Frontiers in rehabilitation sciences最新文献

Background: Stroke survivors often experience impaired balance, increased fall risk, and dependency in activities of daily living (ADLs). Dual-task exercises, combining motor and cognitive challenges, may improve these outcomes. This study was conducted to evaluate the effects of dual-task exercise intervention on balance, fall risk, and ADLs dependency in stroke patients.

Methods: A quasi-experimental single-group pretest-posttest design was used with 54 stroke patients recruited from Ain Shams University Hospitals, Cairo. Participants underwent 16- sessions of individualized dual-task exercises over 8 weeks. Follow-up assessments were conducted immediately post-intervention (two months). Balance was measured at follow-up using the Postural Assessment Scale for Stroke (PASS); fall risk was assessed at follow-up using the Timed Up and Go Test (TUGT); and ADLs dependency was evaluated at follow-up using the Barthel Index (BI). Data were analyzed using SPSS version 27.

Results: Before intervention, 75.9% of participants had low ability to maintain posture, which improved post-intervention to 61.1% with high ability (p < 0.05). Similarly, the ability to change posture improved significantly (81.5% low to 63.0% high; p < 0.05). Pre-intervention 68.5% of patients were at high risk of falling, which decreased post-intervention, with 40.7% classified as low risk and 46.3% as no risk (p < 0.001). Severe ADLs dependency reduced markedly from 75.9% to 9.3% (p < 0.001). Across time points, higher PASS scores (better balance) were negatively associated with fall risk (TUGT) and ADL dependence, while higher BI scores (better ADL independence) were negatively correlated with fall risk and positively correlated with PASS (p = 0.001 for all).

Conclusion: Dual-task exercise training significantly improves balance, reduces fall risk, and enhances independence in ADLs among stroke patients. These findings support integrating dual-task interventions into stroke rehabilitation protocols, especially in resource-limited settings.

In recent years, shifting paradigms in cerebral palsy (CP) rehabilitation have highlighted approaches that promote autonomous movement through active participation, including goal-directed training, task-specific training, context-focused therapy, and constraint-induced movement therapy. Dance has increasingly been recognized in neurorehabilitation as a promising intervention capable of supporting physical, cognitive, and social functioning. Among various dance practices, this mini review focuses on the conceptual framework of creative dance. Creative dance centers on the process of generating movement, which aligns with contemporary paradigms in cerebral palsy rehabilitation. Additionally, because creative dance values the discovery and development of new and unique movements, it provides a setting in which movements, whether with or without disabilities, are respected and accepted as having equal value. These values play a crucial role in fostering a sense of achievement, interest, motivation, and sustained engagement, all of which are emphasized in rehabilitation for individuals with cerebral palsy. However, despite its potential, creative dance remains in the early stages of development as a rehabilitation modality. Establishing a solid evidence base will require a clearer understanding of the movement methodology underlying creative dance. In this mini review, I examine the movement methodology embedded in creative dance-based practice (CBP) and propose a conceptual framework to support its implementation within rehabilitation contexts for individuals with CP.

Background: Children treated for brain tumor (CTBT) experience lasting physical and cognitive impairments that impact quality of life. Given the pervasive impact of brain tumor treatments on cognition, we designed a group exercise program with the specific goal of improving cognition in CTBT. A feasibility study evaluating the program demonstrated improved cognitive and physical outcomes. However, the exercises varied across sessions to maximize participant engagement throughout the 12-week program, which made it difficult to describe the program contents and identify how each element contributed to the observed improvements.

Objective: As a precursor to identifying the effective elements within the group exercise program for CTBT, this study characterized the content of our program according to the exercise categories observed in the exercise sessions, the physical fitness components within the exercises, and the cognitive demand of the exercises.

Methods: This retrospective descriptive analysis coded the content of 50 videos from the exercise program sessions by exercise category (warm-up, aerobic training, games, sports, cool-down), physical fitness components (cardiovascular, coordination, speed, agility, object control, strength, balance, flexibility), and cognitive demand (low, medium, high). Data were descriptively summarized.

