Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.10.009
Brenda Mara Santos da Costa PT , Giovani Bernardo Costa MSc , Karina da Silva MSc , Patricia Fernandes Trevizan PhD , Daniel Godoy Martinez PhD , Leonardo Barbosa de Almeida PhD
Objective
To assess the feasibility, safety, and performance of the 6-minute step test (6MST) in hospitalized patients undergoing hematopoietic stem cell transplantation (HSCT).
Design
Longitudinal observational cohort study.
Setting
Hospitalization, bone marrow transplant unit.
Participants
Thirty-six hospitalized patients (N=36) scheduled for HSCT, aged over 18 years, of both sexes, were invited to participate in the study.
Interventions
Not applicable.
Main Outcome Measures
Primary outcomes include feasibility (recruitment rate: number of patients invited and who agreed to participate and attrition rate: number of patients who agreed but could not participate because of an adverse clinical condition) and safety (number of adverse events per number of 6MST tests performed). Secondary outcome includes patient performance in the test (number of steps, heart rate, blood pressure, oxygen saturation, and perceived exertion).
Results
All patients agreed to participate in the study (recruitment rate=100%) and were submitted to autologous HSCT. Of these, 2 patients could not perform the 6MST at hospital discharge because of postural or clinical instability (attrition rate=5.6%). Five adverse events occurred in 70 tests (1 bleeding episode, 1 loss of central venous access, 1 vomiting episode, 1 oxygen desaturation, and 1 presyncope), representing 7.1% of the total tests. One adverse event occurred at hospital admission (2.8%), while 4 occurred at discharge (11.7%). Patients demonstrated similar exercise capacity at admission and discharge (107.6±25.9 vs 102.1±29.9), but with increased hemodynamic response and perceived exertion at discharge (P<.05).
Conclusions
The 6MST is a feasible assessment for patients hospitalized for autologous HSCT. However, it is associated with a higher incidence of adverse events at discharge compared to hospital admission.
{"title":"Is the 6-Minute Step Test Feasible and Safe for Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation?","authors":"Brenda Mara Santos da Costa PT , Giovani Bernardo Costa MSc , Karina da Silva MSc , Patricia Fernandes Trevizan PhD , Daniel Godoy Martinez PhD , Leonardo Barbosa de Almeida PhD","doi":"10.1016/j.apmr.2025.10.009","DOIUrl":"10.1016/j.apmr.2025.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>To assess the feasibility, safety, and performance of the 6-minute step test (6MST) in hospitalized patients undergoing hematopoietic stem cell transplantation (HSCT).</div></div><div><h3>Design</h3><div>Longitudinal observational cohort study.</div></div><div><h3>Setting</h3><div>Hospitalization, bone marrow transplant unit.</div></div><div><h3>Participants</h3><div>Thirty-six hospitalized patients (N=36) scheduled for HSCT, aged over 18 years, of both sexes, were invited to participate in the study.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcomes include feasibility (recruitment rate: number of patients invited and who agreed to participate and attrition rate: number of patients who agreed but could not participate because of an adverse clinical condition) and safety (number of adverse events per number of 6MST tests performed). Secondary outcome includes patient performance in the test (number of steps, heart rate, blood pressure, oxygen saturation, and perceived exertion).</div></div><div><h3>Results</h3><div>All patients agreed to participate in the study (recruitment rate=100%) and were submitted to autologous HSCT. Of these, 2 patients could not perform the 6MST at hospital discharge because of postural or clinical instability (attrition rate=5.6%). Five adverse events occurred in 70 tests (1 bleeding episode, 1 loss of central venous access, 1 vomiting episode, 1 oxygen desaturation, and 1 presyncope), representing 7.1% of the total tests. One adverse event occurred at hospital admission (2.8%), while 4 occurred at discharge (11.7%). Patients demonstrated similar exercise capacity at admission and discharge (107.6±25.9 vs 102.1±29.9), but with increased hemodynamic response and perceived exertion at discharge (<em>P</em><.05).</div></div><div><h3>Conclusions</h3><div>The 6MST is a feasible assessment for patients hospitalized for autologous HSCT. However, it is associated with a higher incidence of adverse events at discharge compared to hospital admission.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 353-356"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145421015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.07.001
Anna Krason PhD , Erica L. Middleton PhD , John Whyte MD, PhD , Malathi Thothathiri PhD
It remains challenging to optimize treatment for individuals with aphasia. One of the reasons is that the language processing deficits associated with aphasia have various underlying linguistic and nonlinguistic causes. The utility of cognitive training focusing on attention and working memory has been investigated in aphasia treatment. However, a related cognitive function, namely, cognitive control, remains underexplored. This article leverages treatment and enablement theories to evaluate current cognitive treatments and guide the development of new treatments focused on cognitive control in aphasia. We provide the theoretical and empirical rationale for exploring the clinical significance of cognitive control in aphasia rehabilitation and discuss how treatment and enablement theories may be used to develop a systematic cognitive training approach. We conclude with future directions for cognitive control research that can advance more personalized aphasia rehabilitation.
