzed and compared using the smart insole with four pressure sensors and accelerometer, along with conventional spatiotemporal parameters. While no significant changes were observed between pre- and post-tap test in conventional parameters of gait, several changes were found in the data collected from the smart insole, including improved heel strike, step regularity and symmetry. Advanced surgical intervention was performed based on subjective and objective improvement in gait. The improved gait was maintained at 3 and 6 months after surgery. Our case showed that easy-to-use smart insoles could assist clinical decisions by providing additional information.

Lyme disease is a multisystem infection that can affect the joints, heart, and nervous system when untreated. While it can present with cranial nerve palsy, dysphagia is rarely reported. This case highlights a rare instance of dysphagia in Lyme disease, typically known for neurological symptoms like facial nerve palsy. Despite the absence of erythema migrans or a documented tick bite, the patient's facial palsy, hearing loss, vocal cord paralysis, and dysphagia were attributed to Lyme disease. With the rising prevalence of Lyme disease, similar cases may increase, particularly in endemic regions of North America, Europe, and parts of Asia, emphasizing the need for early diagnosis and treatment in patients with unexplained dysphagia.

Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique with potential in stroke rehabilitation by modulating cortical excitability. However, the optimal parameters, including electrode placement, current intensity, stimulation duration, and electrode size, remain poorly understood, and the interactions among these factors contribute to mixed results in motor recovery post-stroke. This review explores the various stimulation parameters and their impact on enhancing corticospinal excitability (CSE) and motor function recovery. Different electrode placement (montages), such as anodal, cathodal, and bi-hemispheric stimulation, have demonstrated varying effectiveness in restoring motor function. Bihemispheric stimulation demonstrated a larger effect size compared to other unihemispheric (anodal or cathodal) stimulation; however, its relative superiority remains inconclusive. Inter-individual anatomical variations, such as skull thickness, lesion location, and cortical atrophy, can affect tDCS outcomes, highlighting the need for personalized electrode placement guided by computational modeling based on brain imaging. Furthermore, stimulation intensity, typically 1-2 mA, exhibited nonlinear effects on CSE, contrasting with the dose-response relationships observed in earlier studies. Stimulation duration is also critical, with evidence suggesting that prolonged stimulation may reverse excitability-enhancing effects beyond a certain threshold. While smaller electrodes enhance focality, an appropriately sized electrode is necessary to effectively modulate electrical activity in the target region, with evidence suggesting a dose-response relationship between electrode size and motor recovery. Overall, the interplay among these parameters underscores the need for personalized and optimized tDCS protocols to achieve consistent motor recovery in stroke patients. Future research should focus on refining these parameters to maximize the therapeutic benefits of tDCS.

Sarcopenia is characterized by the progressive loss of muscle mass and strength and can be categorized as either primary or secondary. Patients who have experienced a stroke may develop sarcopenia, which can adversely impact their functional recovery. The pathophysiology of sarcopenia related to stroke involves nutritional deficiency, disuse atrophy, denervation, and metabolic disturbance. Various evaluation tools are available to diagnose this condition, assessing skeletal muscle mass, muscle strength, and physical function. However, due to the limitations of traditional sarcopenia diagnostic criteria in the context of stroke, there is pressing need to establish diagnostic standards that accurately reflect the disabilities experienced by patients with stroke.