Frontiers in rehabilitation sciences最新文献

Background: Dysphagia is a common complication of severe traumatic brain injury (sTBI) and may persist despite standard treatment. For refractory cases, there appear to be no more effective therapeutic options available.

Case information: A 15-year-old boy continued to suffer from severe dysphagia nine months after severe traumatic brain injury, remaining dependent on tracheostomy and nasogastric feeding. Prior interventions, including two botulinum toxin injections and a 35-day multimodal rehabilitation program, failed to yield meaningful improvement. At readmission, swallowing assessments showed profound impairment, malnutrition, and poor treatment tolerance. Functional near-infrared spectroscopy (fNIRS) was then applied to map cortical activation and guide targeted therapy. After 42 days, swallowing function improved significantly, with the Functional Oral Intake Scale (FOIS) rising from level I to VI and the Penetration-Aspiration Scale (PAS) decreasing from 8 to 2.

Conclusions: The therapeutic outcome of this case suggests that selecting training methods based on fNIRS-identified cortical activation can have a positive and significant impact on swallowing rehabilitation in patients with severe traumatic brain injury.

Background: Transcranial direct current stimulation (tDCS) combined with dual-task training (DTT) has shown potential in promoting neurorehabilitation. However, the transcriptomic mechanisms underlying the synergistic effects of dual-target tDCS remain unexplored. This study aims to evaluate the effects of tDCS + DTT on cognitive and motor functions and preliminarily explore its molecular basis through transcriptomic analysis.

Methods: Fifty two chronic stroke patients were randomized to receive dual-target tDCS (anodal electrodes over affected primary motor cortex M1 and left dorsolateral prefrontal cortex DLPFC) combined with DTT (n = 26) or sham stimulation with DTT (n = 26). Behavioral assessments, including the Visual Cognitive Assessment Test (VCAT), Hamilton Depression Scale (HAMD), Fugl-Meyer Lower Limb Assessment (FMA-L), Timed Up and Go Test (TUG), and Modified Barthel Index (MBI), were conducted before and after the intervention. Peripheral blood transcriptomic analysis was performed on a subset of patients from the tDCS + DTT group to identify differentially expressed genes (DEGs) and enriched pathways.

Results: Significant interactions were observed for VCAT (p < 0.001), MBI (p = 0.033), HAMD (p < 0.001), FM-L (p < 0.001), TUG-CMDT time (p < 0.001), and TUG-CMDT accuracy rate (p < 0.001). Transcriptomic analysis revealed 1,319 DEGs post-treatment, predominantly downregulating inflammation/apoptosis-related genes (1,155) and upregulating neuroplasticity-associated genes (164). KEGG pathway analysis highlighted suppressed NF-κB signaling and apoptosis pathways, alongside enhanced synaptic plasticity mechanisms. Key regulatory genes, such as PPP1R15A, BCL3, GADD45B, and NFKBIA, were identified as potential mediators of tDCS-induced neuroprotection.

Conclusion: Dual-target tDCS combined with DTT promotes functional recovery in stroke patients through transcriptomic reprogramming of inflammatory and neuroplastic pathways, offering a novel strategy for multi-modal neurorehabilitation.

Background: This study examines the current status of rehabilitation therapists in Hunan Province after the COVID-19 outbreak and identifies factors affecting their job satisfaction.

Objective: The purpose of this article is to understand the post-pandemic conditions of rehabilitation therapists in Hunan Province.

Method: After expert review, a cross-sectional questionnaire was disseminated via WeChat using the Wenjuanxing platform. Of 809 questionnaires collected, 769 valid responses were included in the final analysis after excluding incomplete or inconsistent data.

Results: This study analyzed the relationships between demographic factors and job satisfaction among rehabilitation therapists. Significant differences were found in age, work experience, job title, and monthly salary level (P < 0.001). Notably, lower income was strongly associated with greater job dissatisfaction; each one-category increase in monthly income was associated with 51% lower odds of being in a higher (more dissatisfied) category of job satisfaction (OR = 0.49, 95% CI: 0.42-0.57; P < 0.001), underscoring income as a key predictor of job satisfaction.

Conclusions: Our investigation reveals that rehabilitation therapists' roles in Hunan have become more specialized, with monthly income emerging as a critical driver of job satisfaction. These findings underscore the need for competitive compensation and wider professional support to maintain workforce stability. By focusing on the post-pandemic landscape in Hunan Province, this study offers valuable insights that may guide policy and practice for rehabilitation therapists across China.