{"title":"Developing Cognitive Control Training for Aphasia: Insights From Treatment Theory and Enablement Theory","authors":"Anna Krason PhD , Erica L. Middleton PhD , John Whyte MD, PhD , Malathi Thothathiri PhD","doi":"10.1016/j.apmr.2025.07.001","DOIUrl":"10.1016/j.apmr.2025.07.001","url":null,"abstract":"<div><div>It remains challenging to optimize treatment for individuals with aphasia. One of the reasons is that the language processing deficits associated with aphasia have various underlying linguistic and nonlinguistic causes. The utility of cognitive training focusing on attention and working memory has been investigated in aphasia treatment. However, a related cognitive function, namely, cognitive control, remains underexplored. This article leverages treatment and enablement theories to evaluate current cognitive treatments and guide the development of new treatments focused on cognitive control in aphasia. We provide the theoretical and empirical rationale for exploring the clinical significance of cognitive control in aphasia rehabilitation and discuss how treatment and enablement theories may be used to develop a systematic cognitive training approach. We conclude with future directions for cognitive control research that can advance more personalized aphasia rehabilitation.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 357-364"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.05.003
Zitong He MSc , Mengshu Xie PhD , Chunqing Xie BM, Delian An BM, Meng Dai PhD, Hongmei Wen PhD, Yilong Shan PhD
Objective
To explore and compare the distinct characteristics of poststroke dysphagia in patients with cerebellar and different medullary lesions using flexible endoscopic evaluation of swallowing (FEES) and high-resolution pharyngeal manometry (HRPM), by comparing with healthy controls.
Design
Observational study.
Setting
Department of rehabilitation medicine of an academic hospital.
Participants
Healthy individuals and stroke patients were enrolled (N=64). 20 healthy individuals and 44 stroke patients {31 medullary stroke [10 medial medullary infarction (MMI), 21 lateral medullary stroke (LMS-S: nucleus tractus solitaries involvement; LMS-A: only affecting nucleus ambiguous; 13 cerebellar stroke)]} within 2 weeks to 3 months poststroke. All patients remained tube-fed (Functional Oral Intake Scale score≤3) without prior swallowing rehabilitation.
Interventions
Not applicable.
Main Outcome Measures
Outcome measures were assessed using FEES and HRPM, including Murray secretion scale, pharyngeal sensation test, swallow reflex, Rosenbek penetration-aspiration scale (PAS), Yale pharyngeal residue severity rating scale, upper esophageal sphincter (UES) relaxation pressure and relaxation duration, pharyngeal peak pressure and contraction duration, and pharyngeal sequencing.
Results
FEES results showed LMS-S has reduced pharyngeal sensation and delayed pharyngeal swallow initiation, but no significant differences in PAS score, residue, or secretions among the groups. Medullary stroke patients had higher UES residual pressure and shorter UES relaxation duration than cerebellar stroke patients. Subgroup analysis revealed that the UES residual pressure in LMS-S group was significantly higher and the UES relaxation duration shorter compared to the cerebellar stroke group, whereas the UES relaxation duration, velopharyngeal peak pressure, and constriction duration were all shorter in the LMS-A group than the cerebellar stroke group. Both LMS-S and cerebellar stroke patients had pharyngeal missequencing.
Conclusions
Dysphagia characteristics are different in different lesions of medullary stroke and cerebellar stroke. Specific instrumental assessments based on lesions facilitates early intervention in individualized dysphagia rehabilitation.
