Frontiers in rehabilitation sciences最新文献

Introduction: Rehabilitation aftercare serves to maintain the success of treatment following medical rehabilitation. Digital services, such as app-based training or therapist-led video calls, are increasingly being used in rehabilitation and aftercare as alternatives that are more flexible in terms of space and time. However, such systems place various demands on users. The study aims to identify the requirements and competencies needed by patients and therapists for the successful use of telerehabilitation aftercare in Germany.

Materials and methods: The study employed an explorative, qualitative approach. Focused interviews were conducted to gather user experiences with telerehabilitation aftercare. Fifteen therapists participated in three focus group interviews, while five patients took part in three individual or two-person interviews. Using an interview guideline, patients and therapists were asked about steps, preparation processes, required competencies and adaptation possibilities in relation to telerehabilitation aftercare. The evaluation was carried out using structuring content analysis according to Kuckartz and Rädiker.

Results: Depending on the program used and the professional background of the therapists, the perceived usage requirements differed, including technical handling, motivation for training and individual therapy adaptations. Both target groups considered application-, process- and impact-related knowledge, technical, social-emotional and cognitive skills, a positive attitude towards technology and technical experience as necessary. Therapists emphasized professional skills as well as experience, and patients sufficient physical skills such as motor skills. The influence of socio-demographic factors on usage was controversially discussed.

Conclusion: Findings suggest to focus not only on technical but also on professional and social competencies in training and further education in order to promote the competent use of telerehabilitation aftercare. If sufficient opportunities are created to get to know and try out such programs, uncertainties could be reduced and positive user experiences can be promoted. Due to the small sample size, the results cannot be generalized without restriction, and further research with a larger and more diverse sample is necessary.

Background: High-intensity therapy improves outcomes in (pediatric) neurorehabilitation, yet standardized intensity measures accounting for motor and/or mental demands remain scarce.

Objectives: To evaluate the responses and test-retest reliability of heart rate variability (HRV), skin conductance (SC), activity counts and movement repetitions normalized for the maximal capacity (%ACmax and %MOVmax, respectively), and the NASA-TLX across personalized motor and mental load levels in children and adolescents with neurological diagnoses using upper limb exergames.

Methods: In a cross-sectional study, participants engaged in two custom exergames at three intensity levels ("very easy," "challenging," "very difficult"), each lasting 3 min. Responses of the candidate intensity measures were analyzed across conditions, and intraclass correlation coefficients (ICC) assessed reliability across two consecutive sessions.

Results: 30 children and adolescents with neurological diagnoses aged 9-19 years participated in the study. %MOVmax and NASA-TLX (overall, effort, mental) responded to both mental and motor intensity increases. HRV, %ACmax, and NASA-TLX physical subscale responded to motor load only. SC showed no consistent response. HRV and %ACmax demonstrated the highest reliability (ICC > 0.75), especially under motor conditions. NASA-TLX effort showed potential as a simplified surrogate for the full scale, though with variable reliability.

Conclusion: Changes in motor intensity were better captured than changes in mental intensity. Combining HRV, %ACmax, and NASA-TLX effort could offer a multidimensional approach to quantify therapy intensity. However, many measures lacked sufficient reliability or feasibility for clinical implementation. Further research is needed to validate these measures in real-world therapeutic settings and clarify their relationship to individual capacity.

Electrophysiological examination of the pelvic floor plays a crucial role in localizing nerve damage in pelvic floor dysfunction (PFD). Spinal epidural lipomatosis (SEL) is a space-occupying disease of the spinal canal. SEL can cause spine-related symptoms. We report a case of SEL with pelvic floor dysfunction symptoms and provide two sets of pelvic floor electrophysiological data, before and after disease progression. This case highlights the potential utility of electrophysiological assessment in the early diagnosis and monitoring of SEL.

Introduction: Neuromuscular recovery after total joint arthroplasty remains insufficiently understood, and current tools for assessing muscle function lack the resolution to monitor detailed recovery dynamics. High-Density surface Electromyography (HD-sEMG) enables spatiotemporal analysis of muscle activation and may support individualized rehabilitation. However, its clinical application in orthopedic settings remains limited.

Methods: This exploratory study presents a methodological framework for applying wearable 64-channel HD-sEMG system to monitor neuromuscular recovery in patients undergoing total knee or hip arthroplasty. HD-sEMG data were recorded during standardized mobilization exercises at multiple pre- and postoperative time points. A custom signal processing pipeline was developed, encompassing artifact suppression, dimensionality reduction, feature extraction, and the derivation of five functional indices summarizing key aspects of muscle performance.

Results: Initial clinical application demonstrated the feasibility of the approach. The functional indices revealed distinct recovery dynamics across patients and showed promising alignment with patient-reported outcome measures. Individual case analyses suggested the potential of HD-sEMG to differentiate between restitution and dysfunctional compensation patterns.

