Frontiers in rehabilitation sciences最新文献

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.

Objective: This study aimed to investigate the impact of radial extracorporeal shockwave therapy (rESWT) on plantar pressure distribution in patients with chronic plantar fasciitis (PF). While prior research has established rESWT's clinical efficacy in pain relief, its specific biomechanical effects on plantar loading patterns remain less quantified. This study addresses that gap by providing objective pedobarographic evidence of rESWT-induced pressure redistribution.

Methods: A cohort of 42 patients with unilateral chronic PF was enrolled. Plantar pressure parameters-including total foot pressure, forefoot pressure, rearfoot pressure, peak pressure point, mean pressure, and contact area-were assessed using a plantar pressure measurement system before and after a standardized rESWT protocol. Evaluations compared the affected limb with the contralateral unaffected limb.

Results: Following rESWT, significant changes were observed: on the affected side, forefoot pressure increased (p = 0.001) and rearfoot pressure decreased (p = 0.001); on the unaffected side, forefoot pressure also increased (p = 0.002) and rearfoot pressure decreased (p = 0.003). Total foot pressure decreased on the affected side (p = 0.032) but increased on the unaffected side (p = 0.032). Contact area increased significantly only on the unaffected side (p < 0.001). No significant alterations were found in peak pressure point location or mean pressure (p > 0.05). Effect size analysis (Cohen's d > 0.5) confirmed clinically meaningful improvements in forefoot and rearfoot pressure shifts.

Conclusion: rESWT effectively ameliorates abnormal plantar pressure distribution in PF patients, promoting a forward shift in the pressure center and improving gait symmetry. These findings provide a biomechanical rationale for its clinical use. Future studies should incorporate patient-reported outcomes and longer follow-up to link these biomechanical changes to functional improvement.

In this era of high competition and pandemic, the return to work is challenging because it requires organizations to balance operational demands with individualized support for employees recovering from psychological, physical, and/or personal setbacks. Additionally, managerial expectations, misalignment between workplace culture, and employee readiness can hinder effective reintegration, leading to reduced relapse or productivity. This study aimed to examine the influence of key organizational and psychological factors on employees' return-to-work. A stratified sampling approach was employed to collect data from 370 employees who had successfully returned to work after experiencing work-related injuries and diseases. Eight hypotheses were formulated and validated using structural equation modeling with SmartPLS. Findings from the present study reveal that perceived organizational support has an insignificant impact on the return to work; however, it has a significant impact on strategic human resource management and psychological empowerment. In addition, the present study confirmed a significant impact of organizational hierarchy culture on return-to-work and psychological empowerment. Thus, strategic human resource management had a significant impact on return-to-work rates and psychological empowerment. Finally, psychological empowerment had a significant impact on the return to work. The study highlights the importance of culturally aligned human resource strategies and psychological factors in fostering successful employee reintegration after work absence. These findings have practical implications for human resource professionals and policymakers aiming to design effective, inclusive, and sustainable return-to-work programs tailored to hierarchical organizational environments.

Aim: This review systematically analyzes and synthesizes evidence on multicomponent training interventions aimed at improving cognitive function in older adults with mild cognitive impairment (MCI). The goal is to inform clinical practice with actionable insights.

Design: Best evidence summary.

Methods: This review adhered to the 6S model to identify evidence, searching data sources from their inception to April 30, 2025. The process involved systematic screening, quality appraisal, and data extraction for evidence synthesis.

Results: A total of 12 sources were included: one guideline, six systematic reviews, one expert consensus, three evidence summaries, and one meta-analysis. From these sources, 24 best-evidence statements were synthesized across six domains: (a) principles for developing multicomponent training prescriptions, (b) intervention effects, (c) exercise dosage and intensity, (d) safety monitoring and risk management, (e) outcome assessment methods, and (f) strategies for promoting implementation and adherence.

Conclusion: The evidence suggests that healthcare professionals should tailor multicomponent training interventions to the individual needs and clinical contexts of older adults with MCI to effectively slow cognitive decline.

Relevance to clinical practice: This synthesis provides an evidence-based framework for developing multicomponent training protocols for older adults with MCI, supporting targeted interventions that may mitigate cognitive deterioration.

Summary: This evidence synthesis integrates 12 high-quality sources, generating 24 best practice recommendations across six critical domains, including prescription design, exercise dosage, and safety management, offering guidance for personalized clinical application.

Systematic review registration: Identifier [ES20257822].

Background: Myogenous temporomandibular disorders (TMDs) is commonly associated with myofascial pain and functional limitations. Botulinum toxin type A (BoNT-A) has shown potential in relieving chronic muscular pain.

Methods: In this single arm, prospective, pilot study, 25 patients diagnosed with myofascial TMDs received a single bilateral intramuscular injection of 50 units of BoNT-A. Assessments using the Visual Analog Scale (VAS), Chronic Pain Index (CPI), Jaw Functional Limitation Scale (JFLS-8), and Oral Health Impact Profile (OHIP-14) were performed at baseline, 6 weeks, and 12 weeks post-treatment.

Results: Significant reductions in pain (VAS: 6.84 ± 1.03 to 0.84 ± 0.94) and CPI (61.87 ± 8.12 to 9.86 ± 4.46) were observed. Functional improvement (JFLS-8: 5.82 ± 0.56 to 1.08 ± 0.51) and enhanced quality of life (OHIP-14: 24.56 ± 8.39 to 5.96 ± 2.79) were also significant. No adverse effects were reported.

Conclusions: BoNT-A showed promising results in reducing pain and improving function in patients with myofascial pain in Temporomandibular Disorders (M-TMDs). However, the single-arm design, small sample size, and short follow-up limit causal inference and external validity. These findings should be interpreted as preliminary.Clinical Trial Registration: Clinicaltrials.gov, identifier NCT05651256.