{"title":"Characteristics of Dysphagia in Medullary and Cerebellar Stroke: An Observational Study Based on HRPM and FEES","authors":"Zitong He MSc , Mengshu Xie PhD , Chunqing Xie BM, Delian An BM, Meng Dai PhD, Hongmei Wen PhD, Yilong Shan PhD","doi":"10.1016/j.apmr.2025.05.003","DOIUrl":"10.1016/j.apmr.2025.05.003","url":null,"abstract":"<div><h3>Objective</h3><div>To explore and compare the distinct characteristics of poststroke dysphagia in patients with cerebellar and different medullary lesions using flexible endoscopic evaluation of swallowing (FEES) and high-resolution pharyngeal manometry (HRPM), by comparing with healthy controls.</div></div><div><h3>Design</h3><div>Observational study.</div></div><div><h3>Setting</h3><div>Department of rehabilitation medicine of an academic hospital.</div></div><div><h3>Participants</h3><div>Healthy individuals and stroke patients were enrolled (N=64). 20 healthy individuals and 44 stroke patients {31 medullary stroke [10 medial medullary infarction (MMI), 21 lateral medullary stroke (LMS-S: nucleus tractus solitaries involvement; LMS-A: only affecting nucleus ambiguous; 13 cerebellar stroke)]} within 2 weeks to 3 months poststroke. All patients remained tube-fed (Functional Oral Intake Scale score≤3) without prior swallowing rehabilitation.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Outcome measures were assessed using FEES and HRPM, including Murray secretion scale, pharyngeal sensation test, swallow reflex, Rosenbek penetration-aspiration scale (PAS), Yale pharyngeal residue severity rating scale, upper esophageal sphincter (UES) relaxation pressure and relaxation duration, pharyngeal peak pressure and contraction duration, and pharyngeal sequencing.</div></div><div><h3>Results</h3><div>FEES results showed LMS-S has reduced pharyngeal sensation and delayed pharyngeal swallow initiation, but no significant differences in PAS score, residue, or secretions among the groups. Medullary stroke patients had higher UES residual pressure and shorter UES relaxation duration than cerebellar stroke patients. Subgroup analysis revealed that the UES residual pressure in LMS-S group was significantly higher and the UES relaxation duration shorter compared to the cerebellar stroke group, whereas the UES relaxation duration, velopharyngeal peak pressure, and constriction duration were all shorter in the LMS-A group than the cerebellar stroke group. Both LMS-S and cerebellar stroke patients had pharyngeal missequencing.</div></div><div><h3>Conclusions</h3><div>Dysphagia characteristics are different in different lesions of medullary stroke and cerebellar stroke. Specific instrumental assessments based on lesions facilitates early intervention in individualized dysphagia rehabilitation.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 225-234"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To identify which, if any, acoustic measures are associated with swallowing safety.
Design
Prospective, original research.
Setting
Primarily outpatient.
Participants
A total of 34 adults (N=34) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained vowel and reading a sentence before the VFSS and again after swallowing each bolus.
Interventions
Not applicable.
Main Outcome Measures
Swallowing safety was initially quantified using the Penetration-Aspiration Scale with ratings then defined dichotomously (eg, no penetration/aspiration vs penetration and/or aspiration). Acoustic measurements were calculated in Praat and included jitter (relative average perturbation [RAP]), shimmer (local), noise-to-harmonic ratio, and cepstral peak prominence (CPP).
Results
Before bolus swallowing, RAP and shimmer (local) predicted penetration or aspiration (P=.036, P=.046, respectively) when included in a model with diagnosis and sex, whereas changes in CPP significantly predicted penetration or aspiration after bolus swallowing (P=.02) when included in a model with diagnosis and bolus consistency. However, receiver operating characteristic analyses were poor (P>.05), indicating these acoustic measures did not perform well as independent classifiers of airway invasion.
Conclusions
Although RAP, shimmer (local), and CPP may predict subsequent airway invasion in a larger model, they do not appear to be effective predictors when used alone. Noise-to-harmonic ratio was not predictive of penetration or aspiration in any of the models. Results suggest that acoustic voice features are insufficient as standalone indicators of airway invasion risk or events.