Discussion: This study provides a structured, exploratory foundation for longitudinal HD-sEMG research in orthopedic rehabilitation. While not yet suited for clinical decision-making, the proposed framework offers methodological tools for future investigations of neuromuscular recovery trajectories and may contribute to the development of personalized, data-driven rehabilitation strategies.

Background: Virtual reality (VR) rehabilitation shows promise for stroke recovery, but optimal dosage remains unclear. We examined the relationship between VR therapy intensity and patient satisfaction, while assessing methodological challenges in dose-response research.

Objective: To investigate relationships between VR rehabilitation dosage (sessions, duration) and patient satisfaction in subacute stroke patients, and identify requirements for future definitive studies.

Methods: We analyzed data from 19 subacute ischemic stroke patients who received VR rehabilitation using VR Vitalis® Pro system (January-December 2024). Patient satisfaction was measured with the User Satisfaction Evaluation Questionnaire (USEQ). We examined correlations between VR dosage variables and satisfaction, then conducted post-hoc power analysis and confounding assessment.

Results: Patients averaged 25.0 ± 6.8 USEQ points, with 68% achieving high satisfaction. They completed 4.2 ± 4.1 VR sessions (range 1-13), but 58% received only 1-2 sessions due to clinical factors. No significant correlation emerged between sessions and satisfaction (r = 0.18, p = 0.47). Post-hoc analysis revealed only 11% statistical power for the observed effect. VR sessions strongly correlated with hospital stay (r = 0.664, p = 0.002), indicating confounding by clinical severity rather than research-controlled dosage.

Conclusions: Our underpowered study (11% power) with substantial clinical confounding cannot determine dose-response relationships or inform practice. Future studies need larger samples (n ≥ 85) with randomized dosage allocation. Our main contribution is demonstrating methodological requirements for rigorous VR dose-response research.

Introduction: Anterior cruciate ligament (ACL) tears are common in athletic and nonathletic populations, often resulting from activities involving rapid directional changes that place stress on the knee. Although advances in surgery and rehabilitation have improved recovery, many patients still struggle to regain pre-injury performance and face increased risk of re-injury. We hypothesize that combining standard rehabilitation with transcranial direct current stimulation (tDCS) may accelerate recovery, improve neuromuscular control, and strengthen key muscles like the hamstrings and hip abductors, reducing reinjury risk.

Methods/materials: This randomized controlled trial protocol, approved by the Ethics Committee of the Catholic University of Valencia, follows a double-blind, comparative, longitudinal design per SPIRIT guidelines. Elite athletes will be randomized 1:1 into two age- and sex-matched groups: non-invasive brain stimulation (NIBS) + rehabilitation (ProtocolRHB) or sham NIBS + ProtocolRHB. The NIBS intervention uses tDCS to deliver low-intensity direct current to modulate cortical excitability. Data collection spans April 2025 to December 2027 with outcomes assessed at four postsurgical time points. The primary outcome is electromyographic (EMG) activity to evaluate muscle activation, crucial for restoring knee stability and function. Secondary outcomes include knee function (Lysholm Scale) and ACL-specific quality of life. EEG and TMS will assess cortical excitability and plasticity during voluntary muscle contraction.

Impact statement: This study integrates neurophysiology with rehabilitation, offering a novel approach to enhance functional recovery and lower reinjury risk post-ACL reconstruction, potentially informing future evidence-based sports medicine and neurorehabilitation strategies.

Introduction: Cerebral Palsy (CP) refers to a heterogeneous group of disorders resulting from early brain injury during development. The clinical and functional consequences are variable, but primarily characterized by motor and postural deficits that limit independence in activities of daily living, impacting child's and family's quality of life. There is consensus on the effectiveness of rehabilitative interventions when started early and administered intensively, leveraging neuronal plasticity. The Hand-Arm Bimanual Intensive Training Including Lower Extremities (HABIT-ILE) rehabilitation approach was developed to improve motor skills in children with CP, focusing on bimanual activities with integration of the lower limbs. The aim of this study is to present an intensive, individualized motor training protocol, based on HABIT-ILE principles, tailored for children and adolescents with CP.

Methods: To develop the protocol, we conducted a review of literature on HABIT-ILE applications. Additionally, we carried out multidisciplinary focus groups with professionals from three Italian Centers. These discussions focused on therapeutic setting, identifying materials, structuring play activities, to define strategies to enhance applicability and impact of the protocol.

Results: An intensive intervention protocol based on HABIT-ILE was developed. It consists of 30 h over 10 consecutive days, with daily sessions of 3 h. The intervention, structured around bimanual activities and lower limb involvement, was personalized according to clinical and motivational profile and conceived to be administered in pairs to children aged 6-17 years with CP and upper limb asymmetry. Sessions are divided into three components: bimanual tasks, occupational activities, and gross-motor activities, ensuring a global approach and enhancing neuroplasticity. Daily activities are selected by patients from a predetermined pool chosen by therapists, based on individual profiles and adapted progressively.