Results: Most of the exercise session was spent on games, followed closely by sports. 33% of the exercise session involved exercises with high amounts of cardiovascular content and 46% of the exercise session involved exercises with moderate amounts of cardiovascular content. Exercises with high cognitive demand had the most coordination and object control content. Exercises with medium cognitive demand had the most cardiovascular content.

Conclusion: The presence of exercises with either high cardiovascular content or high coordination was the hallmark of our group exercise program for CTBT. These features should be manipulated in future exercise program evaluations to determine their impact on cognitive and physical outcomes in CTBT.

Introduction: In children with Neuromuscular diseases (NMDs), gait monitoring is essential for evaluating motor function over time. The 10-meter walk test (10 mWT) and the 6 Minute Walking test (6 MWT) are commonly used timed tests. Wearable inertial measurement units (IMUs) have recently gained increasing interest and use for gait assessment. The primary objective of the study is to verify the technical feasibility and clinical usability of IMUs in children with NMDs during standard 10 and 6 MWT. Secondly, the authors aimed to investigate the agreement between the results of manual and device-based tests and the device's measurements of the 95th percentile of stride speed (SV95C) and its correlation with the 6 MWT.

Methods: Ambulatory children aged 6-18 with NMDs were enrolled. The IMU used for the study was the mTest³® device. The 10 mWT and 6-MWT were performed both in the standard method and with the device. Feasibility was assessed through the completion rates of tests with the device, the thematic analysis of clinicians' feedback, timing for the device's use and the percentage of usable recordings. Usability was evaluated using the System Usability Scale (SUS) questionnaire and a pediatric-adapted semi-structured patient interview. Agreement between the results of manual and device-based tests and the device's measurements of the 95th percentile of stride speed (SV95C) and its correlation with the 6 MWT were also evaluated.

Results: Twelve patients with NMDs and a mean age of 12 years and 9 months (range: 8-17 years) were enrolled. All patients completed the assessment protocol using the device. Feedback from clinicians was positive, with few outlier recordings identified. Results from the SUS questionnaire and patient interview showed predominance of positive judgments. The study showed good agreement between the measurements, particularly for the 6 MWT. High correlation between SV95C and 6 MWT was also demonstrated.

Conclusion: This study confirmed the feasibility and usability of IMUs for gait assessment in children with NMDs. In addition, agreement between device-based and manual-based measurements and high correlation between SV95C and 6 MWT was also demonstrated. IMUs can serve both as clinical outcome assessment tools and as devices for gait monitoring across various contexts, supporting their integration into pediatric rehabilitation protocols.

We report a rare and uncommon case of ideational apraxia (IA) and conceptual apraxia (CA) in a 70-year-old woman after concurrent cerebral infarctions of the left basal ganglia (BG) extending to the corona radiata and the right pons. The patient abruptly developed difficulty operating devices such as the car's gear shift and smartphone. The brain MRI on admission disclosed infarction in the area involving the left BG and right pons. During rehabilitation therapy, she exhibited features of IA and CA, including sequencing failures when using technological devices and a profound loss of functional knowledge, exemplified by an inability to recall the purpose and functions of an automated teller machine (ATM) despite prior proficiency. A testing error involved using the keyboard rather than the mouse to open a file. Behaviorally, she impulsively initiated actions and sometimes scheduled conflicting appointments. Neuropsychological testing showed preserved scores on the Mini-Mental State Examination (MMSE) and the Hasegawa Dementia Scale-Revised (HDS-R), but memory impairment was evident on the Rivermead Behavioural Memory Test (RBMT) and the Standard Verbal Paired Associates Learning Test (S-PA). The Behavioural Assessment of the Dysexecutive Syndrome (BADS) revealed marked dysexecutive symptoms, and the Clinical Assessment for Attention (CAT) indicated reduced auditory selective attention and diminished inhibitory control. Notably, the Standard Performance Test for Apraxia (SPTA) yielded normal results. Treated with antiplatelets then antihypertensives, she was discharged home four months later. Attention deficits and driving cessation persisted, but daily life was minimally affected. Although IA and CA are typically linked to left-hemisphere damage, particularly to the BG, the right pontine lesion may have contributed to the deficits, possibly through network disruption. This infarct pattern suggests a complex interplay in apraxia development and warrants further mechanistic study.