目的：确定哪些（如果有的话）声学措施与吞咽安全有关。设计：前瞻性，原初研究设置：主要是门诊患者，参与者：34名被推荐进行视频透视吞咽研究（VFSS）的成年人，在VFSS前和吞咽每个药丸后完成一个持续的元音和阅读一个句子的录音。主要结局测量指标：吞咽安全性最初使用穿透-吸入量表（PAS）进行量化，然后进行分级定义（例如，无穿透/吸入与穿透和/或吸入）。声学测量在Praat中计算，包括抖动（相对平均扰动；RAP），闪烁（局部），噪声-谐波比（NHR）和倒谱峰值突出（CPP）。结果：大剂量吞咽前，RAP和微光（局部）预测渗透或吸入（p = ）。036, p = 。当纳入具有诊断和性别的模型时，CPP的变化显著预测了丸剂吞咽后的渗透或吸入（p = .02），当纳入具有诊断和丸剂一致性的模型时。然而，受试者工作特征（ROC）分析较差（p < 0.05），表明这些声学测量不能很好地作为气道侵犯的独立分类器。结论：虽然RAP、shimmer（局部）和CPP在更大的模型中可以预测随后的气道侵犯，但单独使用时它们似乎不是有效的预测因子。在任何模型中，噪声谐波比都不能预测渗透或吸入。结果表明，声学语音特征不足以作为气道侵犯风险或事件的独立指标。
{"title":"Acoustic Measures of Voice Perturbation Offer Limited Value as Standalone Indicators of Laryngeal Penetration or Aspiration","authors":"Lindsay Griffin PhD, CCC-SLP , Jenna Silver Luque PhD, CCC-SLP , Sarah H. Szynkiewicz PhD, CCC-SLP , Erin Kamarunas PhD, CCC-SLP","doi":"10.1016/j.apmr.2025.08.015","DOIUrl":"10.1016/j.apmr.2025.08.015","url":null,"abstract":"<div><h3>Objective</h3><div>To identify which, if any, acoustic measures are associated with swallowing safety.</div></div><div><h3>Design</h3><div>Prospective, original research.</div></div><div><h3>Setting</h3><div>Primarily outpatient.</div></div><div><h3>Participants</h3><div>A total of 34 adults (N=34) referred for a videofluoroscopic swallowing study (VFSS) were audio-recorded completing a sustained vowel and reading a sentence before the VFSS and again after swallowing each bolus.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Swallowing safety was initially quantified using the Penetration-Aspiration Scale with ratings then defined dichotomously (eg, no penetration/aspiration vs penetration and/or aspiration). Acoustic measurements were calculated in Praat and included jitter (relative average perturbation [RAP]), shimmer (local), noise-to-harmonic ratio, and cepstral peak prominence (CPP).</div></div><div><h3>Results</h3><div>Before bolus swallowing, RAP and shimmer (local) predicted penetration or aspiration (<em>P</em>=.036, <em>P</em>=.046, respectively) when included in a model with diagnosis and sex, whereas changes in CPP significantly predicted penetration or aspiration after bolus swallowing (<em>P</em>=.02) when included in a model with diagnosis and bolus consistency. However, receiver operating characteristic analyses were poor (<em>P</em>>.05), indicating these acoustic measures did not perform well as independent classifiers of airway invasion.</div></div><div><h3>Conclusions</h3><div>Although RAP, shimmer (local), and CPP may predict subsequent airway invasion in a larger model, they do not appear to be effective predictors when used alone. Noise-to-harmonic ratio was not predictive of penetration or aspiration in any of the models. Results suggest that acoustic voice features are insufficient as standalone indicators of airway invasion risk or events.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 251-260"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.08.003
Manju Kaushik MPT , Irshad Ahmad PhD
Objective
To identify the factors influencing the functional disability among individuals with the movement control impairment (MCI) subgroup of nonspecific chronic low back pain (NSCLBP).
Design
Cross-sectional study.
Setting
Outpatient department of physiotherapy under a rehabilitation institute.
Participants
The study recruited 66 individuals (N=66) with NSCLBP related to the MCI, specifically with sagittal plane impairment, based on the eligibility criteria.
Interventions
Not applicable.
Main Outcome Measures
After adjusting for potential confounders, the multiple linear regression analysis was performed by regressing the functional disability on a subset of predicting variables such as sagittal lumbosacral (L5-S1) intervertebral rotation and translation motions, pain intensity, fear-avoidance beliefs, and health-related quality of life (physical and mental health).
Results
Individuals with MCI had moderate to severe functional disability with a mean score of 41.41% (SD, 9.69). Multivariable linear regression analysis showed that factors such as high values of pain intensity (B=3.57; t=4.10) and L5-S1 translation motion (B=1.76; t=2.50) alongside low values of L5-S1 rotation motion (B=−0.71; t=−2.72), physical health (B=−0.57; t=−3.53), and mental health (B=−0.38; t=−4.54), all account for 62.1% (adj. R²=0.621) of the overall variance in functional disability among individuals with MCI, excluding the fear-avoidance beliefs.