Background: Painless motor radiculopathy is a rare clinical entity, accounting for approximately 5%-8% of cervical radiculopathy cases. While current guidelines recommend early surgical intervention for patients with severe motor deficits, the efficacy of nonsurgical management remains unclear.

Case presentation: We present a case of a 67-year-old man with sudden onset of right shoulder motor paralysis [Medical Research Council (MRC) grade 3-] without pain. MRI revealed multilevel foraminal stenosis at C5-C7-T1 and central disc protrusion at C4-5, without cord compression. The patient elected nonsurgical management and received four epidural steroid injections (two interlaminar and two transforaminal) over five weeks. Motor function progressively improved, reaching MRC grade 5-, and shoulder range of motion was fully restored. No adverse effects occurred.

Conclusion: This case demonstrates that epidural steroid injections can be an effective alternative to surgery for selected patients with painless cervical motor radiculopathy and severe motor dysfunction. Individualized treatment strategies should be considered, and further research is warranted to establish optimal management approaches.

[This corrects the article DOI: 10.3389/fresc.2025.1589588.].

Objective: Military service is demanding and requires maintenance of optimal physical and mental health. Deployment-related incidents can precipitate the onset of physical and/or psychological trauma necessitating appropriate pharmacological intervention. However, current strategies for medical vocational rehabilitation do not include systematic medication assessment.

Methods: This study analyzed physical performance and long-term medication use in middle-aged soldiers diagnosed with physical impairments and/or posttraumatic stress disorder. Patient records were analyzed to investigate the number of drugs, polypharmacy, drug-drug interactions and drugs targeting the nervous system in relation to bicycle ergometry performance.

Results: A total of 172 patients were inclusion, with 45 patients (26.6%) receiving comprehensive medication. Patients with posttraumatic stress disorder, who were taking an average of 3.0 medications each, demonstrated significantly lower maximum performance than did the controls [n = 93, 217 (200-250) W vs. n = 34, 250 (225-267) W, P = 0.006]. Polypharmacy [n = 42, 217 (200-250) W vs. n = 34, 250 (225-267) W, P = 0.017] and drug-drug interactions [n = 49, 221 (200-250) W vs. n = 34, n = 34, 250 (225-267) W, P = 0.024] negatively impacted maximum performance, with patients experiencing 1.6 interactions on average of varying severity. A significant negative correlation was observed between the number of drugs, anatomical-therapeutic-chemical classification, polypharmacy, number, and severity of drug-drug interactions and poor maximum performance. Although no other significant differences were noted across all groups, posttraumatic stress disorder patients without medication achieved significantly greater performance than did somatic patients [n = 34, 250 (225-267) vs. n = 33, 217 (200-250), P = 0.009].

Conclusion: In conclusion, highly prevalent polypharmacy may contribute to physical performance limitations, highlighting the need for further research and professional support in medication management within rehabilitation programs for mental illnesses.

Introduction: Hybrid-power is a prosthesis class that combines body-power and external-power into a singular embodiment. The class is rarely discussed in literature and is ill-defined, with the term "hybrid" being used to describe a broad range of upper-limb prostheses. This is despite the increased use of hybrid-power prostheses in clinical practice for treating people with above-elbow amputations; there is also little literature assessing their performance relative to the functional benchmarks of body-power or external-power prostheses. This scoping review aims to identify the various subcategories of hybrid prosthesis that exist, with an explicit focus on hybrid-power devices, and to report on the designs and use-cases of hybrid-power devices presented in clinical and research contexts. Where possible, comparisons are made between the performance of hybrid-power devices and other active prostheses.

Methodology: This study follows PRISMA 2020 systematic review reporting guidelines to identify, sort, and select relevant literature from databases. Searches were conducted on three research databases (Scopus, Web of Science, PubMed) and two patent databases (eSpacenet, Derwent Innovations Index) to identify relevant sources on the topic of hybrid-powered prostheses. 142 unique research papers were identified from the three identified research databases, which were screened by title and abstract and further filtered following a full text review, leaving 13 relevant studies and 2 patents which underwent full-text screenings by the lead-author.