Introduction: Virtual reality (VR) is proposed as a support (and potential alternative) to traditional rehabilitation after breast cancer surgery, with expected effects on pain, anxiety, fatigue, and recovery of shoulder ROM (range of movement). The study aims to test a VR system that integrates body illusion, gamification, and distraction, evaluating its usability, user experience, and comfort for clinical use.

Methods: The study was conducted on 31 healthy subjects (28 physiotherapy students, 3 physiotherapists). The software includes a shoulder ROM calibration phase and a training phase involving a VR tennis game, with adjustable parameters and automatic performance recording. SSQ, SUS, UEQ, CRS, and a question on the adequacy of playing speed were administered. A descriptive analysis (mean, standard deviation) and a qualitative analysis of the open-ended responses were conducted.

Results: SSQ: very low average symptoms (minimal discomfort). SUS: good perceived usability (easy, integrated, safe). UEQ: Overall positive experience (clarity, modernity, pleasantness); concerns regarding predictability/slowness. CRS: High tolerability and low anxiety/harm; higher "attachment." Regarding speed: 15 "Yes" votes to making it faster, 16 "No" votes (divided opinions).

Discussion: The VR system is well tolerated, usable, and has a favorable user experience in healthy subjects, indicating promising clinical transferability for shoulder rehabilitation after breast surgery. Dynamics and predictability (adaptive speed/levels) remain to be optimized, and the software needs to be validated on patients and experienced physiotherapists in dedicated studies.

Background and aim: This qualitative study delves into the behavioral nuances of disabled students concerning their interactions with siblings and schoolmates. The main objective of this study was to explore the behavioral dynamics of disabled students through the perspective of their siblings, parents and teachers by using systematic thematic analysis approach.

Method: The data was collected from Vilak Foundation in Malappuram, Kerala by conducting semi-structured interviews with five teachers and parents of 20 persons with disabilities affected by various disabilities like autism spectrum disorder, cerebral palsy, abnormal brain growth and down syndrome.

Results: Thematic analysis process was used to generate thematic map in three stages- initial, developed and final thematic. The six-step process of this technique helped in systematic extraction of 47 codes and formation of 09 broad themes. These are introversion, communication factor, aggression, attachment behavior, emotional awareness, morality, empathy, envy and inappropriate sexual behaviour.

Discussion: Extracted and translated verbatim have been described in-detail by the researcher in the discussion section of the study. The importance of attachment, avoidance, and emotional intelligence must be taken into account when developing strategies to support the emotional health and social competence of disabled adult students.

Background: Several studies have demonstrated the efficacy of shock wave therapy in managing OA-related pain and improving joint function but evidence specific to thumb CMC joint OA remains limited. Therefore, the aim of this study was to evaluate the effectiveness of fESWT in reducing pain and improving function as well as to assess the safety and tolerability of this intervention, providing insight into its potential role as a non-invasive and long-term alternative for patients unresponsive to conventional therapies or seeking to avoid surgery.

Methods: A 64-year-old woman with radiographically confirmed bilateral CMC OA and persistent symptoms unresponsive to prior conservative treatments received three weekly fESWT sessions. Energy flux density was individually adjusted per session based on tolerance. Outcome measures included the QuickDASH questionnaire and grip strength testing, assessed at baseline, 2-, 8-, 26-, and 52-weeks post-intervention.

Results: Treatment was well tolerated with no adverse events. QuickDASH scores improved from 20.5 at baseline to 2.3 at 52 weeks, indicating an improvement in pain and functional disability. Grip strength increased by 29.5% in the right hand and 17.4% in the left hand over the same period. Subjectively, the patient reported pain relief, functional improvement, and sustained benefit at one-year follow-up.

Conclusions: This case demonstrates the potential of individualized fESWT as a safe and effective intervention for thumb CMC OA, with improvements in pain and function lasting up to 12 months. These findings support further investigation of fESWT in larger controlled studies and highlight the importance of individualized dosing strategies in clinical practice.