Conclusions
The functional disability among individuals with the MCI subgroup of NSCLBP is predicted by pain intensity, sagittal L5-S1 intervertebral motions, and health-related quality of life, whereas fear-avoidance beliefs do not. Mental health is the strongest predictor of disability, followed by pain intensity, physical health, and sagittal L5-S1 intervertebral rotation and translation motions among individuals with MCI. This highlights the importance of addressing these factors to manage disability among individuals with MCI effectively.
{"title":"From Impairment to Disability: Unveiling Predictors for Movement Control Impairment Subgroup of Nonspecific Low Back Pain","authors":"Manju Kaushik MPT , Irshad Ahmad PhD","doi":"10.1016/j.apmr.2025.08.003","DOIUrl":"10.1016/j.apmr.2025.08.003","url":null,"abstract":"<div><h3>Objective</h3><div>To identify the factors influencing the functional disability among individuals with the movement control impairment (MCI) subgroup of nonspecific chronic low back pain (NSCLBP).</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Setting</h3><div>Outpatient department of physiotherapy under a rehabilitation institute.</div></div><div><h3>Participants</h3><div>The study recruited 66 individuals (N=66) with NSCLBP related to the MCI, specifically with sagittal plane impairment, based on the eligibility criteria.</div></div><div><h3>Interventions</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>After adjusting for potential confounders, the multiple linear regression analysis was performed by regressing the functional disability on a subset of predicting variables such as sagittal lumbosacral (L5-S1) intervertebral rotation and translation motions, pain intensity, fear-avoidance beliefs, and health-related quality of life (physical and mental health).</div></div><div><h3>Results</h3><div>Individuals with MCI had moderate to severe functional disability with a mean score of 41.41% (SD, 9.69). Multivariable linear regression analysis showed that factors such as high values of pain intensity (<em>B</em>=3.57; <em>t</em>=4.10) and L5-S1 translation motion (<em>B</em>=1.76; <em>t</em>=2.50) alongside low values of L5-S1 rotation motion (<em>B</em>=−0.71; <em>t</em>=−2.72), physical health (<em>B</em>=−0.57; <em>t</em>=−3.53), and mental health (<em>B</em>=−0.38; <em>t</em>=−4.54), all account for 62.1% (adj. <em>R</em>²=0.621) of the overall variance in functional disability among individuals with MCI, excluding the fear-avoidance beliefs.</div></div><div><h3>Conclusions</h3><div>The functional disability among individuals with the MCI subgroup of NSCLBP is predicted by pain intensity, sagittal L5-S1 intervertebral motions, and health-related quality of life, whereas fear-avoidance beliefs do not. Mental health is the strongest predictor of disability, followed by pain intensity, physical health, and sagittal L5-S1 intervertebral rotation and translation motions among individuals with MCI. This highlights the importance of addressing these factors to manage disability among individuals with MCI effectively.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 235-243"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To characterize individuals with stroke who responded or did not respond to upper limb motor treatment by analyzing muscle synergy patterns (similarity, merging, and fractionation).
Design
This study is a secondary analysis of a multicenter randomized controlled trial.
Setting
Inpatients of 2 specialized neurorehabilitation hospitals.
Participants
We enrolled individuals (N=62) with a unilateral first-event ischemic or hemorrhagic stroke and severe-to-mild upper limb motor impairment (Fugl-Meyer Assessment-Upper Extremity score of 5-61, of 66). We excluded people with untreated seizure, severe cognitive, or verbal comprehension impairment.
Interventions
After randomization, individuals were allocated to conventional, virtual reality, or robot-assisted treatment groups (20 sessions, 1 h/d, 5 d/wk, 4wk).
Main Outcome Measures
A blinded assessor performed assessments both before and after the intervention. Surface electromyography recordings from 16 muscles during reaching tasks were collected pre- and post-treatment. We extracted muscle synergy patterns (similarity, merging, and fractionation) of the stroke-affected and unaffected upper limb of each subject.
Results
Overall, individuals improved upper limb motor function (Fugl-Meyer Assessment-Upper Extremity change score=7.14±7.46; P<.001). We identified 34 responders to treatment showing clinically significant improvement (over the Minimal Clinically Important Difference of 5 points on the Fugl-Meyer Assessment-Upper Extremity). The responders showed decreased merging of synergies (P=.016) as compared with the non-responders (P=.025), who conversely showed improved similarity of synergies (P=.006).