Results: Five prominent categories of "hybridisation" were identified: hybrid-power, hybrid-control, hybrid-strategy, hybrid-actuation, and hybrid-feedback. Within the hybrid-power class, two prominent use-cases were identified: increasing active control inputs and reducing the physical effort necessary to operate a prosthesis. Additional use-cases were found within research, including increasing the number of grasps available for a transradial prosthesis, and providing flexible control options in areas with limited resources.

Discussion: Insufficient quantitative evidence was found to draw any conclusions about the performance of hybrid-power prostheses relative to body-power or external-power devices. Further research should be conducted into the testing of conventional hybrid-power devices using standard clinical means, to establish a meaningful benchmark performance that future developments in research can draw from.

Introduction: Despite mild disability, people with multiple sclerosis (PwMS) often face work-related challenges and reduced employment. Their experiences regarding work challenges are understudied.

Purpose: To explore experienced work challenges and possibilities for sustained employment among employed PwMS with mild to moderate disability.

Materials and methods: In-depth interviews with 26 employed PwMS analyzed using systematic text condensation guided by Goffman's theories on self and social interaction.

Results: Three categories were developed: (1) unspoken work challenges, (2) the cumulative impact of mild MS symptoms on work challenges, and (3) disability and work challenges influence "who I am at work". Communication about work challenges was often limited even when MS was disclosed. Most participants experienced difficulties related to cumulation and interplay of symptoms and work challenges, resulting in reduced work capacity, hours and negative thoughts about themselves, confidence and perceived prospects for job retention. Feeling capable in handling work tasks were believed to facilitate sustained employment.

Conclusion: Mildly disabled PwMS often trivialized and avoided addressing work challenges to maintain self-concept, social order and role at work, even after MS was disclosed. Recognizing and addressing mild symptoms and work challenges while maintaining self-concept, sense of capability and acceptance at work, may facilitate sustained employment.

Objective: This study examined differences in the dynamic balance function of healthy elementary school students and university students observed with and without the use of a sensor-integrated gamification application developed for pediatric rehabilitation.

Methods: This cross-sectional study was conducted between January and June 2025. and included a total of 79 participants (43 healthy elementary school students from Fukuoka, Japan; 36 healthy university students from Fukushima, Japan). Measurements were performed using a normal Y-Balance test and a Y-Balance test with a sensor game to encourage slow movements. The sensor sensitivity was set to 0.768 g and 7.53 m/s² during game play.

Results: During the Y-Balance test, all items exhibited no significant interaction effects; however, several outcome measures exhibited main effects. The results of multiple comparison tests indicated different responses between groups attributable to sensor game use. No significant differences in the Y-Balance test items with or without the use of the sensor game for the dominant and non-dominant legs were observed in the university student group. Conversely, in the elementary school student group, the posterolateral scores of the Y-Balance test with the sensor game were significantly lower than those of the normal Y-Balance test.

Conclusion: The sensor-integrated gamification application effectively increased task difficulty for healthy elementary school students by encouraging slower movements, leading to decreased dynamic balance function. This effect was not observed among university students. These findings suggest that sensor games may be valuable because they can appropriately adjust the difficulty level of balance exercises among elementary school students in rehabilitation settings.

Introduction: This research explores the use of Deep Learning (DL) techniques for hand and gesture recognition to support hand rehabilitation programs. The primary objective is to enhance cognitive function and hand-eye coordination through gamified therapeutic exercises that track and respond to hand gestures in real time.

Methods: Pre-trained Convolutional Neural Network (CNN) models were employed for hand recognition using Google's open-source MediaPipe Library. Four classic arcade games-Pong, Tetris, Fruit Ninja, and a Virtual Keyboard-were redeveloped as gesture-controlled rehabilitation tools within a web-based interface built using the Phaser.js framework. A score-based system was implemented to track user performance and progress. Usability was evaluated using the System Usability Scale (SUS), and statistical validation was performed with a one-sample t-test against the industry benchmark.

Results: Data collected from 15 participants demonstrated consistent gesture recognition accuracy and stable game control performance. The SUS evaluation indicated favorable user responses, with usability scores exceeding the benchmark threshold, suggesting that participants found the system intuitive and engaging.

Discussion: The study confirms the feasibility of using monocular camera-based computer vision for hand rehabilitation. Compared to existing low-cost rehabilitation tools, the proposed system provides an accessible, interactive, and affordable alternative. Integrating gesture recognition with gamified interfaces effectively supports dexterity recovery and motivates users through engaging gameplay. These findings establish a foundation for future development of AI-based rehabilitation platforms using standard camera devices.