Background: Independent mobility in early life catalyzes development across motor, perceptual, cognitive, social, and linguistic domains. For young children with motor disabilities, however, opportunities to explore, interact, and learn from their surroundings are commonly restricted, which may limit developmental progress.

Objective: To examine the effects of a play-based powered mobility intervention, using the Permobil Explorer Mini, on developmental and communicative outcomes in toddlers with motor disabilities, using a single-group, repeated measures design.

Methods: Ten children with motor disabilities (ages 12-36 months) participated in a 12-session intervention in an enriched laboratory environment. The intervention consisted of repeated, play-based sessions using the Explorer Mini, an FDA-cleared powered mobility device. Developmental skills were evaluated pre- and post-intervention using standardized assessments, and language environments were systematically analyzed both in the laboratory and at home.

Results: At baseline, participants scored significantly below age-matched norms across all domains (gross and fine motor, receptive and expressive language, cognitive, adaptive behavior, and social-emotional). Following the intervention, children showed significant raw score gains in cognition, receptive language, fine motor, adaptive behavior, and social-emotional development. Scaled score improvements in cognition and receptive vocabulary indicated growth exceeding expected age-related progression. Analyses of the language environment revealed significant increases in children's expressive vocalizations. Specifically, more frequent joyful ("delight") vocalizations and fewer expressions of distress. Increases in delight vocalizations were further strongly correlated with receptive language gains.

Conclusion: These findings suggest that introducing powered mobility during the toddler period can foster agency, exploration, and communication, catalyzing developmental growth beyond motor function alone. By providing young children with the means to move independently, powered mobility may open new pathways for participation, learning, and connection, laying critical groundwork for more equitable developmental opportunities in early childhood.

Objective: This systematic review and meta-analysis aimed to provide the first comprehensive, quantitative assessment of the efficacy of Extracorporeal Shockwave Therapy (ESWT) in improving bone mineral density (BMD) and key trabecular microarchitectural parameters (BV/TV, Tb.Sp, Tb.N, Tb.Th) in animal models of osteoporosis (OP).

Methods: We systematically searched six electronic databases for relevant animal randomized controlled trials (RCTs). Data extraction and quality assessment were performed on the seven studies that met the inclusion criteria. All statistical analyses were conducted using RevMan 5.4.

Results: The meta-analysis revealed that ESWT significantly improved all assessed parameters: (1) a significant increase in BMD [SMD = 2.12, 95% CI (1.50, 2.73), P < 0.00001] with low heterogeneity (I ² = 0%); (2) a significant increase in bone volume fraction [BV/TV, SMD = 2.26, 95% CI (0.20, 4.32), P = 0.03] with high heterogeneity (I ² = 76%); (3) a significant decrease in trabecular separation [Tb.Sp, SMD = -1.39, 95% CI (-2.64, -0.14), P = 0.03] with moderate heterogeneity (I ² = 63%); (4) a significant increase in trabecular number [Tb.N, SMD = 3.51, 95% CI (1.93, 5.10), P < 0.0001] with moderate heterogeneity (I ² = 62%); and (5) a significant increase in trabecular thickness [Tb.Th, MD = 0.09, 95% CI (0.04, 0.13), P = 0.0005] with low heterogeneity (I ² = 20%). Although initial heterogeneity for BV/TV, Tb.Sp, and Tb.N was high, sensitivity analysis identified the sources, and their removal resulted in more stable effect estimates.

Conclusion: As the first quantitative synthesis in this field, this study provides preclinical evidence suggesting that ESWT is associated with improvements in bone density and optimizes bone microarchitecture. These findings establish a critical data foundation for ESWT as a potential non-invasive therapy for OP. However, it is important to note that the certainty of these findings is tempered by several factors, including the observed high heterogeneity for BV/TV, Tb.Sp, and Tb.N, the small total sample sizes across outcomes, and the potential for publication bias. The results are further constrained by exclusive reliance on animal models and a limited number of included studies. Future clinical research is required to validate these findings and further elucidate the underlying mechanisms.