Conclusions
In individuals with stroke undergoing upper limb motor rehabilitation, changes in the synergy merging pattern may serve as a potential marker to distinguish responders from non-responders.
{"title":"Muscle Synergy Analysis for Clinical Characterization of Upper Limb Motor Recovery After Stroke","authors":"Giorgia Pregnolato PhD , Giacomo Severini PhD , Lorenza Maistrello MSc , Daniele Rimini PhD , Tiziana Lencioni PhD , Ilaria Carpinella PhD , Maurizio Ferrarin PhD , Johanna Jonsdottir PhD , Vincent C.K. Cheung PhD , Andrea Turolla PhD","doi":"10.1016/j.apmr.2025.05.019","DOIUrl":"10.1016/j.apmr.2025.05.019","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize individuals with stroke who responded or did not respond to upper limb motor treatment by analyzing muscle synergy patterns (similarity, merging, and fractionation).</div></div><div><h3>Design</h3><div>This study is a secondary analysis of a multicenter randomized controlled trial.</div></div><div><h3>Setting</h3><div>Inpatients of 2 specialized neurorehabilitation hospitals.</div></div><div><h3>Participants</h3><div>We enrolled individuals (N=62) with a unilateral first-event ischemic or hemorrhagic stroke and severe-to-mild upper limb motor impairment (Fugl-Meyer Assessment-Upper Extremity score of 5-61, of 66). We excluded people with untreated seizure, severe cognitive, or verbal comprehension impairment.</div></div><div><h3>Interventions</h3><div>After randomization, individuals were allocated to conventional, virtual reality, or robot-assisted treatment groups (20 sessions, 1 h/d, 5 d/wk, 4wk).</div></div><div><h3>Main Outcome Measures</h3><div>A blinded assessor performed assessments both before and after the intervention. Surface electromyography recordings from 16 muscles during reaching tasks were collected pre- and post-treatment. We extracted muscle synergy patterns (similarity, merging, and fractionation) of the stroke-affected and unaffected upper limb of each subject.</div></div><div><h3>Results</h3><div>Overall, individuals improved upper limb motor function (Fugl-Meyer Assessment-Upper Extremity change score=7.14±7.46; <em>P</em><.001). We identified 34 responders to treatment showing clinically significant improvement (over the Minimal Clinically Important Difference of 5 points on the Fugl-Meyer Assessment-Upper Extremity). The responders showed decreased merging of synergies (<em>P</em>=.016) as compared with the non-responders (<em>P</em>=.025), who conversely showed improved similarity of synergies (<em>P</em>=.006).</div></div><div><h3>Conclusions</h3><div>In individuals with stroke undergoing upper limb motor rehabilitation, changes in the synergy merging pattern may serve as a potential marker to distinguish responders from non-responders.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 261-269"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/S0003-9993(26)00019-5
{"title":"Archives I/EP Guidelines","authors":"","doi":"10.1016/S0003-9993(26)00019-5","DOIUrl":"10.1016/S0003-9993(26)00019-5","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 369-371"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/S0003-9993(26)00006-7
{"title":"Ed Board page","authors":"","doi":"10.1016/S0003-9993(26)00006-7","DOIUrl":"10.1016/S0003-9993(26)00006-7","url":null,"abstract":"","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Page A2"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146096198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.08.022
Zhengkun Wang MBBS , Lin Peng MD , Xiaoyi Yang MD, PhD , Runshi Xu MD , Yujing Zhang MD, PhD , Xinyang Yu MBBS , Hang Li MBBS , Yijie Gao MD
Objective
To determine the efficacy of preoperative rehabilitation on postoperative outcomes after total knee arthroplasty (TKA) and to compare home-based telerehabilitation with clinic-based approaches.
Data Sources
PubMed, Embase, Web of Science, and Cochrane databases were searched from inception through July 2025 following PRISMA 2020 guidelines.
Study Selection
Randomized controlled trials comparing preoperative rehabilitation with standard care for patients with TKA were included. Two independent reviewers performed screening with a third resolving disagreements.
Data Extraction
Standardized mean differences (SMD) and weighted mean differences with 95% CI were calculated using random-effects models. Outcomes were stratified by follow-up period and intervention type. Risk of bias and evidence quality were assessed using Cochrane and Grading of Recommendations, Assessment, Development, and Evaluation approaches.