Discussion: The HABIT-ILE model represents an intensive and individualized approach for improving motor abilities in these patients. Our protocol, including personalization in an ecological context and pairwork, could increase motivation, adherence, and ultimately therapy effectiveness. We plan to verify feasibility, clinical effectiveness and sustainability of this model in multicenter contexts. Ongoing trials will provide evidence of applicability and efficacy, combined with non-invasive brain stimulation (NIBS) techniques such as transcutaneous vagus nerve stimulation or transcranial alternating current stimulation.

Clinical trial registration: ClinicalTrials.gov, Identifiers NCT06372028 and NCT06372041.

Background: Despite the versatile application of the Affolter Model®, using Tactual Interaction Therapy as a treatment approach in health, social and educational care of people with congenital brain disorder or acquired brain injury, high quality studies with robust designs for efficacy are scarce. Evaluation of the effectiveness of the Tactual Interaction Therapy requires agreement and consensus among practitioners of what constitutes this approach. Such consensus has yet to be achieved.

Goal: To map the Affolter Model® by reaching consensus on its core domains among experienced practitioners.

Methods: From September to December 2022, a modified online Delphi process with four survey rounds was conducted to map the core domains of the Affolter Model®. An international, interdisciplinary project group consisting of four senior instructors, trained in the use of the Affolter Model® created 29 initial statements. In the course of the four survey rounds, 40 practitioners (expert panel), all experienced users of the Affolter Model®, rated these statements on a five-point Likert scale. In addition, new statements were developed as well as new versions of existing statements. These were integrated into the surveys and submitted for evaluation. An a-priory consensus was set at a percentage approval of at least 80%.

Results: Thirty-six statements out of a total of 38 statements reached consensus. The majority of statements (29/36) achieved an agreement of more than 90%. Statements that were initially rejected achieved consensus after being rephrased.

Conclusion: Thirty-six core statements describing the Affolter Model® achieved consensus. By mapping the core domains of the Affolter Model®, this study provides a basis for teaching and developing the Affolter Model® in theory and practice and for further research projects to investigate its effectiveness in persons with perceptive and cognitive problems, limiting participation in everyday life.

Long-term cognitive outcomes after stroke and their impact on health-related quality of life remain understudied. This study examined associations between cognitive performance and the Stroke-Specific Quality of Life scale (SS-QOL) four years after stroke. Sixty-five individuals (mean age 64 years, 74% male) with mild-to-moderate strokes completed the SS-QOL, the Modified Rankin Scale (mRS) and a neuropsychological test battery. A previously established principal component analysis of the SS-QOL informed division into Cognitive-Social-Mental (CSM) and Physical-Health (PH) components. Most participants reported no or mild disability on the mRS. Relative to age-adjusted norms, the group performed slightly below average across several cognitive domains, with marked variability indicating a subgroup with pronounced deficits. PH scores were high, reflecting minimal physical disability, whereas CSM scores were lower, indicating persistent challenges. CSM scores were associated with reaction time (ρ = .47), verbal memory (ρ = .42) and fine-motor coordination (ρ = .39; all p ≤ .001). PH scores were associated with fine-motor coordination (ρ = .49; p < .001). No significant associations emerged for language, visuospatial abilities, attention or executive functions after correction for multiple comparisons. In summary, associations between cognitive domains and SS-QOL were circumscribed and concentrated within the CSM component. Results indicate that cognitive and psychosocial factors are relevant in long-term recovery. Even selective cognitive deficits could reduce health-related quality of life and warrant follow-up. Generalisability is limited by the small, predominantly male sample, exclusion of individuals with aphasia, severe disability or age >75 years. Replication in larger, more diverse samples is needed.

Objective: To investigate clinical improvement in persons with severe musculoskeletal injuries following a 4-week high intensity sports-based return to run rehabilitation therapy program (RTR) combined with use of an Intrepid Dynamic Exoskeletal Orthosis (IDEO).

Patients: 41 persons (37 male and 4 female) with lower limb musculoskeletal injuries undergoing treatment and rehabilitation at the Center for the Intrepid were included in the retrospective cohort study.

Methods: Retrospective analysis of clinical data was used to identify changes in Two Minute Walk Test (2MWT) outcomes in patients with lower limb musculoskeletal injuries without the IDEO, with the IDEO alone and after IDEO + RTR. A repeated measures ANOVA was used to examine differences in distance walked across the three groups (NO IDEO, IDEO alone, and IDEO + RTR). Bonferroni post-hoc analysis was performed, and a level of significance was set at 0.05.

Results: A statistically significant difference in distance walked between all groups was observed (p < 0.001). Patients' mean distance walked using the IDEO alone (179 m, p < 0.001) and IDEO + RTR (208 m, p < 0.001) increased significantly compared to NO IDEO (152 m, p < 0.001). These differences surpass the Minimal Clinically Important Difference (37.2 m) and the Minimal Detectable Change (34.3 m) for the 2MWT in the limb loss population.

Conclusion: These data suggest the potential benefit of the combination of IDEO + RTR improved walking in patients with lower limb musculoskeletal injuries and suggest the 2MWT may be a meaningful, simple measure to detect improvement in function.