Data Synthesis
Twenty-nine trials encompassing 2157 participants fulfilled our inclusion criteria. Preoperative rehabilitation yielded significant improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-function scores at mid-term (SMD, −1.21; 95% CI, −2.14 to −0.28; P=.011) and long-term follow-up (SMD, −0.47; 95% CI, −0.90 to −0.04; P=.033). Similarly, WOMAC-pain scores demonstrated significant mid-term improvement (SMD, −0.81; 95% CI, −1.35 to −0.27; P=.003). Home-based telerehabilitation consistently outperformed clinic-based approaches across most outcome measures. Although clinic-based rehabilitation occasionally produced larger point estimates (SMD, −1.06; 95% CI, −2.08 to −0.04; P=.041 for WOMAC-function), home-based interventions demonstrated superior overall effectiveness with more stable results (WOMAC-function: SMD, −0.65; 95% CI, −1.17 to −0.13; P=.014; WOMAC-pain: SMD, −0.77; 95% CI, −1.52 to −0.03; P=.005). Although considerable heterogeneity persisted throughout our analyses (I2>75%), extensive sensitivity testing validated the robustness of treatment effects across all measured outcomes. Overall evidence quality reached moderate levels, with heterogeneity and inherent blinding constraints representing the primary limitations.
Conclusions
Preoperative rehabilitation enhances functional recovery and pain relief after TKA, with benefits primarily during the mid-term phase. Home-based telerehabilitation demonstrated superior efficacy compared with clinic-based approaches, suggesting a paradigm shift in perioperative TKA management. The consistent benefits across diverse interventions support the general principle of preoperative conditioning despite methodological heterogeneity.
{"title":"Effectiveness of Preoperative Rehabilitation Compared With Usual Care in Total Knee Arthroplasty: A Meta-analysis of Randomized Controlled Trials","authors":"Zhengkun Wang MBBS , Lin Peng MD , Xiaoyi Yang MD, PhD , Runshi Xu MD , Yujing Zhang MD, PhD , Xinyang Yu MBBS , Hang Li MBBS , Yijie Gao MD","doi":"10.1016/j.apmr.2025.08.022","DOIUrl":"10.1016/j.apmr.2025.08.022","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the efficacy of preoperative rehabilitation on postoperative outcomes after total knee arthroplasty (TKA) and to compare home-based telerehabilitation with clinic-based approaches.</div></div><div><h3>Data Sources</h3><div>PubMed, Embase, Web of Science, and Cochrane databases were searched from inception through July 2025 following PRISMA 2020 guidelines.</div></div><div><h3>Study Selection</h3><div>Randomized controlled trials comparing preoperative rehabilitation with standard care for patients with TKA were included. Two independent reviewers performed screening with a third resolving disagreements.</div></div><div><h3>Data Extraction</h3><div>Standardized mean differences (SMD) and weighted mean differences with 95% CI were calculated using random-effects models. Outcomes were stratified by follow-up period and intervention type. Risk of bias and evidence quality were assessed using Cochrane and Grading of Recommendations, Assessment, Development, and Evaluation approaches.</div></div><div><h3>Data Synthesis</h3><div>Twenty-nine trials encompassing 2157 participants fulfilled our inclusion criteria. Preoperative rehabilitation yielded significant improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)-function scores at mid-term (SMD, −1.21; 95% CI, −2.14 to −0.28; <em>P</em>=.011) and long-term follow-up (SMD, −0.47; 95% CI, −0.90 to −0.04; <em>P</em>=.033). Similarly, WOMAC-pain scores demonstrated significant mid-term improvement (SMD, −0.81; 95% CI, −1.35 to −0.27; <em>P</em>=.003). Home-based telerehabilitation consistently outperformed clinic-based approaches across most outcome measures. Although clinic-based rehabilitation occasionally produced larger point estimates (SMD, −1.06; 95% CI, −2.08 to −0.04; <em>P</em>=.041 for WOMAC-function), home-based interventions demonstrated superior overall effectiveness with more stable results (WOMAC-function: SMD, −0.65; 95% CI, −1.17 to −0.13; <em>P</em>=.014; WOMAC-pain: SMD, −0.77; 95% CI, −1.52 to −0.03; <em>P</em>=.005). Although considerable heterogeneity persisted throughout our analyses (<em>I</em><sup>2</sup>>75%), extensive sensitivity testing validated the robustness of treatment effects across all measured outcomes. Overall evidence quality reached moderate levels, with heterogeneity and inherent blinding constraints representing the primary limitations.</div></div><div><h3>Conclusions</h3><div>Preoperative rehabilitation enhances functional recovery and pain relief after TKA, with benefits primarily during the mid-term phase. Home-based telerehabilitation demonstrated superior efficacy compared with clinic-based approaches, suggesting a paradigm shift in perioperative TKA management. The consistent benefits across diverse interventions support the general principle of preoperative conditioning despite methodological heterogeneity.</div></div>","PeriodicalId":8313,"journal":{"name":"Archives of physical medicine and rehabilitation","volume":"107 2","pages":"Pages 315-332"},"PeriodicalIF":3.7,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145074245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.apmr.2025.10.023
Huimin Wang MM , Yanan Wang MM , Jiawang Dong MM , Yang Li MM , Shujuan Tian PhD , Jun Xing MM , Xin Guo PhD
Objective
To evaluate the efficacy of transcranial direct current stimulation (tDCS) in treating naming disorders in patients with poststroke aphasia through a meta-analysis.
Data Sources
This systematic review includes randomized controlled trials (RCTs) retrieved from 4 databases: Web of Science, Cochrane Library, EMBASE, and PubMed, with the search period extending from database inception to July 22, 2024.
Study Selection
We included RCTs examining the effects of tDCS on naming ability in patients with poststroke aphasic. Two authors independently searched and screened the literature and assessed studies for compliance with the inclusion and exclusion criteria by reviewing titles, abstracts, and full texts. Any disagreements were resolved by consultation with the other authors.
Data Extraction
Two reviewers independently extracted relevant data (sociodemographic characteristics, clinical information, study characteristics, stimulus parameters, and outcome indicators) from eligible studies and assessed risk of bias using the Cochrane Risk of Bias Tool II. When discrepancies arose, they were resolved by another experienced researcher.
Data Synthesis
We used Review Manager 5.4 software for data analysis. Standardized mean difference (SMD) and 95% CI were used for meta-analysis. This study is registered with PROSPERO (CRD42024586289). A total of 12 studies involving 400 subjects were included. tDCS significantly improved the naming abilities of participants with poststroke aphasia (SMD=0.25; 95% CI=[0.05-0.45], P=.01), particularly in those with chronic stroke (SMD=0.48, 95% CI=[0.10-0.86], P=.01). Anodal tDCS stimulation demonstrated a statistically significant effect on the recovery of naming functions (SMD=0.25, P =.02).
Conclusions
Anodal tDCS could positively impact the naming abilities of patients with poststroke aphasia, particularly those with chronic stroke. Because of the methodological limitations of the included studies, it is worthwhile to further evaluate the value of tDCS in RCTs in future research.
目的：通过荟萃分析，评价经颅直流电刺激（tDCS）治疗脑卒中后失语症患者命名障碍的疗效。数据来源：本系统综述包括随机对照试验（RCTs），检索自Web of Science、Cochrane Library、EMBASE和PubMed四个数据库，检索时间从数据库建立到2024年7月22日。研究选择：我们纳入了检查tDCS对脑卒中后失语症患者命名能力影响的随机对照试验。两位作者独立检索和筛选文献，并通过审查标题、摘要和全文来评估研究是否符合纳入和排除标准。任何分歧都通过与其他作者协商解决。数据提取：两名审评员独立地从符合条件的研究中提取相关数据（社会人口学特征、临床信息、研究特征、刺激参数和结局指标），并使用Cochrane risk of bias Tool II （RoB2）评估偏倚风险。当出现差异时，由另一位经验丰富的研究人员解决。数据综合：我们使用Review Manager 5.4软件进行数据分析。采用标准化均差（SMD）和95%置信区间（CI）进行meta分析。本研究已在PROSPERO注册（CRD42024586289）。共纳入12项研究，涉及400名受试者。tDCS显著提高参与者的命名能力与中风后失语(SMD = 0.25;95%可信区间 = [0.05,0.45],p = 0.01),特别是那些患有慢性中风(SMD = 0.48,95% CI = [0.10,0.86],p = 0.01)。tDCS阳极刺激对命名功能的恢复有统计学意义（SMD = 0.25,p = 0.02）。结论：负极tDCS对脑卒中后失语症患者，尤其是慢性脑卒中失语症患者的命名能力有积极影响。由于纳入研究的方法学局限性，在未来的研究中值得进一步评估tDCS在随机对照试验中的价值。
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